Recurrence of ovarian endometrioma after laparoscopic excision

OBJECTIVE: Our purpose was to evaluate the recurrence rate after laparoscop ic excision of ovarian endometrioma. STUDY DESIGN: An unrandomized prospective clinical study was performed at 2 tertiary-care centers of 366 patients who had a minimum of 6 months of pos toperative follow-up or 6 months after the suspension of medical therapy af ter laparoscopic ovarian endometrioma excision. Patients underwent clinical examination and vaginal ultrasonography 3, 6, and 12 months after surgery and subsequently at least once a year. We evaluated the cumulative recurren ce rate of pain and clinical findings of ovarian endometrioma, the rate of repeated surgery, and the recovery of fertility RESULTS: During follow-up we observed ultrasonographic recurrence in 26 (7. 1%) cases; surgery was repeated in 12 (3.3%) cases. The cumulative rate of ultrasonographic recurrence over 48 months was 11.7%, whereas the cumulativ e rate of a second surgery was 8.2%. Ultrasonographic cyst recurrence was a ssociated with pain recurrence in 73% of cases, whereas in the remaining 27 % the recurrence was asymptomatic. Significant factors related to recurrenc e of endometriomas would appear to be the stage of disease (P =.03) and pre vious surgery for endometriosis (P =.003). Eighty-five (23.2%) women concei ved during follow-up. CONCLUSIONS: Laparoscopic treatment of endometriomas seems to be both effec tive and reliable. The rate of recurrence appears to be correlated to the d uration of follow-up. Stage IV disease and previous surgery for endometrios is are unfavorable prognostic factors.