Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration

Objective: To compare the reoperation rate after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. Design: Retrospective study. Setting: University-affiliated teaching hospital. Patient(s): Two hundred thirty-one premenopausal women with ovarian endomet riomas treated laparoscopically. Intervention(s): Seventy women were treated with fenestration and ablation of the cyst wall and 161 women were treated with excision. Main Outcome Measure(s): The reoperation rates of the two groups of women w ere evaluated using life-table analysis. Result(s): The cumulative probability of reoperation was significantly high er after fenestration than after excision. The reoperation rates at 18 mont hs and 42 months of follow-up were 6.1% and 23.6% after excision and 21.9% and 57.8% after fenestration, respectively. In the fenestration group, the age of the patient and the diameter of the endometrioma were not associated with a higher reoperation rate. In the excision group, a larger cyst was a ssociated with a higher reoperation rate, but age had no influence on the r eoperation rate. Conclusion(s): Laparoscopic excision of ovarian endometriomas is associated with a lower reoperation rate than that of fenestration. The reoperation r ate after fenestration is independent of the size of the endometrioma and t he age of the patient. However, after excision, the reoperation rate is hig her in those with larger cysts. (C) 1999 by American Society for Reproducti ve Medicine.