{"paper_id":"f618cae2-1f07-4f69-911f-6f0886ece795","body_text":"Fashkhami and Beykian  \nMiddle East Fertility Society Journal            (2024) 29:3  \nhttps://doi.org/10.1186/s43043-023-00163-5\nCORRESPONDENCE\nAn insight into the associated factors \nwith recurrent endometriomas after surgical \nexcision\nFaezeh Fashkhami1 and Ali Beykian1*   \nAbstract \nAtwa et al.’s study shed light on endometrioma management and factors affecting recurrence. However, the exclusion \nof open ovarian surgery patients and the potential impact of laparoscopic surgery on ovarian reserve and outcomes \nwarrant consideration. Including both surgical approaches in future studies would enable a comprehensive assess-\nment of their effectiveness and influence on endometrioma recurrence, enhancing our understanding of surgical \nexcision outcomes.\nDear Editor,\nA recent study by Atwa et  al. [1] provides valuable \ninsights into managing endometriomas and the factors \ninfluencing their recurrence. It significantly contributes \nto the existing literature in the field. This letter highlights \nthe importance of considering laparoscopic surgery as a \npotential confounder. Factors associated with recurrent \nendometriomas after surgical excision include incom -\nplete excision, advanced disease stage, hormonal imbal -\nance, endometriosis-associated inflammation, genetic \npredisposition, surgical technique, and postoperative \nmanagement. Furthermore, individualized treatment and \nclose monitoring are important for minimizing the risk of \nrecurrence [2].\nWhile acknowledging the significance of the study, I \nwould like to add some suggestions. Only those patients \nundergoing laparoscopic surgical excision of endometri -\noma were included in the study. Considering the poten -\ntial impact of laparoscopic surgery on ovarian reserve \nand patient outcomes is crucial in assessing the factors \ncontributing to endometrioma recurrence. Laparoscopic \nsurgical interventions have gained wide acceptance and \nare commonly employed in managing endometriomas. \nHowever, laparoscopic procedures, although minimally \ninvasive, can still affect ovarian reserve and subsequent \nfertility outcomes [3]. These effects may include altera -\ntions in ovarian blood supply, unintentional damage to \novarian tissue, or adhesion formation, which may influ -\nence the risk of endometrioma recurrence [4]. Moreo -\nver, a history of pelvic surgeries may be associated with \nan increased risk of endometrioma recurrence. In this \nregard, it might be helpful for a better understanding of \nendometrioma recurrence. The underlying mechanisms \nbehind this association are not yet fully understood, but \nit is hypothesized that surgical trauma, alterations in pel -\nvic anatomy, and potential activation of inflammatory \nprocesses could contribute to the recurrence.\nIncluding patients who underwent both open ovarian \nsurgery and laparoscopic surgery in future studies would \nmake a better assessment of the comparative effective -\nness of different surgical approaches and their impact on \nendometrioma recurrence possible. The comprehensive \napproach would provide a more robust understanding of \nthe factors influencing the outcomes of surgical excision \nfor endometriomas.\nOpen Access\n© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which \npermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the \noriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or \nother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line \nto the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory \nregulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this \nlicence, visit http://creativecommons.org/licenses/by/4.0/.\nMiddle East Fertility\nSociety Journal\n*Correspondence:\nAli Beykian\nali.beykian.md@gmail.com\n1 Guilan University of Medical Sciences, Rasht, Iran\n\nPage 2 of 2Fashkhami and Beykian  Middle East Fertility Society Journal            (2024) 29:3 \nAcknowledgements\nWe use ChatGPT to improve the language of the manuscript.\nAuthors’ contributions\nBoth authors contributed equally to the manuscript. Both authors read and \napproved the final manuscript.\nFunding\nNo funding.\nAvailability of data and materials\nNot applicable.\nDeclarations\nEthics approval and consent to participate\nNot applicable.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare that they have no competing interests.\nReceived: 22 August 2023   Accepted: 17 December 2023\nReferences\n 1. Atwa KA, Ibrahim ZM, El Bassuony EM, Taha OT (2023) Factors associated \nwith recurrent endometriomas after surgical excision. Middle East Fertil \nSoc J 6.https:// doi. org/ 10. 1186/ s43043- 023- 00146-6\n 2. Li X-Y, Chao X-P , Leng J-H, Zhang W, Zhang J-J, Dai Y, Shi J-H, Jia S-Z, Xu \nX-X, Chen S-K, Wu Y-S (2019) Risk factors for postoperative recurrence of \novarian endometriosis: long-term follow-up of 358 women. J Ovarian Res \n12:79. https:// doi. org/ 10. 1186/ s13048- 019- 0552-y\n 3. Mansouri G, Safinataj M, Shahesmaeili A, Allahqoli L, Salehiniya H, \nAlkatout I (2022 Effect of laparoscopic cystectomy on ovarian reserve in \npatients with ovarian cyst. Front. Endocrinol 13. https:// www. front iersin. \norg/ artic les/ 10. 3389/ fendo. 2022. 964229\n 4. Samartzis K, Kathopoulis N, Loutradis D, Protopapas A (2022) Do tech-\nniques of surgical management of ovarian endometrioma affect ovarian \nreserve? A narrative review. J Obstet Gynaecol (Lahore) 42:778–784. \nhttps:// doi. org/ 10. 1080/ 01443 615. 2021. 19628 17\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in pub-\nlished maps and institutional affiliations.","source_license":"CC0","license_restricted":false}