Feasibility study of laparoscopic surgery for ovarian endometrioma rupture

Objective: To assess the attributes and feasibility of conservative laparoscopic surgery for patients with ruptured ovarian endometrioma.Design: Retrospective analysis.Setting: University medical center.Patient(s): Eighteen patients undergoing laparoscopic surgery at our institution between January, 2005 and December, 2008 for presumed ovarian endometrioma rupture.Intervention: Laparoscopy.Measurements and Key Findings: Of 792 patients undergoing laparoscopic surgery for ovarian endometrioma, rupture occurred preoperatively in 18 (2.3%), with a median age of 32 years. Eight were right-sided lesions and 10 were left-sided. Five patients were actively menstruating, four were in follicular phase, and six were in luteal phase. Rupture followed GnRH agonist treatment in three instances. Laparoscopic surgery was performed within 24 hours for most, with exception of one patient who received a six-month course of GnRH agonist, postponing surgical intervention. Concurrent cystectomy was elected in 16 patients to preserve fertility. In the other two, treatment was limited to irrigation only (due to severe inflammation), with the option of delayed cystectomy following medical (GnRH agonist) management. Conclusions: Rupture of ovarian endometrioma is an infrequent event, requiring emergency surgery, but conservative laparoscopic intervention is a viable approach for preservation of fertility.