Pregnancy outcome, and adhesion formation and reformation after laparoscopic cystectomy of ovarian endmetriomas

Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A second-look laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.