Surgical Management of Endometriomas: The Link Between Pathophysiology and Technique

Anubha Arora, Tommaso Falcone
In: Journal of Surgery · 2018 · vol. 8(8) · doi:10.29011/2575-9760.001132 · W2981489879
article OA: diamond CC0 ⤵ 1 in-corpus citation
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This review discusses surgical management of endometriomas, finding cystectomy superior to ablation for pain, recurrence, and pregnancy rates, while emphasizing careful dissection and suturing for hemostasis to preserve ovarian reserve.

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Abstract

Endometriosis is a common condition that affects 6-10% of reproductive age women. The surgical management may be excisional versus ablative surgery. Cystectomies remain first line of treatment as they provide better pain relief, reduced recurrence rates, higher spontaneous pregnancy rates and comparable IVF pregnancy rates when compared to ablative procedures. Stripping the cyst wall damages part of the ovarian tissue, owing to dense extensive adhesions between the pseudocyst formed by invagination and the normal ovarian tissue. Special attention is required during the dissection of the surface of the hilum ovarii. Another important aspect of endometrioma surgery is achieving hemostasis that might be difficult to achieve after the stripping operation and lysis of adhesions. There is growing attention as to whether the hemostasis of bipolar coagulation and ultrasound scalpel will affect the ovarian reserve through thermal damage. The best method to achieve good hemostasis is to optimize dissection by identifying the correct plane of cleavage during surgery. Suturing is effective and less damaging to the ovary and the ovarian reserve in expert hands when compared to the use of other methods. In this literature review we discuss surgical approach to treatment of endometriomas and their impact on ovarian reserve.

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endometriosisendometrioma

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