Laparoscopic sclerotherapy for ovarian endometriomas during surgery for deep endometriosis: Outcomes of a 134-patient cohort

Adrien Crestani, Benjamin Merlot, Merlot B, Goualard PH, Paul-Henri Goualard, Paul‐Henri Goualard, Huet C, C. Huet, Clothilde Huet, Zoé Husson, Husson Z, Zoe Husson, Dennis T, Thomas Dennis, Chanavaz-Lacheray I, Isabella Chanavaz‐Lacheray, Isabella Chanavaz-Lacheray, Roman H, Horace Roman
International Journal of Gynecology & Obstetrics · 2025 · vol. 171(1) , pp. 431–437 · doi:10.1002/ijgo.70201 · PMID:40332134 · W4410159183
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Laparoscopic ethanol sclerotherapy for ovarian endometriomas combined with deep endometriosis resection was safe and achieved a 57% pregnancy rate and 16.5% recurrence over 23 months.

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Abstract

OBJECTIVE: To evaluate postoperative fertility outcomes and recurrence rates in patients undergoing laparoscopic ethanol sclerotherapy for endometriomas, combined with the resection of deep endometriosis lesions. METHODS: A retrospective cohort study was conducted at the Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France. The study included 134 patients who underwent laparoscopic surgical resection of deep endometriosis lesions and ethanol sclerotherapy for endometriomas ≥40 mm, between October 2019 and September 2023. The procedure involved aspiration of cyst contents followed by 96% ethanol instillation. The main outcomes measured were fertility rates, endometrioma recurrence, anti-Müllerian hormone (AMH) levels, and postoperative complications. RESULTS: The mean patient age was 31.8 ± 4.6 years, with 39 (29%) experiencing infertility. Preoperative AMH levels averaged 2.96 ± 2.02 ng/mL and decreased significantly postoperatively (mean difference 1.1 ng/mL, P = 10-8). Severe postoperative complications occurred in 4.5% of patients, none attributed to ethanol sclerotherapy. After surgery, 78 patients expressed a desire to conceive and 45 (57%) achieved pregnancy, with 19 (42%) being spontaneous. The mean time to pregnancy was 13 ± 9 months. Cumulative pregnancy rates were 55.5% at 24 months and 78.8% at 36 months. Predictors of pregnancy included higher preoperative AMH levels (hazard ratio [HR] 1.35, P = 0.008) and absence of prior abdominal surgery (HR 0.32, P = 0.007). Recurrence of endometriomas was observed in 17 (16.5%) patients over a median follow-up of 23 months. CONCLUSION: In this cohort of patients treated with laparoscopic ethanol sclerotherapy during resection surgery for deep endometriosis, the procedure was safe, with satisfactory pregnancy and recurrence rates comparable to other ablative techniques.
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Abstract

Objective To evaluate postoperative fertility outcomes and recurrence rates in patients undergoing laparoscopic ethanol sclerotherapy for endometriomas, combined with the resection of deep endometriosis lesions.

Methods

A retrospective cohort study was conducted at the Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France. The study included 134 patients who underwent laparoscopic surgical resection of deep endometriosis lesions and ethanol sclerotherapy for endometriomas ≥40 mm, between October 2019 and September 2023. The procedure involved aspiration of cyst contents followed by 96% ethanol instillation. The main outcomes measured were fertility rates, endometrioma recurrence, anti-Müllerian hormone (AMH) levels, and postoperative complications.

Results

The mean patient age was 31.8 ± 4.6 years, with 39 (29%) experiencing infertility. Preoperative AMH levels averaged 2.96 ± 2.02 ng/mL and decreased significantly postoperatively (mean difference 1.1 ng/mL, P = 10−8). Severe postoperative complications occurred in 4.5% of patients, none attributed to ethanol sclerotherapy. After surgery, 78 patients expressed a desire to conceive and 45 (57%) achieved pregnancy, with 19 (42%) being spontaneous. The mean time to pregnancy was 13 ± 9 months. Cumulative pregnancy rates were 55.5% at 24 months and 78.8% at 36 months. Predictors of pregnancy included higher preoperative AMH levels (hazard ratio [HR] 1.35, P = 0.008) and absence of prior abdominal surgery (HR 0.32, P = 0.007). Recurrence of endometriomas was observed in 17 (16.5%) patients over a median follow-up of 23 months.

Conclusion

In this cohort of patients treated with laparoscopic ethanol sclerotherapy during resection surgery for deep endometriosis, the procedure was safe, with satisfactory pregnancy and recurrence rates comparable to other ablative techniques. CONFLICT OF INTEREST STATEMENT HR and BM received personal fees from Ethicon Endo-surgery, Plasma Surgical Ltd., Nordic Pharma, and Olympus for their involvement in workshops and masterclasses. The other authors have no conflicts of interest. DATA AVAILABILITY STATEMENT The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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