Endometrioma size is a relevant factor in selection of the most appropriate surgical technique: a prospective randomized preliminary study

Giampaolino P, P. Giampaolino, Pierluigi Giampaolino, G Bifulco, Giuseppe Bifulco, A Di Spiezio Sardo, Attilio Di Spiezio Sardo, Di Spiezio Sardo A, A. Mercorio, Antonio Mercorio, Dario Bruzzese, D Bruzzese, Costantino Di Carlo, C Di Carlo
European journal of obstetrics, gynecology, and reproductive biology · 2015 · vol. 195 , pp. 88–93 · doi:10.1016/j.ejogrb.2015.09.046 · PMID:26492167 · W2142100085
article OA: closed CC0 ⤵ 30 in-corpus citations
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This study prospectively randomized patients to compare surgical techniques for endometriomas, finding endometrioma size is a relevant factor in selecting the most appropriate method.

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Abstract

ObjectivesTo assess and compare the ovarian reserve in patients with different-sized endometriomas undergoing cystectomy or ablative surgery in order to determine the best surgical approach to safeguard healthy ovarian tissue.Study designProspective randomized study on 48 patients with unilateral single ovarian endometriomas. Patients were allocated into two groups based on endometrioma size: <5cm (n=26, Group A, small endometriomas) and ≥5cm (n=22, Group B, large endometriomas). Each group was randomized to coagulation or excision treatment (1:1 ratio) before the procedure. Anti-Müllerian hormone (AMH) levels were evaluated before surgery and 3 months after surgery.ResultsBoth ablation and excision resulted in a significant reduction in AMH level regardless of endometrioma size. A significant interaction effect was observed between endometrioma size and type of surgical technique (analysis of covariance p for interaction=0.039): in Group A, no significant difference was found between the two surgical techniques (-17.6±4.7% vs -18.2±10.6%), whereas in Group B, the excision group showed a significantly greater percentage decrease in AMH level compared with the ablation group (-24.1±9.3% vs -14.8±6.7%, p=0.011).ConclusionsBoth ablative and excision treatment of endometriomas have a negative effect on ovarian function. Endometrioma size is associated with the magnitude of ovarian reserve damage following excision treatment, but in the case of ablative treatment, the decrease in AMH serum level is independent of the size of the cyst. In surgical treatment of large endometriomas, the decrease in AMH level is more consistent and much more severe following cystectomy than ablation.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Electrocoagulation Endometriosis Ovarian Cysts Ovarian Diseases Ovarian Reserve Ovary Adult Anti-Mullerian Hormone Anti-Mullerian Hormone Endometriosis Endometriosis Endometriosis Female Humans Ovarian Cysts Ovarian Cysts Ovarian Cysts Ovarian Diseases Ovarian Diseases Ovarian Diseases

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Cited by (31)

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