Recurrence of Chocolate Cysts after Laparoscopic Ablation

Jones KD, K D Jones, Kevin Jones, Chris Sutton, C J G Sutton, Sutton CJ
The Journal of the American Association of Gynecologic Laparoscopists · 2002 · vol. 9(3) , pp. 315–320 · doi:10.1016/s1074-3804(05)60410-0 · PMID:12101328 · W2129791794
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This paper investigates the recurrence rate of chocolate cysts following laparoscopic ablation in a cohort of patients.

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Abstract

Study objectiveTo estimate the recurrence rate of chocolate cysts 3 to 12 months after ablative laparoscopic surgery. The secondary outcome measure was the need for a repeat surgical procedure.DesignProspective cohort study (Canadian Task Force classification II-2).SettingTertiary referral center for laparoscopic treatment of endometriosis.PatientsSeventy-three consecutive women with chocolate cysts larger than 2 cm.InterventionLaparoscopy at which cyst capsules were vaporized or coagulated with the potassium-titanyl-phosphate (KTP) laser or Bicap bipolar diathermy.Measurements and main resultsThere were 96 cysts (23 bilateral) in 73 women (1 patient underwent a two-stage procedure). Their mean diameter was 4.79 cm (range 2-25 cm). The median r-AFS score was 56 (range 22-128), and 55 patients (75.3%) had stage 4 disease. The KTP laser was used in 50 women (68.5%) and bipolar diathermy in 23 (31.5%). At 12 months, 5 patients (6.9%) were lost to follow-up, and 12 had a recurrent cyst. Therefore, the cyst recurrence rate/patient was 16.4% (12/73) and the rate/cyst was 12.5% (12/96). Women who had recurrences were significantly more likely to have bilateral cysts, 7/12 (58.3%), than those with single cysts, 16/61 (26.2%, p =0.032). Bicap bipolar diathermy was associated with a recurrence rate of 20.8% (5/24). The rate in women who had KTP laser ablation was 14.3% (7/49, NS). Eighteen patients had repeat operations (including on recurrent cysts). Therefore the reoperation rate was 24.6% (18/73). No major surgical complications occurred. One woman had a postoperative wound infection after a second procedure to remove an ovary with a recurrent cyst.ConclusionLaparoscopic cyst fenestration followed by capsule ablation is safe and effective treatment for preventing recurrence of chocolate cysts.

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Condition tags

endometriosis

MeSH descriptors

Catheter Ablation Laparoscopy Ovarian Cysts Ovary Adult Endometriosis Endometriosis Female Humans Ovarian Cysts Ovarian Cysts Ovarian Diseases Ovarian Diseases Ovary Prospective Studies Reoperation Secondary Prevention

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