Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study

OBJECTIVE: To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s). DESIGN: Prospective observational study. SETTING: Tertiary care university hospital. PATIENT(S): One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s). INTERVENTION(S): Laparoscopic conservative treatment of endometriosis. MAIN OUTCOME MEASURE(S): Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years. RESULT(S): Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences. CONCLUSION(S): Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence.