Outcomes of laparoscopic surgery for bilateral ovarian chocolate cysts, with emphasis on recurrence, fertility, and ovarian reserve

Azumi Nakamura, Yutaka Hirota, Eiji Nishio, Masako Miyata, Haruki Nishizawa, Akira Yasue, Misugi Matsuoka, Kazuhiko Tsukada, Yasuhiro Udagawa
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2010 · vol. 26(2) , pp. 503–506 · doi:10.5180/jsgoe.26.503 · W2326146099
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⚙ AI-generated summary by claude@2026-07, 2026-07-09 ⓘ

This study followed 128 patients with bilateral ovarian chocolate cysts, finding that bilateral cystectomy had no recurrence while fenestration/coagulation had a 5.6% recurrence rate.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This 9-year follow-up study included 128 patients diagnosed with bilateral ovarian “chocolate” (endometrioma) cysts, of whom 21 underwent bilateral cystectomy and 107 had bilateral fenestration and coagulation, with inclusion requiring postoperative follow-up of at least six months. Recurrence occurred in 4.7% overall (6/128), exclusively among the fenestration and coagulation group, with a mean time to recurrence of 12.5 months, and no recurrences after cystectomy (0/21). Pregnancy was reported in 42.5% of 40 evaluable patients during the study period (including spontaneous, clomiphene, and IVF-ET conceptions), while postoperative menstrual disorders were more frequent after cystectomy (22.2%) than after fenestration and coagulation (4.1%; p=0.0055). The paper’s key limitation is that the study is based on postoperative follow-up and selective subgroup analyses, without detailing randomization between surgical approaches. This paper is centrally about endometriosis — it evaluates laparoscopic outcomes for bilateral ovarian endometriomas, emphasizing recurrence, fertility, and ovarian reserve.

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Abstract

Objective: Ｗe conducted postoperative follow-up of patients with bilateral ovarian chocolate cysts, focusing on rates of recurrence, potential to conceive, and degree of ovarian reserve.Methods: A total of 128 patients diagnosed with bilateral ovarian chocolate cysts were studied during a 9-year period.Any patient seen postoperatively for six months or more was included in the study.Of this cohort, 21 underwent bilateral cystectomy, while bilateral fenestration and coagulation was performed for the remainder (n=107).Results: The recurrence rate was 4.7% (6/128), with all instances of recurrence limited to the bilateral fenestration and coagulation technique The mean period from surgery to recurrence was 12.5 months (range, 10-31 months).The recurrence rate by surgical procedure was 0% (0/21) for bilateral cystectomy and 5.6% (6/107) for bilateral fenestration and coagulation.Seventeen of 40 (42.5%)patients became pregnant in the study time frame (12 spontaneous cycles, 3 clomiphene cycles, and 2 IVF-ET cycles).We also selectively examined subjects under the age of 40 years (115/128) whose menstrual cycles had been normal prior to surgery.The rate of postoperative menstrual disorders was 22.2% (4/18 cases) for bilateral cystectomy and 4.1% (4/97 cases) for bilateral fenestration and coagulation (p=0.0055).Discussion: Laparoscopic fenestration and coagulation, rather than cystectomy, may be a preferable treatment for bilateral chocolate ovarian cysts in terms of preserving fertility and ovarian reserve.
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Abstract

Objective: We conducted postoperative follow-up of patients with bilateral ovarian chocolate cysts, focusing on rates of recurrence, potential to conceive, and degree of ovarian reserve.

Methods

A total of 128 patients diagnosed with bilateral ovarian chocolate cysts were studied during a 9-year period. Any patient seen postoperatively for six months or more was included in the study. Of this cohort, 21 underwent bilateral cystectomy, while bilateral fenestration and coagulation was performed for the remainder (n=107).

Results

The recurrence rate was 4.7% (6/128), with all instances of recurrence limited to the bilateral fenestration and coagulation technique The mean period from surgery to recurrence was 12.5 months (range, 10-31 months). The recurrence rate by surgical procedure was 0% (0/21) for bilateral cystectomy and 5.6% (6/107) for bilateral fenestration and coagulation. Seventeen of 40 (42.5%) patients became pregnant in the study time frame (12 spontaneous cycles, 3 clomiphene cycles, and 2 IVF-ET cycles). We also selectively examined subjects under the age of 40 years (115/128) whose menstrual cycles had been normal prior to surgery. The rate of postoperative menstrual disorders was 22.2% (4/18 cases) for bilateral cystectomy and 4.1% (4/97 cases) for bilateral fenestration and coagulation (p=0.0055).

Discussion

Laparoscopic fenestration and coagulation, rather than cystectomy, may be a preferable treatment for bilateral chocolate ovarian cysts in terms of preserving fertility and ovarian reserve.

Methods

A total of 128 patients diagnosed with bilateral ovarian chocolate cysts were studied during a 9-year period. Any patient seen postoperatively for six months or more was included in the study. Of this cohort, 21 underwent bilateral cystectomy, while bilateral fenestration and coagulation was performed for the remainder (n=107).

Results

The recurrence rate was 4.7% (6/128), with all instances of recurrence limited to the bilateral fenestration and coagulation technique The mean period from surgery to recurrence was 12.5 months (range, 10-31 months). The recurrence rate by surgical procedure was 0% (0/21) for bilateral cystectomy and 5.6% (6/107) for bilateral fenestration and coagulation. Seventeen of 40 (42.5%) patients became pregnant in the study time frame (12 spontaneous cycles, 3 clomiphene cycles, and 2 IVF-ET cycles). We also selectively examined subjects under the age of 40 years (115/128) whose menstrual cycles had been normal prior to surgery. The rate of postoperative menstrual disorders was 22.2% (4/18 cases) for bilateral cystectomy and 4.1% (4/97 cases) for bilateral fenestration and coagulation (p=0.0055).

Discussion

Laparoscopic fenestration and coagulation, rather than cystectomy, may be a preferable treatment for bilateral chocolate ovarian cysts in terms of preserving fertility and ovarian reserve. © 2010 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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