An insight into the associated factors with recurrent endometriomas after surgical excision

Atwa et al.’s study shed light on endometrioma management and factors affecting recurrence. However, the exclusion of open ovarian surgery patients and the potential impact of laparoscopic surgery on ovarian reserve and outcomes warrant consideration. Including both surgical approaches in future studies would enable a comprehensive assess- ment of their effectiveness and influence on endometrioma recurrence, enhancing our understanding of surgical excision outcomes. Dear Editor, A recent study by Atwa et  al. [1] provides valuable insights into managing endometriomas and the factors influencing their recurrence. It significantly contributes to the existing literature in the field. This letter highlights the importance of considering laparoscopic surgery as a potential confounder. Factors associated with recurrent endometriomas after surgical excision include incom - plete excision, advanced disease stage, hormonal imbal - ance, endometriosis-associated inflammation, genetic predisposition, surgical technique, and postoperative management. Furthermore, individualized treatment and close monitoring are important for minimizing the risk of recurrence [2]. While acknowledging the significance of the study, I would like to add some suggestions. Only those patients undergoing laparoscopic surgical excision of endometri - oma were included in the study. Considering the poten - tial impact of laparoscopic surgery on ovarian reserve and patient outcomes is crucial in assessing the factors contributing to endometrioma recurrence. Laparoscopic surgical interventions have gained wide acceptance and are commonly employed in managing endometriomas. However, laparoscopic procedures, although minimally invasive, can still affect ovarian reserve and subsequent fertility outcomes [3]. These effects may include altera - tions in ovarian blood supply, unintentional damage to ovarian tissue, or adhesion formation, which may influ - ence the risk of endometrioma recurrence [4]. Moreo - ver, a history of pelvic surgeries may be associated with an increased risk of endometrioma recurrence. In this regard, it might be helpful for a better understanding of endometrioma recurrence. The underlying mechanisms behind this association are not yet fully understood, but it is hypothesized that surgical trauma, alterations in pel - vic anatomy, and potential activation of inflammatory processes could contribute to the recurrence. Including patients who underwent both open ovarian surgery and laparoscopic surgery in future studies would make a better assessment of the comparative effective - ness of different surgical approaches and their impact on endometrioma recurrence possible. The comprehensive approach would provide a more robust understanding of the factors influencing the outcomes of surgical excision for endometriomas. Open Access © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Middle East Fertility Society Journal *Correspondence: Ali Beykian [email protected] 1 Guilan University of Medical Sciences, Rasht, Iran Page 2 of 2Fashkhami and Beykian Middle East Fertility Society Journal (2024) 29:3

We use ChatGPT to improve the language of the manuscript. Authors’ contributions Both authors contributed equally to the manuscript. Both authors read and approved the final manuscript. Funding No funding. Availability of data and materials Not applicable. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Received: 22 August 2023 Accepted: 17 December 2023

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