Laparoscopic cystectomy in treating women with endometrioma and pregnancy outcome - a case series.

INTRODUCTION: The aim of this study was to determine the spontaneous pregnancy rate and safety of our surgical technique of performing laparoscopy cystectomy for endometrioma. METHOD: This is a 5-year retrospective study, carried out at Mahkota Medical Centre, Melaka, Malaysia. 143 patients with endometrioma associated with moderate to severe endometriosis underwent laparoscopic cystectomy from 2015 to 2019. The surgery commenced with dissection and excision of all the endometriotic lesions followed by injection of diluted vasopressin into the space between the cyst wall and the normal ovarian cortex. Stripping of the cyst wall was performed until the ovarian hilum was reached. The cyst wall was then excised, leaving some of the cyst wall on the hilum area. Minimal bipolar electrocoagulation was done on this remaining cyst wall. The ovary was then reconstructed with suturing. During the surgery, the severity of the disease was staged, endometrioma diameter and intraoperative findings were recorded. Fertility outcomes were determined among patients who were keen to conceive via telephone questionnaire and further analysed based on different factors. RESULTS: Among the 143 patients, 33.6% had Stage III endometriosis while 66.4% had Stage IV endometriosis. Of the 76 infertile patients, 42.1% conceived spontaneously in the mean duration of 6.9 months. 62.5% patients successfully conceived via assisted reproductive treatment and 10% conceived with ovulation induction. 47.4% patients had an uneventful delivery while 2.6% patients miscarried. 6.6% patients conceived twice post-surgery. CONCLUSION: The aim of performing laparoscopic cystectomy for endometrioma in an infertile patient is to achieve a spontaneous pregnancy. Our technique of performing laparoscopic cystectomy resulted in a spontaneous pregnancy rate of 42.1% in patients with moderate and severe endometriosis.