Ablation, excision, sclerotherapy: what is better in cases of small ovarian endometriomas?

This paper discusses surgical treatment approaches for small ovarian endometriomas, comparing cystectomy (with different methods of hemostasis), isolated ablation, and combined stripping plus ablation, as well as sclerotherapy. It states that cystectomy, regardless of hemostasis method, reduces ovarian reserve and worsens endometriosis-associated infertility, and that isolated ablation of the endometrial capsule has a high recurrence frequency. The authors argue that combining stripping and ablation provides maximum efficacy and safety, while sclerotherapy is described as optimal only for young women (≤25 years) who do not have pregnancy and do not plan to become pregnant, implying these are key limitations/indications. This paper is centrally about endometriosis — specifically, comparative operative strategies for small ovarian endometriomas.

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