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Laparoscopic Excision Ablation or Ablation Alone in Women with Endometrioma

Background: Effect of laparoscopic intervention in management of endometriomas could be associated with a deleterious effect on ovarian function.

Objective: To compare the effect of laparoscopic ablation excision and ablation alone in patients with unilateral mild to moderately sized endometrioma on Antral Follicle Count (AFC), ovarian volume, day 2 FSH (D2 FSH).

Method: Clinical randomized trial carried out on 62 patients was randomly allocated to,

Group A: 31 patients where combined laparoscopic excision/ablation,

Group B: 31 patients where laparoscopic ablation was done.

Primary outcomes: AFC, D2 FSH and ovarian volume.

Results: The range of age in both groups was 22-36 years, demographic data and endometrioma size were comparable, patients in group A was presented mainly by pain and secondary infertility while in group B, the main complaint was primary infertility. FSH showed statistically significant difference after 3 months (Median=5.85 versus 5, P value 0.004) and statistically significant difference found between both groups regarding AFC 6 months postoperative where the AFC decreased more in patients managed by ablation alone. Also, statistical significant difference found between groups regarding volume of ipsilateral ovary 6 months post-operative where the volume decreased more in patients managed by ablation (Median=11 versus 6.25 cm3, P value 0.003), no statistical significant difference found between the two studied groups regarding pregnancy or recurrence rate 3 and 6 months post-operative.

Conclusion: Both laparoscopic excision ablation or ablation alone for management of unilateral endometrioma ≤ 5 cm decreased ovarian volume of ipsilateral ovary and improved serum FSH level but slightly increased AFC. Ablation alone had more negative impact on ovarian volume and AFC.


Nahed Ezzat Allam, Taiseer Maarouf Mohamed and Eman Ibrahiem Ahmed

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