A Cochrane review [Abstract] 1 included 3 studies with a total of 245 subjects. Two randomised studies (total n=164) of the laparoscopic management of ovarian endometriomata of greater than 3 cm in size were included. Laparoscopic excision of the cyst wall of the endometrioma compared with drainage and ablation (electrocoagulation of the cyst wall) was associated with a reduced rate of recurrence of the endometrioma (OR 0.41 CI 0.18-0.93), reduced requirement for further surgery (OR 0.21 CI 0.05-0.79), reduced recurrence rate of the symptoms of dysmenorrhoea (OR 0.15 CI 0.06-0.38), dyspareunia OR 0.08 CI 0.01-0.51) and non-menstrual pelvic pain (OR 0.10 CI 0.02-0.56). It was also associated with a subsequent increased rate of spontaneous pregnancy in women who had documented prior sub-fertility (OR 5.21 CI 2.04-13.29). A further randomised study (n=65) demonstrated that in women trying to conceive, the ovarian response to gonadotrophin stimulation, as part of fertility treatment was better in women who had undergone excisional surgery to remove the cyst compared to ablative surgery (WMD 0.6, 95% CI 0.04 to 1.16), although not affecting the subsequent likelihood of pregnancy after controlled ovarian stimulation and intra-uterine insemination (OR 1.40, 95% CI 0.47 to 4.15).
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment and lack of blinding).
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