Volume : 3
Issue : 2
Online ISSN : 2394-2754
Print ISSN : 2394-2746
Article First Page : 95
Article End Page : 100
Laparoscopic ovarian cystectomy is the technique of choice in patients with large ovarian endometriomas. However, post operative residual ovarian function remains a major concern.
Objectives: The aim of this prospective, randomized study was to compare two different techniques of stripping at the original adhesion site and at the hilus. We also aimed to determine which technique of ovarian cystectomy causes least tissue damage, by histopathology analysis and by determining the residual ovarian volume.
Materials and Methods: 32 patients were enrolled, who had laparoscopically confirmed endometriomas > 3 cm in diameter. The patients were randomized into two groups, by a computer generated random number table. Two different techniques (direct stripping vs. excision of a circular rim of tissue) were compared at the original adhesion site (step 1). At step 2, all patients underwent randomization again, and two different techniques (completion of stripping vs. bipolar coagulation and cutting with scissors) were compared at the hilus. Operative time and operative difficulty were evaluated at both steps by the same surgeon. Histopathology confirmation of the loss of normal ovarian tissue was recorded at the original adhesion site, intermediate part and at the hilus. Residual ovarian volume was calculated at the end of six months.
Results: The mean operating time and difficulty showed no significant difference at both step1 and step 2 with either technique. However complication rate (hemorrhage) was higher at step 2 in the direct stripping group. On histopathology, primordial follicles were identified in similar number of patients in each group. The residual ovarian volume six months post operatively showed no significant difference in both groups.
Conclusion: Both techniques of cystectomy are tissue sparing and can be safely used.
Keywords: Endometrioma, Infertility, Chocolate cyst, Laparoscopic cystectomy, Ovarian volume