Diagnosis and surgical management of endometriomas

Fifty two patients with endometriomas greater than 1 cm were treated by surgical excision either with or without ovarian closure. Diagnosis is reliable when clinical features of the pain, vaginal ultrasound, and laparoscopy, including ovarian mobilization and needling, are considered. Fifty of 52 patients were free of pain after 1 year and 26 (50%) became pregnant within 1 year. A second laparoscopy is justified if pain persists or pregnancy does not occur. Adhesive disease was the most common complication (40%), and persistent or recurrent endometriosis occurred in 15%. Surgery by laparoscopy with drainage and excision of the endometrioma without ovarian sutures may be more effective than excision of the endometrioma and ovarian suture.