[Surgical treatment for endometriomas]

Endovaginal ultrasonography is relevant for the diagnosis of ovarian endometriomas with a good predictive value. Magnetic resonance imaging (MRI) may be recommended if deep endometriosis is suspected. Operative laparoscopic management is the 'gold standard' for surgical treatment, and medical treatment should not be given before surgery. Peritoneal lavage cytology must be performed before cystectomy. First, the cyst is opened and the endometriosic fluid is aspirated. The stripping technique is performed and after hemostasis, the ovarian cortex is reattached with microsurgical sutures. Coagulation or laser vaporization of endometriomas without excision of the pseudocapsule seems to be associated with a significant increase in risk of cyst recurrence. Recurrent ovarian surgery is not recommended in women with infertility, as it might be deleterious for ovarian reserve.