Comparison of different treatment methods of endometriomas by laparoscopy

In a prospective study designed to evaluate four methods of endometrioma treatment by laparoscopy, 26 patients had the endometriomas excised, 24 had them opened and the lining stripped off, 30 had them opened and the lining evaporated by CO2 laser, and 44 had them opened and drained. Only women who had laparoscopy because of pelvic pain and who had no immediate desire for pregnancy were included in this study. Those who did not undergo a second-look laparoscopy were excluded. Pain disappeared completely from all subjects regardless of the method of treatment. At second-look laparoscopy, all women in the excision group, nine (37%) in the group who had the lining stripped, nine (30%) in the group who had the lining evaporated, and 12 (27%) in the drainage group had periadnexal adhesions. Residual endometriosis was found in 23, 25, 33, and 30% of these groups, respectively. Because there was a statistical difference between the excision group and each of the remaining three groups in the formation of adnexal adhesions and because there was no statistical difference among the four groups regarding the presence of residual endometriosis, we conclude that laparoscopic treatment of endometriomas should not include excision but rather drainage with or without elimination of the inner lining.