The efficacy of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas

The aim of this study was to investigate the influence of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas. We identified differences in follicle loss and surgical difficulties with or without preoperative hormonal therapy.

Ninety-six patients with ovarian endometrioma underwent a laparoscopic cystectomy. Patients were divided into three groups: control group A (53 patients, 57 cysts) with no preoperative hormonal therapy; group B (34 patients, 40 cysts) who received gonadotropin-releasing hormone agonist therapy; and group C (9 patients, 11 cysts) who received danazol therapy before surgery. The medical and videotape records of all patients were retrospectively reviewed. The specimens of endometriomas were histologically evaluated.

Mean diameters of endometriomas before hormonal therapy in groups B and C were significantly greater than those in the control group. There were no significant differences in the following: the mean diameter of removed cysts, the revised-American Society of Reproductive Medicine scores, the number of capsules containing follicle(s), and the mean number of follicles attached to a cyst. However, the number of capsules showing fibrosis significantly increased in the preoperative hormonal therapy groups (P < 0.001). Furthermore, the mean operation time of the preoperative hormonal groups was significantly longer than that of the control group (P < 0.01, P < 0.001).

Our data suggested that preoperative hormonal therapy reduced the size of endometriomas. However, with similar revised-American Society of Reproductive Medicine scores, preoperative hormonal therapy did not contribute to the reduction of the loss of ovarian follicles. Fibrosis resulting from hormonal therapy appears to be responsible for these observations.