Risk factors for recurrence rate of ovarian endometriomas following a laparoscopic cystectomy

Objective of the study was to evaluate the risk factors that influence the recurrence of endometrioma after laparoscopic excision.

A cross-sectional study was performed at Arash University Hospital between 2009 and 2011 on patients who had a minimum of one year of postoperative follow-up after undergoing a laparoscopic excision of an ovarian endometrioma. The patients had any prior surgery for ovarian endometriomas was excluded. Recurrence was defined as the presence of endometrioma more than 2 cm in size, detected by ultrasonography within 1 year of surgery. The variables including age at surgery, presence of infertility, uterine myoma, previous medical treatment of endometriosis, the size of the largest cyst at laparoscopy, unilateral or bilateral involvement, serum CA125 level, revised American Society for Reproductive Medicine (ASRM) score and stage, postoperative medical treatment and postoperative treatment were evaluated to assess their independent effects on the recurrence using logistic regression analysis.

A total of 158 patients were admitted to the Surgery Unit for endometriomas cystectomy during the study period. After the initial assessment, 130 patients were eligible for the study. The overall rate of recurrence was 11.5% (15/130). Significant factors that were independently associated with higher recurrence were the size of the largest cyst (odds ratio [OR] =4, 95% confidence interval [95% CI] =1.6-10.4, P=0.002), a high rASRM score (OR=1.2, 95% CI=1-1.4, P=0.04) and woman age at surgery (OR=0.6, 95% CI=0.4-0.9, P=0.01).

A high score of rASRM, large cyst size and young age at surgery were three significant factors that were associated with higher recurrence of endometriomas.