الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Endometriosis is a common condition associated with pelvic pain and infertility in women. Endometriosis is defined as the presence of ectopic deposits of endometrial tissue usually, but not exclusively, limited to the pelvis, which may lead to infertility and pelvic pain. It may be present in up to 22% of asymptomatic women and up to 45% of women with pelvic pain. It has been believed for almost a century by the majority of academic opinion that endometriosis is a disease caused by shedding of menstrual endometrium and its dissemination throughout the pelvis.
Endometrioma are endometriotic deposits within the ovary. The origin of ovarian endometrioma is unknown; however, most authors believe that they result initially from a deposit of endometrium passed through the Fallopian tube, causing adherence of the ovary to the pelvic peritoneum and progressive invagination (folding inwards) of the ovary.
If this is true, an endometrioma would be a pseudocyst (false cyst), the wall of which is the inverted ovarian cortex (centre) and hence the removal of this cyst wall might involve removal of normal ovarian tissue, with possible adverse implications for future fertility.
The primary indications for treatment of ovarian endometrioma are the symptoms of pelvic pain and dyspareunia (pain during or after sexual intercourse) and may impair the outcome of fertility treatment. There is also a small risk of malignant (cancerous) transformation.
The evidence suggests that, although medical treatment will result in a reduction in size of the endometrioma of up to 57%, the most effective approach to treatment is surgical. Furthermore, if they are left, as with any ovarian cyst they have a risk of rupture and torsion. In recent years, laparoscopy has become the gold standard for the treatment of ovarian endometriotic cysts.
When compared to traditional surgery by laparotomy, operative laparoscopy is associated with shorter hospital stay, faster patient recovery, decreased costs and lower incidence of de novo adhesion formation. The pregnancy rates, monthly fecundity and cyst recurrence rates after laparoscopic surgery are comparable.
Laparoscopic surgery for endometrioma does carry a risk of conversion to laparotomy, and this is associated with the experience of the surgeon, the complexity of the surgery as well as patient factors, such as body mass index. The procedure of drainage of the endometrioma alone is not recommended due to the high rate of recurrence.However, the most effective method of laparoscopic surgery (excisional or ablative) remains controversial.
Several alternative laparoscopic techniques have been described for the treatment of ovarian endometrioma: cyst wall laser vaporization, drainage, coagulation and stripping. Excision of the cyst involves the opening of the endometrioma either with or without the use of electrosurgical or laser energy. The wall of the endometrioma is then excised or “stripped away” from the underlying cortex using a combination of scissors (or monopolar hook) and grasping forceps.
Ablation of the endometrioma also involves opening and draining of the endometrioma or fenestration (making a window in the wall of the cyst), followed by the destruction of the cyst wall using either cutting or coagulating current, or using a form of laser energy.
Whatever the surgical modality employed to treat the cyst, a sample of the endometrioma must be sent for histological assessment as there is a need to confirm the clinical diagnosis, to exclude the presence of malignancy as the risk of malignant transformation of the cyst is ∼0.7%.
In the current study we aimed to determine whether laparoscopic surgical excision or ablation is the optimum surgical management of ovarian endometrioma regarding ovarian reserve 58 patients were included and randomized into two groups.
Results
- In the current study we found that there was insignificant difference between two groups regarding age and BMI p-value 0.974,0.479 respectively.
- In the current study we found that there was an insignificant difference between two groups regarding duration of infertility p-value 0.324 and there was insignificant difference between two groups regarding clinical features.
- In the current study we found that there was insignificant difference between two groups regarding size of endmetrioma p-value 0.315
- In the current study we found that there was insignificant difference between two groups regarding Laterality of endmetrioma p-value 0.368
- In the current study we found that there was insignificant difference between two groups regarding No. of antral follicles preoperative p-value 0.855 but postoperative there was significant decrease in excision group p-value < 0.001
- In the current study we found that there was insignificant difference between two groups regarding AMH level preoperative p-value 0.955 but postoperative there was significant decrease in excision group p-value 0.034
- In the current study we found that there was insignificant difference between two groups regarding Total ovarian volume preoperative p-value 0.849 but postoperative there was significant decrease in excision group p-value 0.004
- In the current study we found that there were insignificant difference between two groups regarding Recurrence of non-menstrual pain and Recurrence of dysmenorrheal.