Wednesday 10 August 2005
Excision for endometriomata superior to drainage and ablation
Source: The Cochrane Database of Systematic Reviews 2005; 3: CD004992
Comparing the efficacy of cyst excision with cyst drainage and electrocoagulation for women with endometriomata, with respect to recurrence and fertility.
A team of Cochrane reviewers says that excision should be the "favored surgical approach" to the management of endometriomata, the presence of endometriotic deposits in the ovary.
Surgical management of these blood-filled cysts remains controversial, explain RJ Hart, from the University of Western Australia in Subiaco, and co-workers. "Currently the commonest procedures... are either excision of the cyst capsule or drainage and electrocoagulation of the cyst wall."
To determine which is the most effective approach, they searched a series of databases for relevant trials, including their own records as well as MEDLINE and EMBASE. This yielded no randomized studies of laparotomic management, but two eligible trials of the management of endometriomata by laparoscopy, which is favored for its quicker patient recovery.
Excision of the cyst wall was associated with an almost 60 percent reduction in the rate of endometrioma recurrence, and around a 90 percent decrease in menstrual and non-menstrual pelvic pain, compared with cyst drainage and electrocoagulation, along with an increase in rates of spontaneous pregnancy in women with prior subfertility of more than five fold.
In summary, "there is some evidence that excisional surgery for endometriomata provides for a more favorable outcome than drainage and ablation," writes the team.
Posted: 9 August 2005
http://www.obgynworld.com/international/news/2005/Week_32/Day_2/Excision_for_endomet.asp 
Excision for endometriomata superior to drainage and ablation 
