Laparoscopic surgery vs. laparotomy management for infertile patients with ovarian endometrioma

Objective To determine the usefulness of laparoscopic surgery compared with laparotomy for conservative surgical treatment of patients with ovarian endometrioma. Design Non‐randomized retrospective study. Setting Infertility unit at the Fujita Health University Hospital, Aichi, Japan. Subjects A total of 78 infertile patients with endometrial cysts treated during a 5‐year period. Interventions Conservative surgical treatment by means of laparoscopic surgery (n = 32) or laparotomy (n = 46) with follow up over 24 months. Each group was subdivided according to revised American Fertility Society (r‐AFS) score into two subgroups: those with early‐stage endometrioma (score < 16) and those with advanced‐stage endometrioma (score ≥ 16). Main outcome measures Data for operating time, endometrioma size, r‐AFS score and pregnancy outcome were compared between both groups and subgroups. Results For the patients with advanced‐stage endometrioma, the operating time was significantly longer for the laparoscopic group (154.0 ± 71.1 min; mean ± SD), compared with the laparotomy group (102.0 ± 37.8 min) even though the sizes of the removed endometrioma were similar (laparoscopic group 5.4 ± 2.2 cm, laparotomy group 7.1 ± 3.1 cm). Again for patients with advanced endometrioma, the mean time interval to subsequent pregnancy outcome following conservative surgery was significantly shorter in the laparoscopic group (206.4 ± 168.2 days) than in the laparotomy group (510.2 ± 338.3 days), Conclusions Laparoscopic removal of advanced‐stage ovarian endometriomas seems as effective as laparotomy in terms of pregnancy outcome, but takes a slightly longer operating time compared with laparotomy. The laparoscopic approach has the advantage of a shorter time to pregnancy after surgery. Laparoscopic surgery is the recommended approach for infertile patients with ovarian endometrioma for better postoperative fertility.