Efficacy Of Laparoscopic Surgery For Ovarian Endometriomata: A Systematic Review And Meta-analysis

Objective: To assess determine the most effective technique for treating an ovarianendometrioma, either excision of the cyst capsule or drainage and ablation of the cyst wall.Methods: We searched the Cochrane Library(Issue3,2011), Cochrane Central Registerof Controlled Trials(The Cochrane Library2011, Issue3), MEDLINE(1966to November2011), EMBASE (1980to November2011), CNKI(1980to November2011), CBMdisc(1980to November2011), WANFANG DATABASE(1978to November2011) andreference lists of articles to November2011and hand searched relevant journals.Randomized controlled trials or controlled clinical trials selection and assessment, datacollection and analyses were undertaken by two reviewers independently according to theCochrane Handbook for Systematic Reviews of Interventions. The quality of the includedstudies was evaluated by GRADE(Grades of Recommendation, Assessment,Development and Evaluation) system and principle of Cochrane Reviewer Handbook5.1.4RCT. Meta-analyses were performed with RevMan5.1software. Results: Fiverandomised studies of the laparoscopic management of ovarian endometriomata, sizegreater than3cm, for the primary symptom of pain were included. For the primaryoutcome measures laparoscopic excision of the cyst wall of the endometrioma wasassociated with a reduced recurrence rate of the symptoms of dysmenorrhoea(painfulperiods)(RR0.29,95%CI0.15to0.55), dyspareunia(RR0.09,95%CI0.09to0.77)andnon-menstrual pelvic pain(RR0.19,95%CI0.05to0.76). In those women subsequentlyattempting to conceive excision of the cyst wall was also associated with a subsequentincreased spontaneous pregnancy rate in women who had documented prior subfertility(RR2.64,95%CI1.49to4.69)compared to women who underwent laparoscopic ablation of the endometrioma. Laparoscopic excision of the cyst wall was associated with areduced rate of recurrence of the endometrioma(RR0.50,95%CI0.26to0.97)and with areduced shot time requirement for further surgery (RR0.25,95%CI0.07to0.85)compared with surgery to ablate the endometrioma. A further randomised study wasidentified that demonstrated an increased ovarian follicular response to gonadotrophinstimulation for women who had undergone six months after excisional surgery whencompared to ablative surgery(WMD-4.26,95%CI-5.98to-2.55), but there is notsignificantly different at60months of follow-up(WMD0.27,95%CI-0.18to0.73).Conclusion: Laparoscopic excision of the cyst wall of the endometrioma was associatedwith a reduced recurrence rate of the symptoms of dysmenorrhoea, dyspareunia andnon-menstrual pelvic pain, reduced rate of recurrence of the endometrioma and increasedspontaneous pregnancy rate in women who had documented prior subfertility. Because ofthe studies limited, further andomized controlled trials is required in this field to assessthe quality of life after surgery and clarify the effect of surgery on ovarian function.