Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study

Abstract

Objective: To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s).

Design: Prospective observational study.

Setting: Tertiary care university hospital.

Patient(s): One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s).

Intervention(s): Laparoscopic conservative treatment of endometriosis.

Main outcome measure(s): Patient demographic characteristics, surgical findings, and surgical results were prospectively recorded. Postoperative follow-ups were carried out every 3 months to identify pain and/or endometrioma recurrence for a minimum of 3 years.

Result(s): Dysmenorrheal, dyspareunia, and chronic pelvic pain recurred in 14.5%, 6%, and 5.4% of women, respectively. Prior surgery for endometriosis, adhesion extension, and use of ovarian stimulation drugs (OSD) were unfavorable prognostic factors for pain symptoms. Ovarian endometrioma recurred in 9.6% of cases; negative factors were prior surgery for endometriosis, OSD, pelvic adhesions, and high American Society for Reproductive Medicine disease scores. Postoperative pregnancy showed a significant protective effect on pain and disease recurrences.

Conclusion(s): Prior surgery, presence of adhesions, and ovulation drugs are negative prognostic factors. Pregnancy has a protective effect on disease and pain recurrence.