Effectiveness and Safety of Different Laparoscopic Surgeries for Ovarian Endometrioma: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

Gynaecology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

Keywords：

Laparoscopic surgery; Endometriosis; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130012

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Objective 　To systematically review the effectiveness and safety of different laparoscopic surgeries for ovarian endometrioma (OE).
Methods 　Such databases as The Cochrane Library (Issue 3, 2011), MEDLINE (1966 to November 2011), EMbase (1980 to November 2011), CNKI (1980 to November 2011), CBM (1980 to November 2011) and WanFang Data (1978 to November 2011) were searched on computer, and the relevant references of the included literature were also retrieved manually to collect the randomized controlled trials (RCTs) about laparoscopic cystectomy vs. laparoscopic coagulation for OE. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed quality. Then RevMan 5.1 software was used for meta-analysis.
Results 　A total of 5 RCTs were included. The results of meta-analysis showed that, laparoscopic cystectomy for OE could reduce the reocurrence rates of dysmenorrhoea (RR=0.29, 95%CI 0.15 to 0.55, P=0.000 2), dyspareunia (RR=0.27, 95% CI 0.09 to 0.77, P=0.01) and non-menstrual pelvic pain (RR=0.19, 95% CI 0.05 to 0.76, P=0.02), decrease 1-year (RR=0.33, 95%CI 0.15 to 0.74, P=0.007) and 2-year (RR=0.49, 95%CI 0.26 to 0.95, P=0.03) postoperative reoccurence of OE, and lower the risk of short-term secondary operation (RR=0.25, 95%CI 0.07 to 0.85, P=0.03). However, it didn’t increase the 12-month (RR=2.82, 95%CI 1.44 to 5.50, P=0.002) and 24-month (RR=2.62, 95%CI 1.47 to 4.68, P=0.001) postoperative spontaneous pregnancy rates (SPR). In addition, although laparoscopic coagulation was superior to laparoscopic cystectomy in the 6-month postoperative ovarian reserve function (ORF), there was no significant difference in the 5-year postoperative ORF between the two groups (WMD=0.27, 95%CI −0.18 to 0.73, P=0.24).
Conclusion 　Laparoscopic cystectomy for OE can reduce the reoccurence of dysmenorrhoea, dyspareunia, non-menstrual pelvic pain and endometriosis, decrease the risk of short-term secondary operation, and increase the postoperative SPR in women who had been diagnosed as infertility. Because of the quantity limitation of present clinical trials, this conclusion requires to be further proved by performing more high quality RCTs.

Citation： YE Yuanzheng,WANG Yanhong,MA Cailing. Effectiveness and Safety of Different Laparoscopic Surgeries for Ovarian Endometrioma: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 55-61. doi: 10.7507/1672-2531.20130012 Copy

1.	American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril, 1985, 43(3): 351-353.
2.	Daniell JF, Kurtz BR, Gurley LD. Laser laparoscopic management of large endometriomas. Fertil Steril, 1991, 55(4): 692-695.
3.	Donnez J, Nisolle M, Gillet N, et al. Large ovarian endometriomas. Hum Reprod, 1996, 11(3): 641-646.
4.	Sutton CJ, Ewen SP, Jacobs SA, et al. Laser laparoscopic surgery in the treatment of ovarian endometriomas. J Am Assoc Gynecol Laparosc, 1997, 4(3): 319-323.
5.	Yuen PM, Yu KM, Yip SK, et al. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol, 1997, 177(1): 109-114.
6.	Luciano AA, Lowney J, Jacobs SL. Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits. J Reprod Med, 1992, 37(7): 573-576.
7.	Hachisuga T, Kawarabayashi T. Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod, 2002, 17(2): 432-435.
8.	Maouris P, Brett L. Endometrioitic ovarian cysts: the case for excisional laparoscopic surgery. Gynaecol Endoscopy, 2002, 11(3): 231-234.
9.	Beretta P, Franchi M, Ghezzi F, et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril, 1998, 70(6): 1176-1180.
10.	Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril, 2004, 82(6): 1633-1637.
11.	Alborzi S, Ravanbakhsh R, Parsanezhad ME, et al. A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril, 2007, 88(2): 507-509.
12.	Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril, 2010, 94(1): 71-77.
13.	Carmona F, Martínez-Zamora M, Rabanal A, et al. Ovarian cystectomy versus laser vaporization in thetreatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril, 2011, 96(1): 251-254.
14.	Whiteside JL, Keup HL. Laparoscopic management of the ovarian mass: a practical approach. Clin Obstet Gynecol, 2009, 52(3): 327-334.
15.	Mais V, Ajossa S, Guerriero S, et al. Laparoscopic management of endometriomas: a randomized trial versus laparotomy. J Gynecol Surgery, 1996, 12(1): 41-46.
16.	Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol, 2006, 195(2): 421-425.

1. American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril, 1985, 43(3): 351-353.
2. Daniell JF, Kurtz BR, Gurley LD. Laser laparoscopic management of large endometriomas. Fertil Steril, 1991, 55(4): 692-695.
3. Donnez J, Nisolle M, Gillet N, et al. Large ovarian endometriomas. Hum Reprod, 1996, 11(3): 641-646.
4. Sutton CJ, Ewen SP, Jacobs SA, et al. Laser laparoscopic surgery in the treatment of ovarian endometriomas. J Am Assoc Gynecol Laparosc, 1997, 4(3): 319-323.
5. Yuen PM, Yu KM, Yip SK, et al. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol, 1997, 177(1): 109-114.
6. Luciano AA, Lowney J, Jacobs SL. Endoscopic treatment of endometriosis-associated infertility. Therapeutic, economic and social benefits. J Reprod Med, 1992, 37(7): 573-576.
7. Hachisuga T, Kawarabayashi T. Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Hum Reprod, 2002, 17(2): 432-435.
8. Maouris P, Brett L. Endometrioitic ovarian cysts: the case for excisional laparoscopic surgery. Gynaecol Endoscopy, 2002, 11(3): 231-234.
9. Beretta P, Franchi M, Ghezzi F, et al. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril, 1998, 70(6): 1176-1180.
10. Alborzi S, Momtahan M, Parsanezhad ME, et al. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril, 2004, 82(6): 1633-1637.
11. Alborzi S, Ravanbakhsh R, Parsanezhad ME, et al. A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril, 2007, 88(2): 507-509.
12. Tsolakidis D, Pados G, Vavilis D, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril, 2010, 94(1): 71-77.
13. Carmona F, Martínez-Zamora M, Rabanal A, et al. Ovarian cystectomy versus laser vaporization in thetreatment of ovarian endometriomas: a randomized clinical trial with a five-year follow-up. Fertil Steril, 2011, 96(1): 251-254.
14. Whiteside JL, Keup HL. Laparoscopic management of the ovarian mass: a practical approach. Clin Obstet Gynecol, 2009, 52(3): 327-334.
15. Mais V, Ajossa S, Guerriero S, et al. Laparoscopic management of endometriomas: a randomized trial versus laparotomy. J Gynecol Surgery, 1996, 12(1): 41-46.
16. Busacca M, Riparini J, Somigliana E, et al. Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. Am J Obstet Gynecol, 2006, 195(2): 421-425.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Different Laparoscopic Surgeries for Ovarian Endometrioma: A Systematic Review

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