Comparison of laparoscopic cystectomy and fenestration/cauterization procedures in terms of pelvic pain and recurrence in patients with endometrioma

Abstract

Abstract Introduction: Endometriosis is an estrogen-dependent, progressive inflammatory disease caused by the growth of endometrium-like tissue outside the uterine cavity. In women of reproductive age, it is a prevalent cause of pelvic pain. Surgical intervention may be required in the insufficiency of conservative treatments and laparoscopic procedures should be prioritized for surgery. The objective of our study was to compare the efficacy of laparoscopic fenestration-cauterization and cyst excision in patients with ovarian endometrioma on dysmenorrhea, non-menstrual pelvic pain, dyspareunia, and dyschezia symptoms. Materials and methods: The study comprised 112 patients with endometrioma who underwent laparoscopic surgery and whose data could be obtained. In 76.8% (n=86) of the patients, laparoscopic cystectomy was conducted, and in 23.2% (n=26) of the patients, laparoscopic fenestration+cauterization were performed. The patients' preoperative examination findings and VAS (Visual Analog Scale) pain levels were retrieved retrospectively. Patients were contacted again during the study, VAS pain scores were recalculated, and a gynecological ultrasound scan was performed to check for recurrence. The collected data were analyzed comparatively. Results: The mean age of the patients was 35.5 ± 6.8 years in the fenestration-cauterization group and 32.3 ± 5.9 years in the cystectomy group. 12.5% (n=14) of the cases were classified as stage I, 3.5% (n=4) as stage II, 32% (n=36) as stage III, and 52% (n=58) as stage IV. The operative time was significantly shorter in the fenestration+cauterization group compared to the cystectomy group (respectively/min 50.0±18.4 /61.3.±16.8, p=0.014). In both groups, the number of patients with dysmenorrhea, NMPP, dyspareunia, and dyschezia who had high VAS pain scores decreased significantly (p<0.005). In both procedures, there was no difference between recurrence rates (p=0.801). After surgical treatment, there was a significant decrease in the number of stage III-IV patients with dysmenorrhea and NMPP who had high VAS (p<0.005).  Conclusion: We emphasize the significance of laparoscopy in the surgical treatment of endometriosis. Both laparoscopic fenestration + cauterization and laparoscopic cystectomy significantly reduced pain symptoms, especially in patients with advanced endometriosis. The efficacy and recurrence rates of both treatments were not significantly different. Keywords: Endometriosis, endometrioma, pelvic pain, laparoscopic surgery, recurrence