Laparoscopic cystectomy (LC) is at present viewed as the first-line means of diagnosing and treating endometriosis. This prospective study sought to identify factors related to postoperative recurrence in 315 women with endometriosis whose mean age was 31 years and who were followed up for an average of 21 months following LC. The procedure was performed using transvaginal ultrasonography. Four experienced gynecologists—not the ones who performed LC—evaluated the patients at 6-month intervals. Recurrent disease was defined as a diffuse, hypoechoic area whose long axis extended for at least 2 cm. Severity of disease was assessed using the revised American Society of Reproductive Medicine (r-ASRM) score.
Bilateral LC was carried out in 102 patients and hemilateral LC in 213. The overall rate of recurrent disease was 16%, and the estimated cumulative recurrence rate for all patients 5 years after LC was 32%. The 51 women who became pregnant included 36 of 141 whose chief complaint at the time of primary surgery was sterility (25.5%). In comparison, 9% of women who did not complain of sterility became pregnant. Recurrent disease was relatively frequent in younger patients and those with more severe disease as indicated by their r-ASRM scores. Neither the size of cysts nor the presence of multiple lobules correlated significantly with recurrent disease. Patients undergoing hemilateral LC had a 5% rate of recurrence in the ovary that, at the time of initial surgery, appeared to be normal.
In this prospective study, younger women with endometriosis and those with severe disease were at the highest risk of developing recurrent disease. It is likely that recurrences include both cysts that form spontaneously and others that develop from residual disease in lesions treated by cystectomy.