[Surgery for the management of ovarian endometriomas: from the physiopathology to the pre-, peri- and postoperative treatment]

Abstract

Good knowledge of physiopathology, surgical techniques and of the literature allows for an adequate treatment of ovarian endometrioma. Preoperative medical treatment has not shown to be efficient and might be adapted to each patient (continuation or initiation of hormonal treatment in case of symptomatology, will for contraception, association with functional cyst). Laparoscopy is the mandatory surgical approach. Cystectomy is the surgical technique of choice but may affect normal ovarian tissu. Surgical technique should be meticulous in particular with respect to the hilum of the ovary. Exclusive coagulation using bipolar is not recommended. A hybrid technique associating both cystectomy and vaporization (laser or Plasmajet(©)) at the level of the hilum of the ovary could be interesting. Hemostasis should be spontaneous or obtained with bipolar coagulation with parcimony. Ovarian suture is a solution. Extra-ovarian lesions should be carefully searched for and treated. Anti-adhesion products should be applied. Postoperative medical treatment decreases recurrence and should be systematic for patients who do not want to conceive. Multidisciplinary approach is essential.