NEW YORK (Reuters Health) – For the treatment of ovarian endometriomas, laser vaporization is associated with earlier recurrences and more recurrences compared with laparoscopic cystectomy, although the differences are not statistically significant at 5 years, a randomized controlled trial found.

“Currently, we are using both techniques with a preference for the stripping,” Dr. Francisco Carmona from University of Barcelona told Reuters Health in an e-mail. The study findings were published online May 16 in Fertility and Sterility.

Disease recurrence after surgery is “one of the most frustrating aspects of treating endometrioma,” the clinicians note in their report. Depending on the surgical approach and follow up time, between 10% and 50% of women will have a recurrence after 2 to 5 years.

Dr. Carmona and colleagues say their study is the first randomized prospective trial comparing laser vaporization with cystectomy in terms of long-term recurrence rates. The study enrolled 90 women with ovarian endometriomas and similar baseline clinical and ultrasonographic findings. Half were assigned to cystectomy and half to laser vaporization.

Nine women in the cystectomy group and seven in the laser vaporization group were excluded, leaving 36 and 38, respectively, for the final analysis. There were no conversions to laparotomy or complications during or after surgery in either group.

The investigators report that recurrences happened earlier in the laser group than in the cystectomy group (7.5 months vs 18.1 months); thus, the recurrence rate at 12 months was statistically higher (P = 0.04) in the laser group (12 of 38 patients; 31%) than in the cystectomy group (4 of 36 patients; 11%).

At 5 years follow-up, the endometrioma recurrence rate was also higher, though not statistically so (P = 0.2), in the laser group (14 of 38; 37%) than in the cystectomy group (8 of 36 patients; 22%).

The investigators note that recurrence rates at 5 years were similar in patients using oral contraceptives (OC) after surgery (7 of 24, 29%) and in those not using OC after surgery (15 of 50, 30%). This observation, they say, does not support a recent study that suggested that OC use may protect against endometrioma recurrence.

The investigators also point out in their paper that laser vaporization has been proposed as the best method to preserve ovarian function. Yet, in their study there were no differences in pregnancy rates at 1 year or 5 years in the women who wanted to become pregnant. At 1 year, pregnancy rates were 19.2% and 20.8%, respectively, in the cystectomy and laser groups. At 5 years, these rates were 38.1% and 44.4%, respectively.

The two approaches are “fairly equivalent when you are looking at the long term; however, it is noteworthy that recurrences were earliest in the laser group,” Dr. Carmona commented in an e-mail to Reuters Health.

The investigator also mentioned that the study was not designed to look at cost or side effect differences. “However, there were not side effect differences between groups in terms of hospital stay or surgical complications.”

Fertil Steril 2011.