A 32-year-old woman with severe endometriosis and a 4 cm left ovarian endometrioma desires fertility preservation. She has failed 6 months of GnRH agonist therapy. Laparoscopic cystectomy is planned. According to ESHRE 2022 endometriosis guidelines, the recommended surgical technique for the endometrioma to minimise impact on ovarian reserve is:

• A Fenestration and coagulation of the cyst wall
• B Laser ablation of the inner cyst wall after drainage
• C Three-puncture aspiration under ultrasound guidance
• D Stripping (cystectomy) technique removing the cyst pseudocapsule ✓

Explanation

ESHRE 2022 guidelines recommend cystectomy (stripping technique) over fenestration/coagulation for endometriomas ≥ 3 cm, as cystectomy has higher recurrence-free rates. However, the stripping technique inadvertently removes normal ovarian cortex containing primordial follicles, reducing ovarian reserve (reflected by falling AMH). Despite this, it is still preferred over coagulation due to better disease control. The surgeon should use minimal cautery on the remaining ovarian tissue to preserve follicles. Pre-operative anti-Müllerian hormone measurement is recommended.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.