الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Endometriosis is defined as a presence of endometrium-like tissue outside the uterus. Every tenth woman of reproductive age suffers from this enigmatic disease. Endometriosis occupies the third place in the structure of gynecological morbidity after pelvic inflammatory disease and uterine fibroids and makes upto10% in the structure of the general morbidity.
Endometriosis is currently recognized as one of the most common diseases associated with infertility. The frequency rate of endometriosis in patients with infertility reaches 50% compared to approximately 6–7% among fertile women with preserved reproductive function. Approximately 44% of patients affected by endometriosis have an Ovarian endometrioma (OMA), which is a cystic ovarian formation, often unilocular (or up to four locations), containing ground glass cystic fluid and with typically scattered vascularity.
OMA negatively affecting ovarian reserve through hiding antral follicle during ultrasound examination, stress related to the presence of the ovarian cyst itself, laparoscopic cystectomy due to the removal of healthy ovarian tissue, haemostasis of the bleeding ovarian parenchyma after stripping which damages the healthy ovarian tissue and its vascularisation. Recently, some concerns have been raised toward ablation technique to avoid excessive removal of healthy ovarian tissue with cyst wall left in situ and then ablated or vaporized which could represent ales aggressive approach towards ovarian reserve.
This randomized clinical trial was conducted in minimal access surgery unit at obstetrics & gynecology department at Minia maternity & children university hospital during the period from January 2019 to January 2021.
Eighty one (81) patients were recruited in the study classified into three groups, group I of argon laser, group II of laparoscopic suturing, group III of diathermy coagulation. The aim and technique of the study were simply explained to the patients and a formal consent was taken from all patients, confirming their free approval.
The recruited women were subjected to:-
Detailed history taking,, General examination,, ) Abdominal and pelvic examination,, ) Trans – vaginal ultrasound examination Scanning for both adnexa was done to confirm presence of ovarian endometrioma which was mainly a unilocular tumor and has a low level echogenicity representing old blood in the cyst cavity (commonly termed ground glass) & for evaluation of the antral follicle count.
Laboratory assay: - Blood samples were obtained from all patients for evaluation of serum Anti Mullerian hormone level before laparoscopy.
All patients were subjected to operative laparoscopy after using simple randomization method & classified into three groups each one have 27 patients:
• First group was treated by laparoscopic argon beam coagulation.
• Second group was treated by laparoscopic suturing.
• Third group was treated by laparoscopic diathermy coagulation.
After three months all patients participated in the study reevaluated again for antral follicle count & serum Anti Mullerian hormone level.
Response evaluation was through:
• Changes in the antral follicle count.
• Changes in the serum Anti Mullerian hormone.
• Clinical pregnancy rate following surgery.
• Symptoms recurrence following surgery.
Our study resulted in:
The AFC show statistically significant rise 3 months following surgery in all groups with no statistical significance between each group & other.
The operative characteristics of time of surgery & perioperative blood loss were variable between three groups with statistical significance noted between group I & II.
The AMH level which show statistical significant decrease 3 months following surgery in all groups with no significant difference between each group & other.
The main finding in our results was the surgical outcome which represents the percentage of change in AMH level following surgery which was variable between three groups with statistical significance present between three groups. The least decrease was noted in group I 9.6 %, intermediate decrease in group II 12.8 %, the most decrease in group III 18.3 %.
The clinical pregnancy rate was variable between three groups with no statistical significance during the period of follow up that extended for 6 months and was highest in group I: 22.2 %, intermediate in group II: 14.8 % & lowest in group III: 11.1%.
Symptoms recurrence rate was variable between three groups with no statistical significance during the period of follow up that extended for 6 months and was 33.3 % in group I, 26.9 in group II, 22.2% in group III.
After these results we could conclude that:
Ablation technique should have a superior hand over stripping technique mainly in women seeking future fertility.
Argon laser had the least negative effect on the ovarian reserve rather than suturing or diathermy coagulation.
Ablation technique saves more time & less blood loss rather than stripping technique.
Symptoms recurrence was comparable between both techniques.