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Ovarian Endometrioma's: Are They Persistant?
Title:Recurrence of ovarian endometrioma after laparoscopic excision
Author: Mauro Busacca et al.
Address: Milan, Italy
Source: American Journal of Obstetrics and Gynecology 180: 519-523(March) 1999
Summary: Comparative studies have shown that laparoscopy is the best treatment for ovarian endometrioma's. This finding is based on pregnancy rates and recurrence rates which have been found to be comparable or better than laparotomy. This study looks at endometrioma recurrence. Prior to this stud, the criteria used to define occurrence has been ill defined. Most authors defined based recurrence on symptoms alone. This unrandomized prospective clinical study included 366 patients followed for a minimum of 6 months post surgery after a laparoscopic ovarian endometrioma excision. Vaginal ultrasonography was performed at 3,6,and 12 month intervals and then yearly. Evaluation included: the cumulative recurrence rate of pain; clinical findings of ovarian endometrioma; rate of repeated surgery; and recovery of fertility. The rate of ultrasonographic recurrence was 7.1% (26 pts). Repeat surgery was performed in 3.3% of all study patients (12 pts). The cumulative rate of recurrence over 48 months (ultrasonographic detection) was 11.7% and the second surgery cumulative rate was 8.2%. Pain was associated with 73% of the cases whose recurrence was detected via ultrasound. Recurrence of endometriomas was associated with stage of the disease and previous surgeries for endometriomas. Eighty-five or 23.25 of the women conceived during the follow up. The cumulative pregnancy rate in infertile patients at 48 months post surgery was 55.45. Authors suggest that the rate of recurrence seems to correlate with the duration of follow up and that Stage 4 disease and previous surgery are unfavorable factors. They concur with previous studies and feel that laparoscopic surgery is as effective and reliable as laparotomy for ovarian endometriomas.
Comment: Endometriomašs remain to be one of the worst manifestations of endometriosis. The best treatment of ovarian endometriotic cysts remains controversial. Some state that fenestration is comparable to removal or ablation. Seldom is aspiration alone curative. I wish we had the cure rate for endometrioma's stated in the above article.
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