Symptomatic recurrence of endometriomas after ultrasound and laparoscopic surgery

• Published in: Ginecologia y obstetricia de Mexico Vol. 80; no. 12; pp. 753 - 760
• Main Authors: López Carpintero, Nayara, Paz Ramírez, Lucía, Hernández Gutiérrez, Alicia, de Santiago García, Javier, San José Valentín, Belén
• Format: Journal Article
• Language: Spanish
• Published: Mexico 01-12-2012
• Subjects: Adult; Endometriosis - diagnosis; Endometriosis - diagnostic imaging; Endometriosis - surgery; Female; Follow-Up Studies; Humans; Laparoscopy; Recurrence; Retrospective Studies; Ultrasonography
• ISSN: 0300-9041

Endometriosis affects to 5-12% women. Laparoscopic surgery is the treatment of choice, but the high rate of recurrence is alarming.
Analyse the influence of various variables in the recurrence after ovarian endometrioma laparoscopic excision.
Retrospective study of 214 cases with laparoscopic treatment in 2005 and 2006 in the Hospital La Paz. A 5 years follow-up was made. Choosen recurrence criteria were pain and suggestive ultrasound finding. Variables studied were: age, pain (0-10), Ca 125 levels, myoma, adenomyosis, number, size and laterality of cyst, medical treatment before and after laparoscopic surgery, infertility, kind of surgery and characteristics, progression and treatment of recurrences.
30,8% (66/214) of patients presented pain recurrence, 28% (60/214) ultrasound recurrence. Patients with symptomatic recurrence had a bigger degree of dysmenorrhea and dyspareunia before surgery (6.8 +/- 2.5 and 1.3 +/- 2.5 against 3.8 +/- 3.4 and 0.2 +/- 1.0 in no recurrence ones (p = 0.0001; p = 0.0001). Previous dysmenorrheal and dyspareunia punctuation was also greater in ultrasound recurrences (5.9 +/- 3.3 and 1.2 +/- 2.5 against 4.3 +/- 3.4 and 0.2 +/- 1.1 of those with no recurrence) (p = 0.003; p = 0.002). Dysmenorrhea recurrence was greater in young (31.3 +/- 5.4 years old versus 34.3 +/- 7.8; p = 0.02), with cystectomy (35% versus 16,7% in adnexectomy; p = 0.02), adhesiolysis (46.4% versus 23.4%; p = 0.001) and with medical treatment after surgery (41.5% against 22.5%; p = 0.004). The mean time of no symptomatic recurrence was 44 months (CI 95%: 41-47) and the no ultrasound recurrence was 47 months (CI 95%: 45-50).
Dysmenorrhea and dyspareunia degree before surgery was the most clearly associated factor with recurrence.