The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up

Background and Objectives:The study was designed to analyze preoperative clinical and surgical findings at enucleation of ovarian endometrioma with their impact on recurrence and pregnancy rates.Methods:This is a retrospective study of 550 histologically verified ovarian endometriomas operated on at the Department of Obstetrics and Gynecology, University Hospital Kiel, Germany, between 1995 and 2004. Preoperative data, surgical findings, and postoperative outcomes of 289 cases were analyzed. The average follow-up period was 12.9 years.Results:Ovarian endometriomas recurred in 23.9% of patients. Risk factors identified for recurrence of endometriomas were preoperative pain (P = .013), dysmenorrhea (P = .013), larger cyst size (>8 cm), younger age (<25 years), and preoperative cyst rupture. Factors associated with postoperative dysmenorrhea were younger age <25 years (P < .001), nulliparity (P = .020), and lager cyst size >8 cm (P = .048). Recurrence of pain was influenced by previous surgery of endometrioma (P < .05). Laparoscopy had a higher percentage of symptom-free patients than laparotomy did (49.0% vs 33.3%). Additional postoperative hormonal treatment resulted in a higher spontaneous pregnancy rate (41.4% vs 12.6%; P < .001) but a lower recurrence-free interval rate (70.5% vs 82.6%; P = .050) when compared with surgery only.Conclusions:We identified preoperative and intraoperative findings associated with higher risk of recurrence of endometrioma, pain, and dysmenorrhea. Patients desiring pregnancy benefited from postoperative hormone treatment, but no favorable results from combined therapy were observed with regard to recurrence rate.

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“…These observations agree with those of Cheong et al, 13 but not with the lower requirement of reoperation in other observations. 12,14 …”

Section: Discussionmentioning

confidence: 99%

Surgical Therapy of Ovarian Endometrioma: Recurrence and Pregnancy Rates

Maul

Morrision

Schollmeyer

et al. 2014

JSLS

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“…However, some clinical studies provide evidence that pain symptoms are reduced after surgical excision of the pEL [31,32], but still less than half of the treated women responded to the pain-reducing surgery [33,34]. However, other studies could not verify this level of chronic pelvic pain reduction after peritoneal lesion excision in endometriosis patients [35,36].…”

Section: Discussionmentioning

confidence: 99%

“…However, other studies could not verify this level of chronic pelvic pain reduction after peritoneal lesion excision in endometriosis patients [35,36]. In addition, it is reported that 40–50% of the patients experienced pain recurrence to a level that subsequent laparoscopy was performed within 2 years [32,35,37] and 20% of the patients with severe recurrent symptoms still had no visible endometriotic lesions [32]. This indicates that a reduction in pain through an excision of the visible lesion is still not fully satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Neuroimmunomodulatory Alterations in Non-Lesional Peritoneum Close to Peritoneal Endometriosis

Arnold¹,

Vercellino²,

Chiàntera³

et al. 2012

Neuroimmunomodulation

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Objectives: An imbalance in the ratio of sensory to sympathetic nerve fibre (NF) density in peritoneal endometriotic lesions (pEL) has recently been demonstrated and leads to the assumption that this preponderance of the sensory pro-inflammatory milieu is a major cause of pain in endometriosis. Therefore, the density of sensory and sympathetic NFs was determined in distal unaffected peritoneum of endometriosis patients to be able to detect possible alterations in unaffected peritoneum. Methods: In serial pEL sections (n = 40), lesional and matching unaffected peritoneum as well as healthy peritoneum (HP) from patients without endometriosis (n = 15) were immunohistochemically analysed to identify protein gene product 9.5-, substance P- and tyrosine hydroxylase-positive NFs (intact, sensory and sympathetic NFs, respectively). In addition, the amount of immune cell infiltrates and the expression of nerve growth factor (NGF) and interleukin (IL)-1β in nerves of peritoneal endometriotic specimens were compared to those in the HP. Results: The overall NF density in the non-lesional, unaffected peritoneum of endometriosis patients is significantly reduced in comparison to both HP and pEL, while sensory NFs remain the same; the sympathetic NF density is significantly decreased compared to HP, but is still higher than the density close to the pEL. Immune cell infiltrates as well as NGF and IL-1β expression in nerves is significantly elevated in distal unaffected peritoneum in comparison to HP. Conclusion: The altered NF density in the non-lesional, unaffected peritoneum of endometriosis patients suggests new aspects in the understanding of the development of endometriosis and pain management in endometriosis.

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“…The disease has a large impact on the quality of life and is associated with extensive physical and psychological morbidity [10,11,12,13,14]. Moreover, the cost of endometriosis is a burden to society due to medical costs of treatment and economic costs because of the inability to work [11,15].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Delay of Endometriosis in the Netherlands

Staal

Zanden

Nap³

2016

Gynecol Obstet Invest

125

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Background/Aims: Endometriosis has a long diagnostic delay that is influenced by varying socio-economic and healthcare factors. In the Dutch situation, these factors are not yet identified. The aim of this study is to determine the length of the diagnostic delay of endometriosis in the Netherlands and to identify which variables affect this delay. Methods: A retrospective study among 139 patients diagnosed with endometriosis in a secondary care hospital with a specialized multidisciplinary endometriosis team. The diagnostic process was evaluated using a questionnaire-guided telephonic interview. Results: The median time interval from the onset of symptoms to diagnosis was 89 months or 7.4 years, divided in 7 months patient delay, 35 months general practitioner (GP) delay and 5 months gynecologist delay. Determinants for a longer diagnostic delay were young age at onset of symptoms, use of oral contraceptives or analgesics prescribed by GP, alternative diagnoses considered by the GP, and cyclic symptoms. Subfertility as presenting symptom resulted in faster diagnosis. Conclusion: This study shows that the time interval to the diagnosis of endometriosis is long and mainly consists of the period of time the woman consults her first line medical professional.

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The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up

Abstract: Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life for up to 5 years. The probability of requiring further surgery is 36%. Return of pain following laparoscopic excision is not always associated with clinical evidence of recurrence.

Cited by 353 publications

References 19 publications

Surgical Therapy of Ovarian Endometrioma: Recurrence and Pregnancy Rates

Surgical Therapy of Ovarian Endometrioma: Recurrence and Pregnancy Rates

Neuroimmunomodulatory Alterations in Non-Lesional Peritoneum Close to Peritoneal Endometriosis

Diagnostic Delay of Endometriosis in the Netherlands

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