Is the presence of endometrioma always associated with more severe disease?

Abstract

The aim of this prospective study was to estimate whether the presence of endometrioma was associated with more severe disease, and with operative findings that were considered to make surgery more demanding in patients with deeply infiltrating endometriosis located in the posterior fornix of the vagina. Ninety-eight patients scheduled for primary surgery underwent complete excision of all visible endometriotic lesions and adhesions by laparoscopy (86 patients, 87.8%) or by laparotomy (12 patients, 12.2%) in four hospitals specialized in the surgical treatment of endometriosis. Endometrioma was detected in 46 patients (47.0%). No statistically significant difference was detected between patients with and without an endometrioma, in the presence of six studied operative findings: total obstruction of the pouch of Douglas (28% vs. 27%, p = 0.88), attachment of a posterior deep lesion to the ureter (52% vs. 44%, p = 0.43), peritoneal endometriotic lesions (80% vs. 75%, p = 0.52), other deep lesions (24% vs. 33%, p = 0.34), attachment of bowel to the uterosacral ligament deep lesion (65% vs. 69%, p = 0.71), and attachment of the rectum to a rectovaginal deep lesion (81% vs. 84%, p > 0.99). Endometrioma did not seem to be associated with operative findings that were considered to represent more severe disease, and make surgery more demanding in patients with deep endometriotic lesions in the posterior fornix of the vagina and with no previous pelvic surgery.