Recurrence of Endometriosis After Laparoscopic Hysterectomy

Abstract

Video Objective Endometriosis is known to have a remarkably negative effect on the Quality of Life (QOL) of the women. Surgery is considered when medical therapy is unsuccessful or in the setting of infertility. A high recurrence rate is reported in advanced stages of endometriosis. Thus, Complete excision and prevention of recurrence is particularly important. Following hysterectomy, pelvic pain and vaginal bleeding are a rare but real occurrence. We evaluated the recurrence of pain and bleeding in patients following hysterectomy and infertility sparing procedures. Design Retrospective cohort. Setting Kurashiki medical center, private hospital, in Japan. Interventions We evaluated postoperative recurrence of endometriosis from January, 2004 to December, 2018 in patients who underwent laparoscopic excision of endometriosis, with or without postoperative hormone therapy. Main Results In our facility, endometriosis recurred in 20 cases (3.85%) out of 519 total laparoscopic hysterectomy (TLH) with ovarian sparing procedures. 17 of the 20 cases were not treated with hormone therapy postoperatively. No recurrence was found in 288 patients who underwent TLH plus bilateral salpingo-oophorectomy. In fertility sparing cases, 7.5%(152/2012 cases) had recurrence after surgery. Recurrence rate decreased to 4.9%(85/1750 cases) after January, 2008 compared with 24.7%(67/271) before December, 2007.For fertility sparing endometriosis excision surgery, postoperative recurrence without hormone therapy was found in six (1case in rectum, 5 cases in ovaries) out of fifteen cases. With postoperative hormone treatment using dienogest, a “fourth-generation” progestin, recurrence was found in only one case out of fifteen hormone therapy groups. Median recurrent period was 6 months. Surprisingly, 11 out of 22 fertility sparing cases were diagnosed as endometrioma with 1 month postoperative MRI. Conclusion Approval of dienogest in 2008 may have contributed to the dramatic improvement in preventing recurrence of endometriosis. Hysterectomy significantly decreases patient symptoms and recurrence rate. Ovarian conservation conferred a higher rate of recurrence of symptoms of endometriosis.