Sonosclerocystocleisis of recurrent ovarian endometriomata

Abstract

Recurrent ovarian endometriomata present a frequent challenge in patients with endometriosis. Repeat laparoscopic excision and fulguration becomes technically more difficult because of added adhesive disease, and progressively distorted pelvic anatomy. Noninvasive sonographically guided sclerotherapy of ovarian cysts has received very limited attention in the medical community. The purpose of this report was to prospectively follow patients with recurrent endometriomata who underwent sonosclerocystocleisis. None. Nineteen patients with recurrent endometriomata of the ovaries (1yr–2 cm in size) underwent sonosclerocystocleisis between 1998 and 2002 using vaginal probe sonographically guided needle instillation of 200 mg of Doxycycline, suspended in one ml of solvent. All patients had previous laparoscopic documentation of ovarian endometriomata and peritoneal endometriosis. The procedure was performed under local anesthesia with added intramuscular administration of a narcotic agent. Prior to administration of Doxycycline into the endometriomata, aspiration of the cyst was performed and the cavity was irrigated using 1% lidocaine solution. All recurrent endometriomata were identified during followup of previous endometriosis patients who underwent laparoscopic exploration and treatment of their disease. All 19 patients with recurrent ovarian endometriomata demonstrated chocolate like material during subsequent sonographic aspiration of the ovarian cyst. All patients demonstrated variable postprocedural pain which was manageable using oral analgesics and on occasion, oral narcotic agents. Seventeen (90%) patients demonstrated a less than 5 mm cystic structure in their ovary during a three-month ultrasound followup. Two patients (10%) demonstrated persistence of their previously treated by sclerocystocleisis endometriomata. At one-year followup 12 of of 15 (80%) of the patients demonstrated sonographically undetectable endometriosis of their ovary. The remaining four patients were lost to followup. Of the 9 patients available for a two-year followup, 3 patients demonstrated less than 1 cm recurrent growth of their ovarian endometriomata. Those patients were subjected to repeat sonosclerocystocleisis. They were followed for an additional year without any signs of recurrence. A single patient with recurrent disease underwent three sclerosing procedures during a three-year period with a subsequent re-laparoscopic cystectomy. Sonosclerotherapy of recurrent small ovarian endometriomata is a very simple, inexpensive and effective substitute to laparoscopic reoperation. These remarkable followup results of patients with recurrent ovarian endometriomata suggest that a serious consideration be given to this treatment modality. The ease of performance, lack of peri and postoperative complications and the elimination of recurrent laparoscopic pelvic exploration, make this approach a powerful alternative to surgery. Early sonographic detection of recurrent endometriomata is paramount to a successful sonosclerocystocleisis.