Women operated for recurrent endometrioma exhibit more multiple deep infiltrating endometriosis lesions

Abstract

ObjectiveTo determine whether recurrent endometriomas are associated with multiple deep infiltrating endometriosis (DIE) lesions. Study DesignThis was an observational, cross-sectional, cohort study of 611 consecutive symptomatic women with endometrioma who underwent surgical treatment. We compared 124 patients with previous surgery for endometrioma (study group, PSO(+)) versus 487 patients without previous surgery for endometrioma (control group, PSO(−)). The primary outcome was the presence of multiple (≥2) DIE lesions. The secondary outcomes included painful associated symptoms, the presence of intestinal lesions, and the mean total revised American Society for Reproductive Medicine (rASMR) scores. ResultsThe occurrence of DIE lesions was higher in the PSO(+) group than in the PSO(−) group (67.7% vs. 37.3%, respectively; p < 0.01). Among the patients with DIE, more patients had multiple (≥ 2) lesions in the PSO(+) group than in the PSO(−) group: 91.7% vs. 77.8%, respectively; p < 0.01. The patients in the PSO(+) group had more painful symptoms than did the patients in the PSO(−) group (90.9% vs. 74.5%, respectively; p < 0.01). Intestinal lesions were more frequently observed in the PSO(+) group than in the PSO(−) group: 55.6% vs. 19.1%, respectively; p < 0.01. The patients in the PSO(+) group had a higher rASRM mean score than the patients in the PSO(−) group (65.0 vs. 46.1, respectively; p < 0.01). After adjusting for confounding factors, PSO was significantly associated with the presence of multiple DIE lesions (OR 4.1). ConclusionsRecurrence of endometrioma is a marker of DIE severity with more multiple lesions.