Recurrent Endometriosis Research Articles

Total or Subtotal Hysterectomy for the Treatment of Endometriosis: A Review.

The purpose of the review was to evaluate and compare outcomes after total or subtotal hysterectomy in women with endometriosis or adenomyosis. We searched four electronic databases: Medline (PubMed), Scopus, Embase, and Web of Science (WoS). The first aim of the study was to compare outcomes after total and subtotal hysterectomy in women with endometriosis, and the second aim was to compare the two procedures in women with adenomyosis. Publications that reported short- and long-term outcomes after total and subtotal hysterectomy were included in the review. The search was not subject to any limitation in terms of time or method. After screening 4948 records, we included 35 studies published from 1988 to 2021; the studies were based on various methodologies. With regard to the first aim of the review, we found 32 eligible studies and divided these into the following four categories: postoperative short- and long-term outcomes, recurrence of endometriosis, quality of life and sexual function, and patient satisfaction after total or subtotal hysterectomy in women with endometriosis. Five investigations were deemed eligible for the second aim of the review. No differences were seen in terms of postoperative short- and long-term outcomes after subtotal or total hysterectomy in women with endometriosis or adenomyosis. Preservation or removal of the cervix in women with endometriosis or adenomyosis appears to have no effect on short- or long-term outcomes, recurrence of endometriosis, quality of life and sexual function, or patient satisfaction. Nevertheless, we lack randomized blinded controlled trials on these aspects. Such trials will be needed to enhance our comprehension of both surgical approaches.

The Efficacy of Dienogest in Reducing Disease and Pain Recurrence After Endometriosis Surgery: a Systematic Review and Meta-Analysis.

The objective of this study is to determine whether dienogest therapy after endometriosis surgery reduces the risk of recurrence compared with placebo or alternative treatments (GnRH agonist, other progestins, and estro-progestins). The design used in this study is systematic review with meta-analysis. The data source includes PubMed and EMBASE searched up to March 2022. A systematic review and meta-analysis were performed in accordance with guidelines from the Cochrane Collaboration. Keywords such as "dienogest," "endometriosis surgery," "endometriosis treatment," and "endometriosis medical therapy" were used to identify relevant studies. The primary outcome was recurrence of endometriosis after surgery. The secondary outcome was pain recurrence. An additional analysis focused on comparing side effects between groups. Nine studies were eligible, including a total of 1668 patients. At primary analysis, dienogest significantly reduced the rate of cyst recurrence compared with placebo (p < 0.0001). In 191 patients, the rate of cyst recurrence comparing dienogest vs GnRHa was evaluated, but no statistically significant difference was reported. In the secondary analysis, a trend toward reduction of pain at 6 months was reported in patients treated with dienogest over placebo, with each study reporting a significantly higher reduction of pain after dienogest treatment. In terms of side effects, dienogest treatment compared with GnRHa significantly increased the rate of spotting (p = 0.0007) and weight gain (p = 0.03), but it was associated with a lower rate of hot flashes (p = 0.0006) and a trend to lower incidence of vaginal dryness. Dienogest is superior to placebo and similar to GnRHa in decreasing rate of recurrence after endometriosis surgery. A significantly higher reduction of pain after dienogest compared with placebo was reported in two separate studies, whereas a trend toward reduction of pain at 6 months was evident at meta-analysis. Dienogest treatment compared with GnRHa was associated with a lower rate of hot flashes and a trend to lower incidence of vaginal dryness.

Recurrent genital endometriosis: risk factors and possible prevention strategy

Endometriosis is one of the most common gynecological diseases in women of reproductive age, which is characterized by a relapsing course. The recurrence rate varies greatly among literary sources. This review covers symptoms and types of endometriosis, laboratory tests, options for hormonal therapy, as well as features of surgical approaches that may be associated with the disease recurrence risk. The aim of this article was to analyze and summarize current literature on the definition of endometriosis recurrence, risk factors and prevention strategy. Despite advances in the study of various mechanisms for the development of endometriosis and the use of combined treatment, a high recurrence rate remains an unsolved problem for this disease. All of this underscores the need to develop new methods for early diagnosis and treatment, taking into account the risk group and a personalized approach.

Diagnosis of struma peritonei 15 years after rupture of mature teratoma

Background: Struma peritonei is an extremely rare presentation of struma ovarii. Case: Here we report the case of a 38-year-old woman with a history of papillary thyroid cancer, left ovary struma ovarii, ruptured mature cystic teratoma of the right ovary, and endometriosis presenting with pelvic pain, dysmenorrhea, abnormal uterine bleeding, and infertility. A diagnostic laparoscopy was performed to evaluate for recurrence of endometriosis. However, multiple abnormal appearing lesions were found on her left hemidiaphragm and left abdominal wall. The tissue was identified as ectopic thyroid tissue identical to the patients ruptured mature cystic teratoma which occurred 15 years prior. A second subsequent laparoscopy was performed to excise the lesions. Eleven additional lesions were identified as ectopic thyroid tissue. This peritoneal dissemination was likely a result of tissue seeding post-mature teratoma rupture. Conclusion: Gynecologists should consider the possibility of struma peritonei in patients who have a history of papillary thyroid cancer and struma ovarii who present with significant pelvic pain and abnormal uterine bleeding.

Peculiarities of the course of genital endometriosis and its recurrence in women of reproductive age

Endometriosis remains one of the most studied pathologies in modern gynecology, as it is accompanied by such complications as constant pelvic pain, menstrual cycle disorders, and infertility. These complications not only prevent the implementation of a woman’s reproductive function, but also worsen the normal life of a woman in general. The early diagnosis and the right choice of treatment is the basis of prevention of disease recurrence. Therefore, most of the efforts of scientists are directed to this.The objective: to reduce the frequency of genital endometriosis recurrence and improve the implementation of reproductive functions based on the improved approaches to its diagnosis and treatment.Materials and methods. The study included two groups of patients. The 1st group included 60 women with a diagnosis of ovarian endometriosis, whose data were analyzed retrospectively based on the results of medical histories. The 2nd group was studied prospectively and included 60 women with a diagnosis of ovarian endometriosis.All patients had general clinical and laboratory examinations, specific laboratory and ultrasound examinations. In patients of the 2nd group tumor markers were additionally determined, in particular CA-125, HE4, CA 19-9, CA 72-4, CA 15-3, REA, and the level of anti-Müllerian hormone, magnetic resonance imaging was performed. Patients of both groups were operated and histological examination of the material obtained during the operation was performed.The difference in the management of the postoperative period in the 2nd group was that, in addition to anti-inflammatory therapy all women received hormonal therapy (gonadotropin-releasing hormone agonist (GnRH agonist) with subsequent use of combined oral contraceptives (COCs) or simultaneous use of GnRH agonist and COCs with subsequent transition in both variants for dienogest for 6 months continuously). Recurrence of the pathology was detected after 3 and 6 months on the basis of a repeated diagnosis of ovarian endometriosis.Results. The obtained data showed that in the postoperative period, 3 months after treatment 5 (8.3 %) women in the 1st group had a recurrence of ovarian endometriosis and 4 (6.7 %) patients – pelvic adhesions. Whereas in the 2nd group, there were no cases of recurrence and adhesions.In 6 months after treatment in the 1st group 11 (18.3 %) patients were diagnosed with ovarian endometriosis recurrence, and 6 (10.0 %) women were diagnosed with pelvic adhesions. In the 2nd group recurrence of ovarian endometriosis was found only in 1 (1.7 %) woman, pelvic adhesions were not detected (p&lt;0.05). During the year after treatment the number of pregnant women among persons who wished to become pregnant and had a history of infertility was statistically higher in the 2nd group compared to the 1st group, in particular, 10 (16.7 %) and 2 (3.3 %) women, respectively (p&lt;0.05).Conclusions. The proposed algorithm for the diagnosis and treatment of genital endometriosis minimizes the risk of its recurrence and improves reproductive function.

Evaluation of Ki-67 staining index and BRAF mutation in women diagnosed with advanced endometriosis

Introduction: Recent studies have proposed that advanced endometriosis might harbor histopathological, molecular, and genetic properties of malignant lesion. Thus we aimed to investigate the presence of Ki-67 staining index (KSI) and BRAF mutation in patients with and without recurrent endometriosis of stage III and IV. Materials and methods: Cross sectional study on 50 consecutive patients with endometriosis of stage III and IV was performed. Tissue specimens collected during laparoscopic surgery were used for the evaluation of presence of KSI and BRAF mutation. Also, serum levels of tumor markers including CA-125, CA19-9, AMH and αFP were gathered. Results: The mean ± SD of KSI was 12.18 ± 16.58. Forty-one out of 50 (82%) patients had a non-recurrent disease. KSI ⩾ 10% was found in 20 patients (40%). Furthermore, 29 patients (58%) and 13 patients (26%) had high levels of CA-125 and CA19-9, respectively. No evidence of significant correlation was observed between the KSI and CA-125 and CA19-9 (all p values &gt; 0.05). However, a positive correlation was observed between CA-125 and CA19-9 ( r = 0.55, p-value = 0.02). KSI level was insignificantly lower in recurrent patients compared with non-recurrent patients (9.78 ± 6.24 vs 12.71 ± 18.09, p-value = 0.33). Other tumor markers did not show any statistically significant difference (all p values &gt; 0.05). None of the participants had BRAF V600E mutation. Conclusion: Endometriosis manifests malignant behavioral of rapid proliferation but the exact genetic alteration causing this phenomenon is not understood.

The Clinical Picture and Fecundity of Primary and Recurrent Ovarian Endometriosis with Family History: A Retrospective Analysis

This study aims to evaluate the role of endometriosis family history on the clinical manifestation and fertility performance of primary and recurrent endometriosis. In total, 312 primary and 323 recurrent endometrioma patients with a histological diagnosis were included in this study. Family history was significantly correlated with recurrent endometriosis (adjusted OR: 3.52, 95% CI: 1.09-9.46, p = 0.008). Patients with a family history showed a significantly higher proportion of recurrent endometriosis (75.76% vs. 49.50%), higher rASRM scores, higher incidence of severe dysmenorrhea, and severe pelvic pain than the sporadic cases. Recurrent endometrioma showed statistical increase in rASRM scores, percentage of rASRM Stage IV, dysmenorrhea, dyschezia, those undergoing semi-radical surgery or unilateral oophorosalpingectomy, postoperative medical treatment, e with a positive family history, while a decrease in the incidence of asymptomatic phenomena and those undergoing ovarian cystectomy compared to those with primary endometriosis. The naturally conceived pregnancy rate was higher in primary endometriosis compared to recurrent endometriosis. Compared to recurrent endometriosis with a negative family history, recurrent endometriosis with a positive family history had a higher incidence of severe dysmenorrhea, chronic pelvic pain, a higher spontaneous abortion rate, and a lower natural pregnancy rate. Primary endometriosis with a family history presented a higher incidence of severe dysmenorrhea than those without a family history. In conclusion, endometriosis patients with a positive family history presented a higher pain severity and lower conception probability compared to the sporadic cases. Recurrent endometriosis showed further-exacerbated clinical manifestations, more pronounced familial tendency, and lower pregnancy rates than primary endometriosis.

Status and related factors of postoperative recurrence of ovarian endometriosis: a cross-sectional study of 874 cases

PurposeExploring the status and related factors of postoperative recurrence of ovarian endometriosis.MethodsThis study analyzed the results of questionnaires conducted in 27 hospitals across the country from January 2019 to November 2021. All women were divided into recurrence group and non-recurrence group to analyze the recurrence rate and related factors after ovarian endometriosis surgery.ResultsThe recurrence rates of ovarian endometriosis within 1 year, 1–2 years, 2–3 years, 3–4 years, 4–5 years and more than 5 years were 6.27%, 35.85%, 55.38%, 65.00% and 56.82%, respectively. Significant differences were found between two groups in terms of age at surgery (OR: 0.342, 95%CI: 0.244–0.481, P < 0.001), presence of dysmenorrhea (OR: 1.758, 95%CI: 1.337–2.312, P < 0.001), presence of adenomyosis (OR: 1.948, 95%CI: 1.417–2.678, P < 0.001) and family history of endometriosis or adenomyosis (OR: 1.678, 95%CI: 1.035–2.721, P = 0.021). The age at surgery (OR: 0.358, 95%CI: 0.253–0.506, P < 0.001), presence of dysmenorrhea (OR: 1.379, 95%CI: 1.026–1.853, P = 0.033) and presence of adenomyosis (OR: 1.799, 95%CI: 1.275–2.537, P = 0.001) were significantly associated with endometrioma recurrence in multivariate analysis. No significant associations were found between the recurrence rate and body mass index (BMI), educational background, age of menarche, gravida, parity, uterine leiomyoma, endometrial polyps or postoperative use of gonadotropin-releasing hormone agonist (GnRH-a).ConclusionsDysmenorrhea and presence of adenomyosis are independent risk factors for postoperative recurrence of ovarian endometriosis, and older age is an independent protective factor for postoperative recurrence.

Invasiveness of endometrial cancer cell lines is potentiated by estradiol and blocked by a traditional medicine Guizhi Fuling at clinically relevant doses.

The Traditional Chinese medicine, Guizhi Fuling (here called Fuling), has been confirmed in meta-analysis studies to reduce recurrence of endometriosis and improve pregnancy outcomes; however, the possible use of Fuling as a fertility-preserving treatment in endometrial cancer has not previously been tested. Results here are the first to demonstrate dose-dependent inhibition of cell motility by Fuling in two endometrial cancer cell lines, classified as Grade I which is responsive to progesterone treatment, and Grade III (MFE-280) which is resistant. The major outcome of this study was the novel demonstration that Fuling (30-80 µg/ml) significantly inhibits invasiveness in both high and low grades of EC cells, achieving 70-80% block of trans-barrier migration without cytotoxicity. This effective dose range is estimated to be comparable to that used in human clinical trials and traditional practice. Results here further show that clinically relevant doses of Fuling override the motility-promoting effects of estradiol in endometrial cancer cell lines. Medroxyprogesterone acetate has to date been the standard therapy to treat metastatic or inoperable endometrial cancers; however, success rates are low with high rates of recurrence, due in part to acquired resistance to medroxyprogesterone acetate therapy. The discovery here that Fuling appears to control the spread of treatment-resistant advanced cancers is an exciting prospect.

Assessment of risk factors for progression and recurrence of ovarian endometriosis

Assessment of risk factors for progression and recurrence of ovarian endometriosis

The role of the intestinal and reproductive tract microbiota in the progression and recurrence of genital endometriosis

The role of the intestinal and reproductive tract microbiota in the progression and recurrence of genital endometriosis

HRT in Women Undergoing Pelvic Clearance for Endometriosis—A Case Report and a National Survey

The optimal hormone replacement therapy (HRT) in women who have undergone pelvic clearance for endometriosis remains uncertain with insufficient evidence. The purpose of this case report and the national survey was to highlight the potential HRT-related risks and to establish current HRT practice in this group of women. The case was a 45-year-old woman presenting with recurrence of severe chronic pelvic pain while on oestrogen-only HRT (EO-HRT) for five years after subtotal hysterectomy and bilateral oophorectomy for severe endometriosis. MRI revealed multiple peri-cervical endometriomas and severe right hydroureter/hydronephrosis with complete right renal parenchymal loss. The survey was a 21-item questionnaire administered electronically using SurveyMonkey. It was reviewed and approved by British Menopause Society and British Society of Gynaecological endoscopy and was sent to their members as well as NHS Gynaecologists. A total of 216 physicians responded including 120 (55.6%) Gynaecology Consultants and 96 (44.4%) GPs/Nurses in Menopause clinics. Overall, 68.6% of responders prescribe combined HRT (C-HRT), 11.1% tibolone, 13.0% EO-HRT and 7.8% varied HRT. Fifty-one percent prescribe the progestogen component of C-HRT indefinitely, 22% for 3-6 months and 27% for varied durations. In conclusion, this study highlights the real risk of endometriosis recurrence in EO-HRT users after pelvic clearance for endometriosis. The survey revealed that only two thirds of Gynecologists/Menopause practitioners prescribe combined HRT in this group of women.

Cost-effectiveness Analysis of Dienogest Compared with Combined Oral Contraceptives after Surgery for Endometriosis

To assess the cost-effectiveness of different strategies, including the dienogest (DNG) and combined oral contraceptives (COC) therapy, for the prevention of endometriosis recurrence after surgery. A decision tree model was created. The analysis was based on data from a healthcare provider in China. Model inputs were derived from published data. The end points included incremental cost effectiveness ratio, net monetary benefit (NMB), and incremental NMB associated with prevention of recurrence. The uncertainty was assessed through one way and probabilistic sensitivity analysis. The Consolidated Health Economic Evaluation Reporting Standards 2022 checklist was used to assess quality of the reporting. China healthcare system. Individuals undergoing laparoscopic surgery for endometriosis. DNG vs COC. The base case analysis showed that hormone supression via DNG resulted in 0.7493 quality-adjusted life years (QALYs) at a cost of $1625.49 compared with COC, which resulted in 0.7346 QALYs at a cost of $343.61. The incremental cost effectiveness ratio was $87 679.89 per additional QALY gained and the DNG treatment was associated with an incremental NMB of -$731.39. Probabilistic sensitivity analysis indicated that DNG is not cost-effective in most cases at a threshold consistent with World Health Organisation recommendations of $37 653/QALY. The result of our present analysis suggests that the DNG might not be cost-effective for the prevention of endometriosis recurrence after surgery in China.

Risk factors for recurrence of endometrioid ovarian cysts after combined treatment

BACKGROUND: The main method of endometrioid ovarian cyst treatment is considered surgery with further hormone therapy. However, the recurrence rate of endometriomas, even 57 years after combined treatment, can reach 50%.&#x0D; AIM: The aim of this study was to identify risk factors for recurrence of endometrioid ovarian cysts among women of reproductive age after combined treatment.&#x0D; MATERIALS AND METHODS: This study included 196 women operated on for ovarian endometriosis. We carried out a comparative analysis of the data between the study groups: the main group comprised 45 patients with a relapse of the disease; the comparison group consisted of 151 women without a relapse. Hematoxylin-eosin staining was used for morphological examination of the surgical material, and monoclonal mouse antibodies to Ki-67 and bcl-2 (DAKO, Denmark) were used for immunohistochemical examination. The construction of a statistical model for predicting the recurrence of ovarian endometriosis among women of reproductive age was carried out using multivariate binary logistic regression analysis in reverse stepwise mode. The influence of the independent variable on the likelihood of recurrence was determined using the odds ratio and its 95% confidence interval, with the sensitivity, specificity and diagnostic accuracy evaluated.&#x0D; RESULTS: A set of predictors has been identified that provides the greatest contribution to recurrence of ovarian endometriosis. Immunohistochemistry study showed that the level of Ki-67 protein was higher in the group with relapsed endometriomas compared to the non-recurrent course: in the epithelial lining of the cyst, 9.08 2.60 and 2.06 1.16%, respectively (p = 0.043); in the cytogenic stroma, 11.67 4.10 and 9.81 3.40%, respectively (p = 0.48). Bcl-2 expression was reduced in the epithelial lining of the cyst capsule in the main group in comparison with the material where there was no recurrence: 0.653 0.043 and 0.961 0.056%, respectively (p = 0.31).&#x0D; CONCLUSIONS: Of significance in predicting the risk of recurrence of ovarian endometriosis is a combination of four signs in one patient: primary infertility; pelvic organ surgery in history, unrelated to endometriosis; elevated levels of CA-125 oncoprotein and proliferative changes in cytogenic stroma cells, as well as increased expression of the Ki-67 antigen in the epithelial lining of the endometrioid cyst.

Morphological and molecular features of recurrent endometrioid ovarian cysts

BACKGROUND: One of the clinical course features of ovarian endometriosis is its recurrent nature, which leads to repeated operations and increased damage to the ovarian follicular apparatus.&#x0D; AIM: The aim of this study was to evaluate morphological and molecular features of recurrent endometrioid ovarian cysts in patients of reproductive age.&#x0D; MATERIALS AND METHODS: Morphological and immunohistochemical studies of the surgical material of 196 observations of endometrioid ovarian cysts were performed 23 observations of the first surgical intervention with further diagnosed relapse, 22 observations of repeated surgery and 151 observations of a relapse-free course of endometriosis. Monoclonal mouse antibodies to CD68, transforming growth factor -1, CD34, and -smooth muscle actin were used.&#x0D; RESULTS: CD68 (macrophage) expression was detected in lympho-macrophage infiltrates of the cytogenic stroma and endometrioid cyst capsule. Significantly greater values of the expression were obtained in recurrent endometrioid cysts in the surgical material of both the first (cytogenic stroma 31 [8; 53]%, capsule 23 [3; 42]%) and second operation (23 [12; 36] and 9 [5; 20]%, respectively) compared to the relapse-free course of the disease (8 [6; 9] and 2 [0; 4]%, respectively). The transforming growth factor -1 expression area in the endometrioid cyst capsule was significantly higher in the surgical material of both the first (22.8 [21.6; 24.8]%) and second operation (31.2 [30.5; 32.2]%) with recurrent endometriosis compared to cases with no relapse (12.7 [11.2; 13.9]%). But in the cytogenic stroma was it only detected in cases of repeated surgical endometrioid cyst treatment (18.7 [18.0; 19.7]%). The positive -smooth muscle actin expression area was higher in the surgical material of the second operation with recurrent endometriosis in both the cytogenic stroma (68.3 [66.3; 69.6]%) and endometrioma capsule (82.5 [80.5; 83.8]%). A large area of CD34 expression was also detected in the recurrent course of ovarian endometriosis in the surgical material of both the first (cytogenic stroma 34.8 [33.4; 35.8]%, capsule 52.6 [50.4; 55.0]%) and second operation (51.3 [49.0; 53.3] and 48.7 [46.7; 49.8]%, respectively).&#x0D; CONCLUSIONS: The recurrent course of ovarian endometriosis is characterized by more pronounced inflammation, angiogenesis, myofibroblast proliferation, and fibrogenesis, which indicates the importance of these pathological processes in the chronicity of the disease. Further study of the role of macrophages and the cascade of regenerative and reparative processes that they trigger is important for understanding the pathogenesis of endometriosis and searching for diagnostic markers of its recurrent course.

ЗНАЧЕНИЕ NK-КЛЕТОК ПЕРИФЕРИЧЕСКОЙ КРОВИ И ЭКСПРЕССИИ ТРАНСФОРМИРУЮЩЕГО ФАКТОРА РОСТА БЕТА-1 ПРИ РЕЦИДИВИРУЮЩЕМ ТЕЧЕНИИ ЭНДОМЕТРИОЗА ЯИЧНИКОВ

Affiliation.Federal state budgetary educational institution of higher education «North-Western State Medical University named after I. I. Mechnikov» under the Ministry of Health of the Russian Federation, Saint-PetersburgIntroduction.Elevated level of transforming growth factor-β1 (TGF-β1) can be the cause of impaired immune response among women with endometriosis due to its ability to reduce the activity of NK-cells, which contributes to the survival of ectopic endometrial cells in the abdominal cavity and plays a key role in the progression of the disease.Materials and methods.196 endometrioma observations were studied, an immunological study of peripheral blood was performed with the determination of CD3-CD16/56+(natural killers) and an IHC study of the expression of TGF-β1 in the capsuleof an endometrioid cyst and in a preserved cytogenic stroma. Results.The IHC study showed that the expression area of TGF-β1 was significantly larger in the surgical material in the recurrent course of endometriosis; an immunological study revealed a significant decrease in NKcells during the endo-metrioma recurrence.Conclusion:Further study of the relationship between TGF-β1 and NK cells may be important as prognostic markers of recurrent endometriosis.

Endometrial Mesenchymal Stem Cells and Their Role in the Origin and Treatment of Endometriosis

Background: To identify endometrial mesenchymal stem cells (eMSCs) in retrograde menstruation, in various endometriosis lesions, in normal control tissues, and to investigate the association between eMSCs and endometriosis. We also plan to evaluate the effect of gonadotropin-releasing hormone agonists (GnRH-a) on eMSCs. Methods: Patients diagnosed with endometriosis were included if they had experienced surgery during the time frame 1 January 2015 to 31 December 2019 in West China Second Hospital, Sichuan University. Immunofluorescence was performed to identify eMSCs in those tissues with cell surface markers PDGFR-β/CD146. The percents of eMSCs in various tissues were calculated, and compared using analysis of variance. A two-sided pvalue less than 0.05 showed significant difference. Results: This study included 508 patients. eMSCs were identified in retrograde menstruation and numerous pathologic specimen but were not detected in normal control tissues. There was no significant difference in the percent of eMSCs between the GnRH-a treatment group and the control group (p &gt; 0.05). Conclusions: Our study demonstrated that eMSCs played a critical role in the development and recurrence of endometriosis and that GnRH-a did not affect eMSCs. Gynecologists should regard endometriosis as a chronic disease requiring lifetime management, especially for patients with chronic pelvic pain.

Risk factors for coexisting deep endometriosis for patients with recurrent ovarian endometrioma.

The aim of this study was to assess the risk factors for coexisting deep endometriosis (DE) in patients with recurrent ovarian endometrioma (OE). We retrospectively reviewed 151 recurrent OE patients who had been diagnosed of OE but not DE at the time of their first surgery and then received a second surgery for recurrent endometriosis with or without DE. Their clinical characteristics at the time of the first and second surgeries were collected. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for coexisting DE in patients with recurrent OE. Among the 151 recurrent OE patients, 46 were diagnosed of DE during the recurrent surgery and included in the DE group, while the remaining 105 patients were included in the non-DE group. In univariate analysis, there were significant differences in terms of uterine retroversion during the primary surgery and the follow-up time after the primary surgery between the DE and non-DE groups. The multivariate analysis also showed that both uterine retroversion and the follow-up time (≥5 years) were associated with the coexistence of DE during the recurrent surgery. The odds ratio (OR) for uterine retroversion was 3.72 [95% confidence interval (CI) 1.62-8.53], and the OR for follow-up time (≥5 years) was 5.03 (95% CI 2.29-11.02). Our study suggested that for recurrent OE patients, uterine retroversion during the first surgery and a follow-up time of at least 5 years are risk factors for the coexistence of DE in recurrent surgery, early prevention and full preparation before the recurrent surgery should be emphasized in these conditions.

Laparoscopic-Assisted Transanal Total Mesorectal Excision for a Patient with Bowel Endometriosis

<h3>Study Objective</h3> To explore a less-invasive surgical route for patient with bowel endometriosis to undergo segmental colorectal resection. <h3>Design</h3> A case report. <h3>Setting</h3> A university-based tertiary hospital. <h3>Patients or Participants</h3> A 34-year-old female was readmitted two years post-conservative surgery for endometriosis due to consistent digestive dysfunction symptoms. A 3-cm nodule within the muscle layer of lower rectal wall was identified by pelvic MRI. <h3>Interventions</h3> A laparoscopic-assisted transanal total mesorectal excion (TaTME) was performed (a 4-minute video clip included). <h3>Measurements and Main Results</h3> The patient was placed in a Trendelenburg position. For the laparoscopic step, the rectovaginal space was dissected. Lateral, posterior and anterior experitoneal rectal and left sigmoid dissection was performed adequately. Pay attention to protect the ureter and hypogastric nerve. An articulated endoscopic cutter was used to transect the distal rectal segment. For the trans-anal step, the rectal lumen was irrigated, the distal end of rectum was grasped out through anus. A safe margin down to the endometriotic lesion was chosen, 3-0 suture was placed followed by reloaded staplers to close the distal rectal lumen. TME was performed utilizing a "bottom up" approach. An avil was placed inside of proximal sigmoid. Rectosigmoid anastomosis completed successfully by using a circular stapler. No protective ileostomy was adopted. The surgery was uncomplicated with minimal blood loss. Significant improvement of bowel symptoms was reported within the first month postoperatively. During 3-year follow-up period no recurrence of endometriosis or digestive dysfunction symptoms was observed. <h3>Conclusion</h3> As a novel technique, laparoscopic-assisted TaTME shows advantage over laparoscopic surgery, such as better visualization of the distal resection margin while avoiding a bigger abdominal scar. Young women with colorectal endometriosis can benefit for more radical but less invasive surgical outcome. An experienced multidisciplinary team making comprehensive evaluation and discussion before surgery will ensure this technically highly demanding operation feasible and safe.

Efficacy of Dienogest for Prevention of Endometriosis Recurrence: A Systematic Review and Meta-Analysis

Aim of Study: To evaluate the efficacy of postoperative dienogest for prevention of endometriosis recurrence. Methods: Several databases were used to search for recent studies (i.e., published in 2016-2020). The search keywords included: “dienogest,” and “endometr*,” Patients who were not treated with dienogest were considered controls. Reviews, comments, animal trials, case reports, abstracts, single-arm studies, low-quality studies, and non-English articles were excluded. The primary outcome of interest was to determine the odds of recurrence in patients who received dienogest compared to controls who were managed expectantly, or offered a substitute hormonal therapy. Secondary outcomes included pain improvement and side effects of received treatment. Results: Included studies comprised three retrospective cohort studies, and two prospective cohort studies. These studies included 608 patients; 216 were managed in the Dienogest Group, while 392 were managed in the Control Group (163 received hormonal suppression, and 228 received no treatment). Overall, the recurrence rate of endometriosis in patients receiving Dienogest was 8/216, i.e., 3.7 events per 100 treated women over a mean duration of 28.5 months, and 1.3 recurrences per 1000 woman-months. On the other hand, the recurrence rate of endometriosis in the Control Group was 69/392 recurrences over a mean duration of 29.3 months, i.e., 17.6 per 100 women (6.0 recurrences per 1000 women-months). Difference in recurrence rates between study groups was statisticallysignificant (X2=24.3, p&lt;0.001). Reported recurrence rates were significantly less among patients in the Dienogest Group than those in the Control Group, with a pooled estimate of RR = 0.239, and 95% CI: 0.119-0.488. Generally, patients in the Dienogest Group experienced less pain and less side effects than those in the control group. Conclusions: Endometriosis patients who receive dienogest following conservative surgery have a significantly lower rate of recurrence, better pain control, and less side effects than their control counterparts. Key Words: Endometriosis, Dienogest, Goserelin, Systematic Review, Meta-Analysis,