Surgery For Endometriomas Research Articles

Serum interleukin-8 levels are elevated in patients with ovarian endometrioma

To determine whether serum interleukin (IL)-8 concentration can be measured in patients with ovarian endometrioma and whether this measurement is a useful tool in diagnosing this disease. A controlled clinical study and an in vitro study. Department of Obstetrics and Gynecology, Tottori University, Japan. Seventy patients with ovarian endometrioma and 21 patients with benign ovarian cyst. Laparoscopic surgery or laparotomy for ovarian endometriomas or benign ovarian cyst was performed. Preoperative blood samples were obtained. Endometriotic stromal cells obtained from nine patients with endometrioma were cultured. Interleukin-8 concentration in the serum or supernatant of the cell culture was measured with use of ELISA. The serum concentration of IL-8 in patients with endometrioma was significantly higher than in patients with benign ovarian cyst. The serum IL-8 threshold (25 pg/mL) had a higher sensitivity (71.4%) for diagnosing ovarian endometrioma than did serum CA-125 level. The increased rates of IL-8 concentration in the culture supernatants after adding tumor necrosis factor alpha were significantly higher in patients whose serum IL-8 levels were >or=25 pg/mL than in those with levels <25 pg/mL. Measuring of serum IL-8 concentration may be a valuable tool in diagnosing endometriosis.

Patterns of and Factors Potentially Influencing the Age at First Surgery for Women with Ovarian Endometriomas

Aim: To investigate patterns of and factors that may influence age at the first surgery (AATFS) for ovarian endometrioma. Methods: Five hundred and ninety-two consecutive patients with ovarian endometriomas who underwent surgery at the Shanghai OB/GYN Hospital from 2003 to 2004 were interviewed and their charts studied. Twelve variables were examined to assess their effect on AATFS using survival analysis methodology. All diagnoses were confirmed histologically. Twelve factors that potentially influence AATFS were recorded and subjected to univariate and multiple-variable statistical analyses. Results: A Weibull distribution fitted the AATFS data very well. In addition, age at menarche, body mass index, parity, number of previous induced abortions, rAFS stage (revised classification of the American Fertility Society), presence of adhesions, myomas/adenomyosis, and dysmenorrhea were identified to be associated with AATFS. Conclusion: The AATFS may be determined by a myriad of independent factors, including age at menarche, body mass index, parity, number of pregnancies, rAFS stage, and presence of adhesions, myomas/adenomyosis, and dysmenorrhea. The identification of these and other factors that influence AATFS and delineation of their roles in the pathogenesis of endometriosis may help us devise strategies for better patient care and better allocate health care resources in the future.

Impact of GnRH agonist treatment on recurrence of ovarian endometriomas after conservative laparoscopic surgery

To analyze the influence of postoperative GnRH agonist treatment on disease recurrence after conservative laparoscopic surgery for ovarian endometriomas according to duration of the treatment. Retrospective cohort study. University hospital. One hundred nine consecutive premenopausal women who underwent conservative laparoscopic surgery for ovarian endometriomas (endometriosis stage III/IV) were enrolled in the study. The patients were divided into four treatment groups: expectant management (n = 37) and GnRH agonist therapy for 3 (n = 28), 4 (n = 21), and 6 months (n = 23). None. An ultrasound confirmed recurrence of ovarian endometriomas. The overall crude recurrence rate was 16.5% after follow-up for an average of 20.1 months. The crude recurrence and the cumulative probabilities of disease recurrence at 24/36 months tended to be lower in patients who received a GnRH agonist for 6 months (4.3%, 5.3%/5.3%) compared with those who received it for 3 months (17.9%, 12.5%/25.0%) and 4 months (28.6%, 18.9%/39.2%) and patients with expectant management (16.2%, 22.4%/37.9%). However, the differences did not reach statistical significance. Treatment with GnRH agonist for six months had a beneficial impact on the recurrence rate after conservative laparoscopic surgery for ovarian endometriomas.

IVF-ICSI outcome in women operated on for bilateral endometriomas

The influence of previous conservative surgery for endometriomas on IVF-ICSI outcome is debated. Conflicting information emerging from the literature may be consequent to the fact that endometriomas are mostly monolateral. The contralateral intact ovary may adequately supply for the reduced function of the affected one. To clarify this point, we assess IVF-ICSI outcome in women operated on for bilateral endometriomas. Women selected for IVF-ICSI cycles who previously underwent bilateral endometriomas cystectomy were matched (1:2) for age and study period with patients who did not undergo prior ovarian surgery. Sixty-eight cases and 136 controls were recruited. Women operated on for bilateral endometriotic ovarian cysts had a higher withdrawal rate for poor response (P < 0.001). In these patients, despite the use of higher doses of gonadotrophins, the number of follicles (P = 0.006), oocytes retrieved (P = 0.024) and embryos obtained (P = 0.024) were significantly lower. The clinical pregnancy rate per started cycle in cases and controls was 7% and 19% (P = 0.037) and the delivery rate per started cycle was 4% and 17%, respectively (P = 0.013). IVF outcome is significantly impaired in women operated on for bilateral ovarian endometriomas.

Endometrioma Surgery May Not Harm Ovaries

Endometrioma Surgery May Not Harm Ovaries

209: Oral Estroprogestins After Laparoscopic Surgery for Endometriomas: Continuous or Cyclic Administration? Results of a Multicentric Randomized Study

209: Oral Estroprogestins After Laparoscopic Surgery for Endometriomas: Continuous or Cyclic Administration? Results of a Multicentric Randomized Study

GnRH agonist and antagonist protocols for stage I–II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles

To investigate the outcomes of intracytoplasmic sperm injection (ICSI) cycles after controlled ovarian hyperstimulation (COH) with GnRH antagonist or GnRH agonist (GnRH-a) in mild-to-moderate endometriosis and endometrioma. Prospective randomize trial. A private IVF center. A total of 246 ICSI cycles in 246 patients were divided into three groups: women with mild-to-moderate endometriosis (n = 98); women who had ovarian surgery for endometrioma (n = 81); women with endometrioma and no history of previous surgery (n = 67). Patients in each group were randomized to COH with either triptrolein or cetrorelix. Clinical parameters, characteristics of COH, and ICSI results were analyzed. Outcomes of COH with both GnRH antagonist and GnRH-a were similar in patients with mild-to-moderate endometriosis. Implantation rates were 15.9% vs. 22.6% and clinical pregnancy rates were 27.5% vs. 39% with GnRH antagonist and GnRH-a protocols, respectively, in patients who had ovarian surgery for endometrioma. Implantation rates were 12.5% vs. 14.8% and clinical pregnancy rates were 20.5% vs. 24.2% with GnRH antagonist and GnRH-a protocols, respectively, in patients with endometrioma and no history of ovarian surgery. Considering the implantation and clinical pregnancy rates, COH with both GnRH antagonist and GnRH-a protocols may be equally effective in patients with mild-to-moderate endometriosis and endometrioma who did and did not undergo ovarian surgery.

Abdominal wall endometriomas

Objective: To investigate the clinical characteristics, treatment, and factors of recurrence of abdominal wall endometriomas (AWE). Method: Sixty-four cases of AWE diagnosed at Peking Union Medical College Hospital (PUMCH) from 1983 to 2003 were reviewed retrospectively. Result: There was an AWE incidence of 0.044% among the parturients undergoing cesarean section at PUMCH, of whom 87.5% had the typical complaint of an enlarging mass and pain during menstruation. Among these women, 62 underwent low abdominal surgery for endometrioma (2 for primary umbilicus endometrioma); 2 women with small endometriomas opted for a temporary medical solution and had relief after menopause. The latent period of AWE positively correlated to the women's age at onset of symptoms ( P < 0.001). Of the 62 women who underwent local excision, 19 had an unsatisfactory experience with medical management. There were 5 recurrences and 1 evolution to malignancy during a mean follow-up of 83.7 months. Recurrence was closely related to the size and depth of lesions. Conclusion: Because of its typical clinical manifestations, abdominal wall endometriomas could be diagnosed before pregnancy. Surgical excision is the only effective treatment and wide local excision with clear margins is the key point to prevent recurrence.

Aspiration of ovarian endometriomas before intracytoplasmic sperm injection

To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes. Prospective study. University hospital. A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4). Aspiration of endometriomas. Clinical parameters, characteristics of COH, and ICSI results were analyzed. We observed higher levels of E(2) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups. In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1-6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.

Patient satisfaction and changes in pain scores after ablative laparoscopic surgery for stage III–IV endometriosis and endometriotic cysts

Objective To document the changes in pain scores 3–12 months following ablative laparoscopic surgery. Secondary outcome measures included patient satisfaction scores. Design A prospective, cohort study. Setting A tertiary referral center for the treatment of endometriosis. Patient(s) Seventy-three consecutive women with stage III–IV endometriosis and an endometrioma >2 cm. Intervention(s) A laparoscopy was performed. The extraovarian endometriosis was ablated with a CO 2 laser, and the endometrioma capsule was fenestrated then ablated with the potassium-titanic-phosphate (KTP) laser or the Bicap™ bipolar diathermy. Main outcome measure(s) Pre- and postoperative visual analogue scores for pelvic pain were completed. Patient satisfaction was scored from 1 to 10, with a score of 10 being “most satisfied.” Result(s) A total of 73 women with stage III–IV endometriosis and 96 cysts (23 cysts were bilateral). The mean revised American Fertility Society (AFS) score was 65.5 (range 22–128). At 12 months, the mean temporal decrease in the pain score for dyspareunia was 2.14 ± 0.41; for dysmenorrhea, 1.52 ± 0.38; and for chronic nonmenstrual pain, 2.37 ± 0.43. Sixty-four (87.7%) patients were satisfied or very satisfied with the treatment. No surgical complications occurred. Conclusion(s) Laparoscopic ablative surgery for endometriomas in the presence of stage III–IV endometriosis is an effective treatment for relieving pelvic pain.

Three-dimensional power Doppler imaging of ovarian stromal blood flow in women with endometriosis undergoing in vitro fertilization.

The aims of this retrospective study were to investigate whether the quantification of ovarian stromal blood flow and/or leptin concentration are predictive of in vitro fertilization (IVF) outcomes in women after laparoscopic ovarian cystectomy for large endometriomas. Twenty-two women undergoing IVF after laparoscopic surgery for ovarian endometriomas (> 6 cm) comprised the study group. Twenty-six women with tubal factor infertility constituted the control group. Ovarian stromal blood flow was evaluated by three-dimensional (3D) power Doppler ultrasound imaging using virtual organ computer-aided analysis (VOCAL( trade mark )). Serum and follicular fluid (FF) leptin concentrations were quantified using an enzyme-linked immunosorbent assay kit. There were significantly decreased ovarian stromal blood flow parameters (including vascularization index, flow index (FI), and vascularization flow index) in the endometriosis group without an evident difference in total ovarian volume on the day of human chorionic gonadotropin. The value of FF leptin demonstrated a negative correlation with ovarian stromal FI in the control group, but there was a loss of this effect in the endometriosis group. Quantification of ovarian stromal blood flow by 3D power Doppler ultrasound in women with endometriosis may provide an important prognostic indicator in those undergoing IVF.

Laparoscopic Surgery for the Management of Ovarian Endometrioma

The purpose of this study was to evaluate the effects of laparoscopic surgery on the symptoms associated with ovarian endometrioma. We also examined serum IL-6 concentrations in patients with endometrioma. Ninety-two patients who underwent laparoscopic surgery for ovarian endometrioma were enrolled in this study. The mean duration of follow-up was 27.6 months. Transvaginal ultrasound examinations revealed a recurrence of endometrioma in 13% of the cases. We evaluated the severity of dysmenorrhea using a 0–3-point verbal rating scale, and found that the dysmenorrhea score was statistically improved after the operation. Follicular growth was preserved in 94%, and the pregnancy rate was 43%. We measured serum IL-6 concentrations in 14 patients with ovarian endometrioma and 4 patients with benign gynecologic disease without endometriosis. IL-6 was significantly higher in patients with endometrioma than in those without endometriosis at the time of diagnosis. The mean serum IL-6 concentration significantly decreased after the operation. In conclusion, laparoscopic surgery is effective for alleviating pain and preserving fertility in patients with endometrioma. Measurements of serum IL-6 concentrations may be useful for the management of endometrioma.

Does Laparoscopic Surgery for Endometriomas Really Relieve Painful Symptoms?

The objective of this study was to determine whether laparoscopic surgery for endometriomas relieves painful symptoms. A systematic literature search was carried out to identify papers relating to the laparoscopic management of endometriomas, where relief of painful symptoms was an outcome measure. Each paper was analyzed using preset criteria to identify the methodology used and how the results were reported. There is very little objective, prospective evidence to support the practice of laparoscopic surgery for endometriomas in terms of relieving pelvic pain. Only one study out of six analyzed dysmenorrhea, dyspareunia, and chronic nonmenstrual pain individually, using visual analog scores. This study demonstrated a benefit following surgery. There is an urgent need for studies with objective end points or a national system to audit results.

Pregnancy rates following ablative laparoscopic surgery for endometriomas.

In this prospective, cohort study we present the cumulative pregnancy rate following ablative laparoscopic surgery in patients with endometriomas. The cyst was mobilized, fenestrated, and the capsule treated with the potassium-titanyl-phosphate (KTP) laser or bipolar diathermy. Pre- and post-operative transvaginal ultrasound scans were performed, and a detailed fertility history recorded. There were 39 women (38 intention to treat as a single procedure) who had been trying to conceive for >12 months. The mean age of the patients was 33.8 years (range 20-43), and there were 42 cysts (three bilateral) with a mean diameter of 4.8 cm (range 2-25). The mean revised American Fertility Society score was 64.9 (range 22-124), and 29 (74.4%) patients had stage IV disease. Seven patients (18%) had previously had a live birth, and 17 (43.6%) had undergone assisted conception in the past. The cumulative pregnancy rate was 15/38 (39.5%). The pregnancy rate in patients with stage IV disease was 11/28 (39.3%). There were no major complications. Our results indicate that laparoscopic cyst fenestration and capsule ablation is a safe and effective treatment for improving fertility.

Fertility after laparoscopic surgery for endometriomas

There are a number of published studies documenting pregnancy rates after endoscopic surgery in patients with endometriomas. These reports present similar pregnancy rates regardless of the surgical technique used to treat the cyst. This finding indicates that it does not matter whether the endometrioma is excised or ablated. However, debate about the nature of the cleavage plane of the cyst has led some surgeons to suggest that excision may damage the follicular reserve of the ovary. Furthermore, pregnancy rates after surgery cannot be compared in the same way as pregnancy rates after in vitro fertilization and embryo transfer because of lack of standardization. A review of the published studies relating to the laparoscopic management of endometriomas was performed to examine this issue further. Each paper was analysed using pre-set criteria to identify the methodology used and how the results were presented. Wide variation was found in the criteria used to select patients and in the way the results were reported. In view of these findings, there is an urgent need for surgical studies with consistent definitions of infertility and end-points, or a national system of audit.

Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin?

Objective: To evaluate the ovarian response to stimulation conducted for IVF treatment in women who have undergone conservative surgery for endometriomas.Design: Retrospective study with prospective selection of participants and controls.Setting: University infertility clinic.Patient(s): A series of 374 women who underwent in vitro fertilization (IVF). The study group consisted of 85 patients with ovarian endometriomas who had undergone laparoscopic surgery in an attempt to become pregnant, but had failed within a year of surgery. The control group consisted of 289 patients with tubal factor infertility.Intervention(s): IVF-embryo transfer procedures.Main Outcome Measure(s): Stimulation parameters, fertilization, implantation, and pregnancy rates were analyzed in both groups.Result(s): There was no significant difference between the two groups in stimulation parameters or IVF outcome.Conclusion(s): A total of 820 cycles were analyzed. A similar IVF-ET outcome was observed in patients with endometriosis after ablation of endometriomas compared to women with tubal factors. In conclusion, endometrioma surgery by internal wall vaporization does not impair IVF outcome. The clinical pregnancy rate was respectively 37.4% and 34.6% in the endometriosis group and the control group.

Operative transvaginal hydrolaparoscopy of a large ovarian endometrioma

Objectives The purpose of this case report is to describe the feasibility of transvaginal underwater surgery for reconstruction of the ovary with a large endometrioma. Design Descriptive study. Setting Tertiary referral centre for reproductive medicine. Interventions Transvaginal hydrolaparoscopy and bipolar surgery were used as the techniques for access and surgery of a large ovarian endometrioma. Results A two-step procedure was performed with the first step under general anaesthesia and the second under conscious sedation. Transvaginal hydrolaparoscopy allowed easy access, bloodless dissection of the adhesions and marsupialization and coagulation of the endometrioma. Conclusions The report proves the feasibility of reconstruction of the ovary with a large endometrioma using the new technique of transvaginal hydrolaparoscopy. The technique has the advantage of easy access to the endometrioma and accurate dissection and coagulation of adhesions. The low morbidity makes a two-step technique more acceptable to the patient.

A prospective study of patients who underwent laparoscopic surgery for endometriomas

A prospective study of patients who underwent laparoscopic surgery for endometriomas

Surgery of endometrioma of the ileum and colon

1. 1. The subject of endometrioma of the small and large intestine associated with intestinal obstruction is reviewed. 2. 2. The clinical manifestations, the treatment and the associated pathology are presented pertinent to ten patients with involvement of the intestine by isolated endometrioma. Range in age of these ten patients was thirty-three to forty-eight years. 3. 3. A solitary endometrioma of long-standing may involve the ileum and sigmoid or rectosigmoid colon to such an extent that gastrointestinal symptoms and signs of partial or complete intestinal obstruction may appear. 4. 4. The occurrence of obstructive symptoms, accentuated preceding or during the menstrual period, should suggest endometrioma of the small or large intestine in the differential diagnosis of intestinal obstruction. 5. 5. An endometrioma of the small or large intestine may be diagnosed on an awareness of the possibility of the disease, a complete history, and a combined rectovaginal examination coupled with the findings of the proctoscopic and barium enema examinations. 6. 6. The symptomatology and the gross appearance of an endometrioma and carcinoma of the colon are so similar that it is often difficult to distinguish these lesions even at operation. Anterior resection of the colon is recommended if any doubt exists. 7. 7. The management of patients with a solitary endometrioma or multiple endometrial implants affecting the small or large intestine should be individualized. The choice of treatment depends upon the age of the patient, the evaluation of the severity of symptoms, and the extent of the involvement of the intestine and pelvic organs. 8. 8. The recommended treatment of an acute obstruction of the ileum and sigmoid or rectosigmoid colon by an endometrioma is resection with end to end anastomosis, whenever possible. A Mikulicz procedure or lateral anastomosis may be indicated in patients who are poor risks. 9. 9. When chronic or recurring symptoms of low-grade intestinal obstruction are present, segmental resection of the colon may be contemplated. Local excisions of small isolated endometriomas may be adequate treatment in certain instances. 10. 10. In the surgical management of these patients, the preservation of ovarian function is advocated whenever possible.