{"paper_id":"a9d9f5ab-2223-48b5-a0a5-4bcde4a12cd2","body_text":"Abstract\nIn situ examination of ovaries with a chocolate cyst has shown that the endometrioma is not an intraovarian cyst of deeply infiltrating endometriosis but an extraovarian pseudocyst consisting of invaginated ovarian cortex fused and sealed off by adhesions and colonized by superficial endometriotic implants. If the adhesions and menstrual bleeding of superficial implants are the cause of the pseudocyst formation, the rational surgical approach is lysis of adhesions and ablation of superficial endometriosis. This chapter describes the nosography of the ovarian endometriotic cyst, the observations that support the thesis of an extraovarian pseudocyst, and proposes adhesiolysis, eversion via the stigma of inversion, and coagulation of superficial implants as the first-choice surgical treatment.\nPreview\nUnable to display preview. Download preview PDF.\nSimilar content being viewed by others\nReferences\nRussell WW. Aberrant portions of the müllerian duct found in the ovary. John Hopkins Hosp Bull. 1899; 10: 8–10.\nBenagiano G, Brosens I. The history of endometriosis: identifying the disease. Hum Reprod. 1991; 7: 963–968.\nNorris CC. Ovary containing endometrium. Am J Obstet Gynecol. 1921; 1: 831–834.\nSampson JA. Perforating hemorrhagic (chocolate) cysts of the ovary. Arch Surg. 1921; 3: 245–323.\nSampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1921; 14: 422–469.\nHughesdon PE. The structure of endometrial cysts of the ovary. J Obstet Gynaecol Br Emp. 1957; 44: 481–487.\nNieminen U. Studies on the vascular pattern of ectopic endometrium with special reference to cyclic changes. Acta Obstet Gynecol Scand. 1962; 41 (suppl 3): 1–81.\nVercellini P, Vendola N, Bocciolone L, Rognoni M, Carinelli S, Candiani G. Reliability of the visual diagnosis of ovarian endometriosis. Fertil Steril. 1990; 53: 1198–1200.\nBrosens IA, Puttemans PJ. Double-optic laparoscopy. Salpingoscopy, ovarian cystoscopy and endo-ovarian surgery with the argon laser. Baillieres Clin Obstet Gynaecol. 1989; 3: 595–608.\nBrosens IA, Puttemans PJ, Deprest J. The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril. 1994; 61: 1034–1038.\nMartin DC, Berry JD. Histology of chocolate cysts. J Gynecol Surg. 1990; 6: 43–46.\nFayez JA, Vogel MF. Comparison of different treatment methods of endometriomas by laparoscopy. Obstet Gynecol. 1991; 78: 660–605.\nNisolle-Pochet M, Casanas-Roux F, Donnez J. Histologic study of ovarian endometriosis after hormonal therapy. Fertil Steril. 1988; 3: 423–426.\nMetzger DA, Szpak CA, Haney AF. Histologic features associated with hormonal responsiveness of ectopic endometrium. Fertil Steril. 1993; 59: 83–88.\nBergqvist A, Fernoe M. Estrogen and progesterone receptors in endometriotic tissue and endometrium: comparison according to localization and recurrence. Fertil Steril. 1993; 60: 63–68.\nThe American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril. 1985; 43: 351–352.\nCanis M, Mage G, Wattiez A, Chapron C, Pouly JL, Bassil S. Second-look laparoscopy after laparoscopic cystectomy of large ovarian endometriomas (see comments). Fertil Steril. 1992; 58: 617–619.\nCanis M, Pouly JL, Wattiez A, Manhes H, Mage G, Bruhat MA. Incidence of bilateral adnexal disease in severe endometriosis (revised American Fertility Society (AFS), stage IV): should a stage V be included in the AFS classification? Fertil Steril. 1992; 57: 691–692.\nCanis M, Pouly JL, Wattiez A, Manhes H, Mage G, Bruhat MA. Incidence of bilateral adnexal disease in severe endometriosis (revised American Fertility Society (AFS), stage IV): should a stage V be included in the AFS classification? Fertil Steril. 1992; 57: 691–692.\nNezhat F, Nezhat C, Allan CJ, Metzger DA, Sears DL. A clinical and histologic classification of endometriomas: implications for a mechanism of pathogenesis. J Reprod Med. 1992; 37: 771–776.\nVercellini P, Vendola N, Bocciolone L, Colombo A, Rognoni MT, Bolis G. Laparoscopic aspiration of ovarian endometriomas. Effect with postoperative gonadotropin releasing hormone agonist treatment. J Reprod Med. 1992; 37: 577–580.\nDonnez J, Nisolle M, Clerckx F, et al. The ovarian endometrial cyst: the combined (hormonal and surgical) therapy. In: Brosens I, Jacobs HS, Runnebaum B, eds. LNRHAnalogues in Gynaecology. Fort Meyers, FL: Parthenon; 1990: 165–175.\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 1997 Springer Science+Business Media New York\nAbout this chapter\nCite this chapter\nBrosens, I.A., Puttemans, P. (1997). Reconstruction of the Ovary with Endometrioma: A Problem of Adhesions. In: diZerega, G.S., et al. Pelvic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1864-7_18\nDownload citation\nDOI: https://doi.org/10.1007/978-1-4612-1864-7_18\nPublisher Name: Springer, New York, NY\nPrint ISBN: 978-1-4612-7316-5\nOnline ISBN: 978-1-4612-1864-7\neBook Packages: Springer Book Archive\nKeywords\nThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.","source_license":"CC0","license_restricted":false}