Feasibility study of laparoscopic surgery for ovarian endometrioma rupture

Sachiko Tokita, Jun Kumakiri, Makoto Jinushi, Shozo Matsuoka, Iwaho Kikuchi, Mari Kitade, Satoru Takeda
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2010 · vol. 26(2) , pp. 600–604 · doi:10.5180/jsgoe.26.600 · W2335711766
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This retrospective study assessed laparoscopic surgery for 18 patients with ruptured ovarian endometrioma, finding conservative intervention to be a viable approach for fertility preservation in this infrequent emergency condition.

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This retrospective study evaluated the feasibility of conservative laparoscopic surgery for eighteen patients who presented with preoperative rupture of ovarian endometriomas. The researchers found that while such ruptures are infrequent, occurring in only 2.3% of cases within their cohort, emergency surgical intervention was necessary for most individuals. Concurrent cystectomy was successfully performed in sixteen patients to preserve fertility, whereas two others required only irrigation due to severe inflammation. This paper is centrally about endometriosis — specifically addressing the acute management and surgical outcomes of ruptured ovarian endometriomas.

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Abstract

Objective: To assess the attributes and feasibility of conservative laparoscopic surgery for patients with ruptured ovarian endometrioma.Design: Retrospective analysis.Setting: University medical center.Patient(s): Eighteen patients undergoing laparoscopic surgery at our institution between January, 2005 and December, 2008 for presumed ovarian endometrioma rupture.Intervention: Laparoscopy.Measurements and Key Findings: Of 792 patients undergoing laparoscopic surgery for ovarian endometrioma, rupture occurred preoperatively in 18 (2.3%), with a median age of 32 years. Eight were right-sided lesions and 10 were left-sided. Five patients were actively menstruating, four were in follicular phase, and six were in luteal phase. Rupture followed GnRH agonist treatment in three instances. Laparoscopic surgery was performed within 24 hours for most, with exception of one patient who received a six-month course of GnRH agonist, postponing surgical intervention. Concurrent cystectomy was elected in 16 patients to preserve fertility. In the other two, treatment was limited to irrigation only (due to severe inflammation), with the option of delayed cystectomy following medical (GnRH agonist) management. Conclusions: Rupture of ovarian endometrioma is an infrequent event, requiring emergency surgery, but conservative laparoscopic intervention is a viable approach for preservation of fertility.
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Abstract

Objective: To assess the attributes and feasibility of conservative laparoscopic surgery for patients with ruptured ovarian endometrioma. Design: Retrospective analysis. Setting: University medical center. Patient(s): Eighteen patients undergoing laparoscopic surgery at our institution between January, 2005 and December, 2008 for presumed ovarian endometrioma rupture. Intervention: Laparoscopy. Measurements and Key Findings: Of 792 patients undergoing laparoscopic surgery for ovarian endometrioma, rupture occurred preoperatively in 18 (2.3%), with a median age of 32 years. Eight were right-sided lesions and 10 were left-sided. Five patients were actively menstruating, four were in follicular phase, and six were in luteal phase. Rupture followed GnRH agonist treatment in three instances. Laparoscopic surgery was performed within 24 hours for most, with exception of one patient who received a six-month course of GnRH agonist, postponing surgical intervention. Concurrent cystectomy was elected in 16 patients to preserve fertility. In the other two, treatment was limited to irrigation only (due to severe inflammation), with the option of delayed cystectomy following medical (GnRH agonist) management.

Conclusions

Rupture of ovarian endometrioma is an infrequent event, requiring emergency surgery, but conservative laparoscopic intervention is a viable approach for preservation of fertility. Design: Retrospective analysis. Setting: University medical center. Patient(s): Eighteen patients undergoing laparoscopic surgery at our institution between January, 2005 and December, 2008 for presumed ovarian endometrioma rupture. Intervention: Laparoscopy. Measurements and Key Findings: Of 792 patients undergoing laparoscopic surgery for ovarian endometrioma, rupture occurred preoperatively in 18 (2.3%), with a median age of 32 years. Eight were right-sided lesions and 10 were left-sided. Five patients were actively menstruating, four were in follicular phase, and six were in luteal phase. Rupture followed GnRH agonist treatment in three instances. Laparoscopic surgery was performed within 24 hours for most, with exception of one patient who received a six-month course of GnRH agonist, postponing surgical intervention. Concurrent cystectomy was elected in 16 patients to preserve fertility. In the other two, treatment was limited to irrigation only (due to severe inflammation), with the option of delayed cystectomy following medical (GnRH agonist) management.

Conclusions

Rupture of ovarian endometrioma is an infrequent event, requiring emergency surgery, but conservative laparoscopic intervention is a viable approach for preservation of fertility. © 2010 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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Condition tags

endometrioma

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