The Importance of the Surgical Approach in the Prevention of Recurrence of Endometriosis

Ana Jovanović, Ana Mitrovic Jovanovic, Svetlana Dragojević-Dikić, Svetlana Janković-Ražnatović, Jelena Savija, Jovana Radaković
In: Journal of Gynecologic Surgery · 2015 · vol. 31(2) , pp. 71–77 · doi:10.1089/gyn.2014.0090 · W1422500291
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Abstract

Background: One of the characteristics of endometriosis is its frequent recurrence. According to existing studies, the 2-year recurrence rate of this conditions ranges between 6% and 67%. Objective: The aim of this study was to determine if surgical approach, operative technique, and postoperative pharmaceutical treatment influence the frequency of recurrence of endometriosis. Materials and Methods: This was a cohort study that was performed in the University Clinic of Gynecology and Obstetrics of Narodni Front, in Belgrade, Serbia. The study included 111 patients who were treated surgically at this institution during a 1-year period. The study included only patients with peritoneal endometriosis and ovarian endometriomas with a diameter >3 cm. The surgical approaches used (laparotomy, laparoscopy) were evaluated as were the pathologic forms of endometriosis (nodes, endometrioma), operative treatments (conservative, semiconservative, radical), and techniques (cystectomy, cystotomy) applied to treat ovarian endometriomas. Data were gathered regarding disease recurrence and postoperative medical therapy over a 2-year period. Statistical analysis used included both descriptive and analytical methods as follows: a t-test for numerical parameters and a χ2 test for descriptive parameters. Significance was set at p<0.05. Results: The overall recurrence rate was 38.7%. The statistical analysis indicated that there was no significant difference in recurrence rate between women who had laparoscopic cystectomy and women who had cystectomy via laparotomy (χ2=1.06, p>0.05). The recurrence rate in women who had laparoscopic cystectomy was 41.9% in 2 years, and this was not significantly different from the recurrence rate in women who had laparoscopic cystotomy (56.7%). Recurrence rates in women who received postoperative pharmaceutical treatment and in those who did not were not significantly different (χ2=2.94, p>0.05). Conclusions: The compared surgical approaches and techniques were equally effective for preventing recurrence of endometriosis within a 2-year period. Postoperative pharmaceutical treatment does not reduce the risk of endometriosis recurrence. (J GYNECOL SURG 31:71)

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