Recurrence of endometrioma, four months after laparoscopic excision: a case report

Endometriosis is a chronic disease that occurs roughly in 10% of women. Endometriosis can be found in anywhere in the body, but the most common lesions are in the ovary, known as endometrioma and accounting for 55% of endometriosis. Laparoscopic excision is the most frequently chosen form of treatment for endometrioma, to reduce pelvic pain and prevent loss of fertility. There is a problem with endometrioma recurrence after surgery, however. The recurrence rate is said to be almost 30% three to five years after surgery, and prophylaxis of endometrioma recurrence is thus a major issue. We experienced a case of endometrioma relapse in the same ovary after four months of laparoscopic surgery in a 25-year old woman who had suffered with endometrioma for more than seven years. The size of the endometrioma began to increase so we decided to operate after GnRHa therapy for six months. Two months after laparoscopic excision, we started to use oral contraceptives to avoid recurrence, but this occurred anyway, four months after the laparoscopic surgery, so a second laparoscopic excision was performed. We were sure to remove the whole lesion macroscopically, and again used oral contraceptives to prevent recurrence for two months after operation. One possible reason for the recurrence is that we started to use oral contraceptives after the resumption of menses. It may be that the most important way to prevent recurrence is to start medication therapy soon after the laparoscopic excision.