[Symptomatic recurrence of endometriomas after ultrasound and laparoscopic surgery].

BACKGROUND: Endometriosis affects to 5-12% women. Laparoscopic surgery is the treatment of choice, but the high rate of recurrence is alarming. OBJECTIVE: Analyse the influence of various variables in the recurrence after ovarian endometrioma laparoscopic excision. MATERIAL AND METHODS: Retrospective study of 214 cases with laparoscopic treatment in 2005 and 2006 in the Hospital La Paz. A 5 years follow-up was made. Choosen recurrence criteria were pain and suggestive ultrasound finding. Variables studied were: age, pain (0-10), Ca 125 levels, myoma, adenomyosis, number, size and laterality of cyst, medical treatment before and after laparoscopic surgery, infertility, kind of surgery and characteristics, progression and treatment of recurrences. RESULTS: 30,8% (66/214) of patients presented pain recurrence, 28% (60/214) ultrasound recurrence. Patients with symptomatic recurrence had a bigger degree of dysmenorrhea and dyspareunia before surgery (6.8 +/- 2.5 and 1.3 +/- 2.5 against 3.8 +/- 3.4 and 0.2 +/- 1.0 in no recurrence ones (p = 0.0001; p = 0.0001). Previous dysmenorrheal and dyspareunia punctuation was also greater in ultrasound recurrences (5.9 +/- 3.3 and 1.2 +/- 2.5 against 4.3 +/- 3.4 and 0.2 +/- 1.1 of those with no recurrence) (p = 0.003; p = 0.002). Dysmenorrhea recurrence was greater in young (31.3 +/- 5.4 years old versus 34.3 +/- 7.8; p = 0.02), with cystectomy (35% versus 16,7% in adnexectomy; p = 0.02), adhesiolysis (46.4% versus 23.4%; p = 0.001) and with medical treatment after surgery (41.5% against 22.5%; p = 0.004). The mean time of no symptomatic recurrence was 44 months (CI 95%: 41-47) and the no ultrasound recurrence was 47 months (CI 95%: 45-50). CONCLUSION: Dysmenorrhea and dyspareunia degree before surgery was the most clearly associated factor with recurrence.