Reconstruction of the Ovary with Endometrioma: A Problem of Adhesions

In 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. Preview Unable to display preview. Download preview PDF. Similar content being viewed by others

Russell WW. Aberrant portions of the müllerian duct found in the ovary. John Hopkins Hosp Bull. 1899; 10: 8–10. Benagiano G, Brosens I. The history of endometriosis: identifying the disease. Hum Reprod. 1991; 7: 963–968. Norris CC. Ovary containing endometrium. Am J Obstet Gynecol. 1921; 1: 831–834. Sampson JA. Perforating hemorrhagic (chocolate) cysts of the ovary. Arch Surg. 1921; 3: 245–323. Sampson JA. Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1921; 14: 422–469. Hughesdon PE. The structure of endometrial cysts of the ovary. J Obstet Gynaecol Br Emp. 1957; 44: 481–487. Nieminen 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. Vercellini 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. Brosens 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. Brosens IA, Puttemans PJ, Deprest J. The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril. 1994; 61: 1034–1038. Martin DC, Berry JD. Histology of chocolate cysts. J Gynecol Surg. 1990; 6: 43–46. Fayez JA, Vogel MF. Comparison of different treatment methods of endometriomas by laparoscopy. Obstet Gynecol. 1991; 78: 660–605. Nisolle-Pochet M, Casanas-Roux F, Donnez J. Histologic study of ovarian endometriosis after hormonal therapy. Fertil Steril. 1988; 3: 423–426. Metzger DA, Szpak CA, Haney AF. Histologic features associated with hormonal responsiveness of ectopic endometrium. Fertil Steril. 1993; 59: 83–88. Bergqvist A, Fernoe M. Estrogen and progesterone receptors in endometriotic tissue and endometrium: comparison according to localization and recurrence. Fertil Steril. 1993; 60: 63–68. The American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril. 1985; 43: 351–352. Canis 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. Canis 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. Canis 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. Nezhat 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. Vercellini 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. Donnez 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. Editor information Editors and Affiliations Rights and permissions Copyright information © 1997 Springer Science+Business Media New York About this chapter Cite this chapter Brosens, 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 Download citation DOI: https://doi.org/10.1007/978-1-4612-1864-7_18 Publisher Name: Springer, New York, NY Print ISBN: 978-1-4612-7316-5 Online ISBN: 978-1-4612-1864-7 eBook Packages: Springer Book Archive

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