Recurrence rate of ovarian endometriosis in patients treated with laparoscopic surgery and postoperative suppressive therapy

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This study found that postoperative suppressive therapy with GnRH analogues delayed endometriosis recurrence, particularly in more severe stages, with no significant difference based on surgical technique.

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This prospective study at a single gynecology clinic followed women with ovarian endometrioma treated with laparoscopic surgery, aiming to quantify relapse rates in relation to disease stage and operative technique, and to compare outcomes for patients receiving postoperative gonadotropin-releasing hormone (GnRH) analogues versus those not receiving suppressive therapy. Recurrence was monitored with scheduled ultrasound assessments over the first postoperative year, and any detected recurrent endometrioma larger than three centimeters prompted repeat laparoscopic removal and histopathological confirmation. The paper reports no statistically significant difference in recurrence distribution by surgical technique (cystectomy versus cystotomy), while recurrence occurred later among patients treated with GnRH analogues, including within more severe (Stage III/IV) disease. This paper is centrally about endometriosis—specifically ovarian endometriosis recurrence after laparoscopic surgery and postoperative GnRH suppressive therapy, including timing by stage.

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Abstract

INTRODUCTION: The testing represented a prospective study that was performed at the Gynaecology and Obstetrics Clinic "Narodni Front" in Belgrade during a two-year period. The study encompassed female patients with ovarian endometrioma operated with laparoscopic surgery. The research objective was to determine the percentage of occurrence of relapses in patients operated for endometriosis of the ovary in relation to the stage of the disease and the type of performed operation, and which were receiving suppressive therapy with gonadotropin-releasing hormone (GnRH) analogues after the surgery compared to those who were not receiving suppressive therapy after the operation. MATERIALS AND METHODS: The recurrence of endometriosis on the ovary of the test and control groups was monitored during the first year after surgery. In all patients ultrasound checks were done every month during the first six months after surgery, and then every three months for the next six months. In all patients in whom the recurrence, i.e. endometrioma on the ovary larger than three cm was revealed postoperatively by ultrasound, the laparoscopic removal of the endometrioma was performed again as well as the histopathological examination of the material. RESULTS AND CONCLUSION: There was no statistically significant difference in the distribution of recurrence of endometriosis between the groups formed according to the type of surgical technique (cystectomy or cystotomy). The recurrence of endometriosis occurred later in the group of patients in which the treatment GnRH analogues was applied after the surgical treatment. The recurrence of endometriosis in more severe stages (Stage III and IV) occurs later in the group of patients in which the treatment GnRH analogues is applied after the surgical treatment.
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Abstract

Introduction: The testing represented a prospective study that was performed at the Gynaecology and Obstetrics Clinic “Narodni Front” in Belgrade during a two-year period. The study encompassed female patients with ovarian endometrioma operated with laparoscopic surgery. The research objective was to determine the percentage of occurrence of relapses in patients operated for endometriosis of the ovary in relation to the stage of the disease and the type of performed operation, and which were receiving suppressive therapy with gonadotropin-releasing hormone (GnRH) analogues after the surgery compared to those who were not receiving suppressive therapy after the operation. Materials and Methods: The recurrence of endometriosis on the ovary of the test and control groups was monitored during the first year after surgery. In all patients ultrasound checks were done every month during the first six months after surgery, and then every three months for the next six months. In all patients in whom the recurrence, i.e. endometrioma on the ovary larger than three cm was revealed postoperatively by ultrasound, the laparoscopic removal of the endometrioma was performed again as well as the histopathological examination of the material. Results and Conclusion: There was no statistically significant difference in the distribution of recurrence of endometriosis between the groups formed according to the type of surgical technique (cystectomy or cystotomy). The recurrence of endometriosis occurred later in the group of patients in which the treatment GnRH analogues was applied after the surgical treatment.The recurrence of endometriosis in more severe stages (Stage III and IV) occurs later in the group of patients in which the treatment GnRH analogues is applied after the surgical treatment.

Keywords

- GnRH analogues - Ovarian endometrioma - Cystectomy - Cystotomy - Laparoscopy

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Gonadotropin-Releasing Hormone Gonadotropin-Releasing Hormone Ovarian Diseases Ovary Triptorelin Pamoate Adult Endometriosis Female Gonadotropin-Releasing Hormone Goserelin Gynecologic Surgical Procedures Humans Laparoscopy Middle Aged Ovarian Diseases Ovary Pregnancy Prospective Studies Recurrence

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