Surgical treatment of endometriosis: location and patterns of disease at reoperation
Received 18 April 2008; received in revised form 3 September 2008; accepted 29 September 2008. published online 11 November 2008.
Objective
To assess the behavior of revised American Fertility Society stages I and II endometriosis after surgical treatment, by observation of location of pelvic involvement at reoperation.
Design
Prospective study.
Setting
Tertiary referral center at a university-based hospital.
Patient(s)
Thirty-nine women with persistent or recurrent chronic pelvic pain after laparoscopic excision or ablation of histologically confirmed endometriosis who underwent a second laparoscopy.
Intervention(s)
Laparoscopic pelvic mapping and surgical treatment of endometriosis, followed by repeat laparoscopic pelvic mapping of endometriosis at a second laparoscopy.
Result(s)
Superficial peritoneal endometriosis (revised American Fertility Society stage I–II) endometriosis recurred in 37% of pelvic regions after surgical treatment. Endometriosis was more likely to recur in a treated pelvic region than an adjacent or distant pelvic region (relative risk 2.54; 95% confidence interval 1.63-3.97). A region adjacent to a previously affected pelvic region that was unaffected by endometriosis at the initial laparoscopy was more likely to have endometriosis at the second laparoscopy than a pelvic region distant from the treated pelvic region (relative risk 1.29; 95% confidence interval 0.84-2.0). Unaffected regions at initial laparoscopy had a low probability of having new endometriosis (11%) in the second laparoscopy.
Conclusion(s)
Recurrence of histologically proven endometriosis after surgical excision is more likely to cluster close to the original area of involvement, reflecting either incomplete excision at the initial surgery or a nonrandom favored implantation of new endometrial implants in adjacent peritoneum. Further studies are needed to elucidate the pathophysiology and mechanisms of recurrence of endometriosis.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, British Columbia Women's Hospital and Health Care Centre, Vancouver, British Columbia, Canada
Reprint requests: Christina Williams, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, British Columbia Women's Hospital and Health Care Centre, D600, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada (FAX: 604-875-2569).
E.T. has nothing to disclose. C.W. has nothing to disclose.
ABSTRACT