Ultrasonographic Evaluation of Postoperative Ovarian Cyst Formation after Laparoscopic Excision of Endometriomas

Histologic analysis of endometriomas: what the surgeon needs to know

OBJECTIVE

To evaluate by thorough pathologic analysis the histologic features of the endometrioma wall excised at laparoscopy.

DESIGN

Prospective series of consecutive patients.

SETTING

Tertiary care, university hospital.

PATIENT(S)

Fifty-nine patients with ovarian endometriomas. A total of 70 cysts were examined.

INTERVENTION(S)

Patients underwent operative laparoscopy with the stripping technique for excision of the ovarian endometrioma.

MAIN OUTCOME MEASURE(S)

A thorough histologic examination was performed on the entire cyst wall specimen.

RESULT(S)

Histologic examination confirmed the endometriotic nature of the cyst in 100% of the cases. The inner wall of the endometrioma was covered by endometriotic tissue on 60% of the surface. The mean cyst wall thickness was 1.4 mm. The mean value of maximal depth of endometriosis penetration in the endometrioma wall was 0.6 mm. In 99% of the cases the maximal penetration of the endometriotic tissue was <1.5 mm.

CONCLUSION(S)

In the present study, we demonstrate that the endometrioma wall contains endometriotic tissue in 100% of the cases. However, the endometriotic tissue may cover the inner cyst wall for a surface that varies between 10% and 98% of the entire wall (median value 60%). This tissue may reach a depth of 2 mm, but for most of the surface it does not penetrate >1.5 mm. These histologic data may help the gynecologic laparoscopist select the surgical approach that maximally preserves healthy ovarian tissue.

Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis

OBJECTIVE

This study was undertaken to analyze the frequency and the determinants of long-term clinically detectable recurrence rate of deep, ovarian, and pelvic endometriosis.

STUDY DESIGN

The clinical data of 1106 women with first diagnosis of endometriosis observed between 1979 and 2001 were collected.

RESULTS

The 4-year recurrence rate was 24.6%, 17.8%, 30.6% and 23.7%, respectively, for cases of ovarian, pelvic, deep, and ovarian and pelvic endometriosis (P < .05). The recurrence rates decreased in all groups (with the exception of ovarian endometriosis) in the class age 34 years or older, these findings were significant (P < .05). Radicality was associated with lower recurrence rates in all the groups. A pregnancy after diagnosis was associated with a reduced risk of recurrence.

CONCLUSION

The study shows that the recurrence rates of endometriosis were higher in case of deep endometriosis and that the risk factors for recurrence were similar among women with endometriosis at different sites.

Diagnostic and therapeutic capabilities of ultrasound in the management of pelvic pain

PURPOSE OF REVIEW

This review discusses the current diagnostic and therapeutic role of ultrasound in the management of pelvic pain.

RECENT FINDINGS

Recent advances in ultrasound technology and expertise have facilitated the accurate diagnosis of common gynaecological and nongynaecological pathologies. Peritoneal and deep infiltrating endometriosis can now be diagnosed using hard and soft ultrasound-based markers. The combination of ultrasound-guided aspiration and instillation of a sclerosant is an alternative to surgery in the management of adnexal masses.

SUMMARY

Experience is a key factor in the ability of transvaginal ultrasound to characterize common gynaecological disorders with accuracy. Therapeutic ultrasound provides an alternative to surgery.