Treatment of endometriosis

Cutaneous endometriosis: a combination of medical and surgical treatment

Cutaneous and subcutaneous endometriosis occurs most commonly as a secondary process in scars after abdominal or pelvic surgical procedures including hysterectomy, cesarean sections and episiotomy. Simple excision is the recommended management and local recurrence after adequate excision is uncommon. A 32-year-old woman presented with a 5-cm firm tumor on the right perineum. There was cyclical bleeding and fluctuation in size. She was initially treated with subcutaneous goserelin acetate. The lesion decreased in size and was then successfully excised 4 months later.

Laparoscopic management of hepatic endometriosis: Report of two cases and review of the literature

Hepatic endometriosis is rare. Only 15 cases have been reported in the literature. All 15 were treated by laparotomy. We report two additional cases of hepatic endometriosis managed for the first time laparoscopically. Endometriosis is a progressive disease especially in women of reproductive age. One of the differential diagnoses of liver endometriosis is malignancy. Currently, there are no reports in the literature regarding complications arising from the progression of hepatic endometriosis. However, this lack of evidence does not deny its existence.

Recurrence of ovarian endometriosis and anatomical location of the primary lesion

OBJECTIVE

To investigate whether the risk of endometriosis recurrence and pregnancy rate are related to the side of the pelvis on which the primary lesion is found.

DESIGN

Cross-sectional study.

SETTING

Tertiary institutional hospital.

PATIENT(S)

One hundred and twenty-one patients with advanced-stage pelvic endometriosis.

INTERVENTION(S)

Conservative laparoscopic treatment.

MAIN OUTCOME MEASURE(S)

Endometriosis recurrence and pregnancy rate.

RESULT(S)

Endometriosis was localized on the left hemipelvis, right hemipelvis, and bilaterally in 47.9%, 33.9%, and 18.2% of patients, respectively. The overall rate of disease recurrence was 17.3%. The recurrence rate was higher when the left ovary was involved than when it was not (29% vs. 7.3%; P<.05). The overall rate of spontaneous pregnancy was 48.1%. The median interval between surgery and occurrence of pregnancy was shorter in patients with endometriosis limited to the right hemipelvis than in those with disease limited to the left side (21 months [range, 12-48 months] vs. 9 months [range, 6-12 months]; P<.01).

CONCLUSION(S)

The likelihood of disease recurrence is lower when endometriosis is located only on the right side of the pelvis than when the left side is involved. In patients who try to conceive, the time between surgery and occurrence of pregnancy seems to be shorter when the endometriosis is localized in the right hemipelvis.