Management of Ovarian Endometrioma - Nursing Center

Management of Ovarian Endometrioma 483randomized clinical trials comparing the Table 2 shows the recurrence ratesment of endometriotic cysts. 57 In thistechnique, the inner lining of the cyst is LAPAROSCOPIC FENESTRATION,DRAINAGE, AND ABLATION OFdissected from the ovary by 2 atraumaticCYST WALLgrasping forcepses that are pulled inDifficulty of performing cystectomy andopposite directions and the inner liningsare sent for histologic examination. 57 questionable effect of removal of cyst onfollicular reserve, has led some surgeonsoutcome of laparoscopic surgery and of cysts after excision with no adjuvantlaparotomy and showed that these medical therapy 44,54,57–63 and Table 3techniques exposed patients equally tocomplications.Despite the above mentioned argument,laparotomy should be consideredfor severe endometriosis associated withdense extensive adhesions or for deeplyinfiltrating endometriomas. 51,52shows the cyst recurrence rate usingperioperative medication with cystectomy.Brosens et al 67 and Donnez et al, 68reported that ovarian cystectomy mayinduce damage to ovarian reserve byremoval of healthy ovarian tissue alongwith the wall of ovarian cyst, and thisLAPAROSCOPIC DRAINAGE OF event may cause reduction of follicularENDOMETRIOMAresponse in controlled ovarian hyperestimulation.However, recently, MuziiThe major problem with laparoscopiccyst drainage is a high risk of recurrence et al 70 performed a histologic analysis ofof about 80% to 100%. 53,54 Giving 26 ovarian endometriomas, removed byGnRH-a after laparoscopic drainage, cystectomy, and detected ovarian tissuesignificantly reduces the size of the cyst with cyst pseudocapsule in 54% of cases.up to 50% but it has no effect on But, the ovarian tissue adjacent to therecurrence rate. 55,56 Nowadays, it is cyst wall did not show the follicularaccepted that simple aspiration by pattern that is observed in normallaparoscopy should not be used to treat ovaries in any of the specimensendometrioma.examined. 70 Therefore, it was suggestedthat postcystectomy ovarian response toLAPAROSCOPIC CYSTECTOMY gonadotropin was comparable to theLaparoscopic cystectomy remains the contralateral ovary. 9first line choice for conservative treat-to use this technique. In this method,fenestration and aspiration is done.TABLE 2. Ovarian Cystectomy andRecurrence RateAuthor’s NameNo.F/U(mo)Bateman et al 44 36 12 11.1Marana et al 58 42 21 7Muzii et al 59 21 12 4.8Montanino et al 60 11 12 11.1Beretta et al 57 32 24 6.2Fayez and Vogel 61 26 2 0Hemmings et al 62 23 36 12Saleh and Tulandi 54 161 18 6.1Alborzi et al 63 52 24 17.3RecurrenceRate %TABLE 3. Ovarian Cystectomy WithPerioperative Medication andRecurrence RateAuthor’s NameNo.F/U(mo)Fayes and Vogel 61 66 2 0-22Canis et al 64 42 3-6 7.6Marana et al 58 40 21 10Muzii et al59 20 12 5Montanino et al 60 25 12 11.1Gurgan et al 65 19 3 5.2Busacca et al 66 366 48 11.7RecurrenceRate