Surgery for functional cysts: is it unnecessary?

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.

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

STUDY OBJECTIVE

To evaluate, by means of serial transvaginal ultrasound (US) examinations, the ovary after laparoscopic excision of endometriomas with the stripping technique.

DESIGN

Prospective, controlled, single-blind clinical trial (Canadian Task Force classification II-1).

SETTING

Tertiary care university hospital.

PATIENTS

Forty-seven patients, from 21- to 35-years old, undergoing laparoscopic excision of a monolateral ovarian endometrioma.

INTERVENTION

The patients underwent serial US scans performed by a blinded observer during the first, third, and sixth menstrual cycle after surgery.

MEASUREMENTS AND MAIN RESULTS

At the first follow-up US examination, an abnormal finding, namely the presence of an ovarian cyst on the operated ovary, was diagnosed in five of 47 patients (10.6%; p = .03 when compared with the nonoperated ovary). In the remaining 42 patients (89.4%), no gross abnormalities were evident. No differences were present between the two ovaries as to ovarian volume or follicular development pattern. During the third follow-up US, in 47 patients (100%) no gross abnormalities were present.

CONCLUSION

The US follow-up of ovaries operated on for endometriomas by laparoscopy demonstrates that the evidence of an ovarian cyst in the early postoperative period is not an uncommon event. This finding, occurring in approximately 10% of cases, seems to be a transient one occurring during ovarian healing after surgery, since no evidence of such anomaly was present on subsequent US scans. Therefore, treatment for US evidence of recurrence of an ovarian endometrioma should be deferred for at least 3 to 6 months if the diagnosis of recurrence is made in the early postoperative period. Apart from this finding, the operated ovary is indistinguishable from the contralateral one, even 1 month after surgery.