Laparoscopic cystectomy in treating women with endometrioma and pregnancy outcome - a case series

INTRODUCTION

The aim of this study was to determine the spontaneous pregnancy rate and safety of our surgical technique of performing laparoscopy cystectomy for endometrioma.

METHOD

This is a 5-year retrospective study, carried out at Mahkota Medical Centre, Melaka, Malaysia. 143 patients with endometrioma associated with moderate to severe endometriosis underwent laparoscopic cystectomy from 2015 to 2019. The surgery commenced with dissection and excision of all the endometriotic lesions followed by injection of diluted vasopressin into the space between the cyst wall and the normal ovarian cortex. Stripping of the cyst wall was performed until the ovarian hilum was reached. The cyst wall was then excised, leaving some of the cyst wall on the hilum area. Minimal bipolar electrocoagulation was done on this remaining cyst wall. The ovary was then reconstructed with suturing. During the surgery, the severity of the disease was staged, endometrioma diameter and intraoperative findings were recorded. Fertility outcomes were determined among patients who were keen to conceive via telephone questionnaire and further analysed based on different factors.

RESULTS

Among the 143 patients, 33.6% had Stage III endometriosis while 66.4% had Stage IV endometriosis. Of the 76 infertile patients, 42.1% conceived spontaneously in the mean duration of 6.9 months. 62.5% patients successfully conceived via assisted reproductive treatment and 10% conceived with ovulation induction. 47.4% patients had an uneventful delivery while 2.6% patients miscarried. 6.6% patients conceived twice post-surgery.

CONCLUSION

The aim of performing laparoscopic cystectomy for endometrioma in an infertile patient is to achieve a spontaneous pregnancy. Our technique of performing laparoscopic cystectomy resulted in a spontaneous pregnancy rate of 42.1% in patients with moderate and severe endometriosis.

Diagnosis and laparoscopic excision of accessory cavitated uterine mass in young women: Two case reports

Introduction

An accessory cavitated uterine mass (ACUM) is a rare congenital Mullerian anomaly where an accessory cavity with normal endometrial lining lies within a normally functioning uterus. It is common among young and nulliparous women presenting with severe dysmenorrhea and infertility.

Presentation of the Cases

We present two cases of ACUM. The first case was a 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with non-communicating rudimentary horn The second case was a 36-year-old woman who presented with primary infertility and dysmenorrhea. Gynecological examination and ultrasound scanning were done for both patients. Subsequently, laparoscopic excision of the ACUM was performed on both patients. Histopathological examination confirmed the diagnosis. Postoperatively, both patients did well, with no further dysmenorrhea. The second patient conceived spontaneously at the first attempt and at the time of writing was 33 weeks pregnant without any maternal or fetal problems.

Conclusion

The diagnosis of ACUM is often confused with non-communicating rudimentary uterine horn, true cavitated adenomyosis and degenerating fibroids. It is important to understand and distinguish ACUM. A thorough history, detailed gynecological examination and correct radiological modalities are critical to a proper diagnosis so that the correct surgery can be performed, especially when fertility is desired.

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Accessory cavitated uterine mass is rare congenital Mullerian anomaly.

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It happens among young, nulliparous women presenting with dysmenorrhea and infertility.

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It is a diagnostic challenge and often confused with other differential diagnosis.

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A thorough history, detailed and proper examination and imaging are mandatory.

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Laparoscopic excision is crucial to relieve symptoms and improve reproduction.