Recommendations for the surgical treatment of endometriosis—part 1: ovarian endometrioma

Gynecological Surgery - 2017
Wes, Ertan Sarıdoğan1, Christian M. Becker2, Anis Féki3, Grigoris Grimbizis4, Lone Hummelshøj5, J. Keckstein6, Michelle Nisolle7, Vasilios Tanos8, U. Ulrich9, Nathalie Vermeulen10, Rudy Leon De Wilde11
1Institute for Women's Health, University College Hospital, Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, London, NW1 2BU, UK
2Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Endometriosis CaRe Centre, John Radcliffe Hospital, Women's Centre, Oxford, OX3 9DU, UK
3Department of Obstetrics and Gynecology, HFR Fribourg Hôpital Cantonal, 1708, Fribourg, Switzerland
41st Department of Obstetrics & Gynecology, Medical School, Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623, Thessaloniki, Greece
5World Endometriosis Society, London, N1 3JS, UK
6Landeskrankenanstalten-Betriebsgesellschaft (KABEG) and Landeskrankenhaus Villach, Abteilung für Gynäkologie und Geburtshilfe, 9500, Villach, Austria
7Hôpital de la Citadelle, Department of Obstetrics & Gynecology, BE-4000, Liège, Belgium
8Department of Ob/Gyn, Aretaeio Hospital, 2024, Nicosia, Cyprus
9Department of Obstetrics and Gynecology/Endometriosis Center, Martin-Luther Hospital, 14193, Berlin, Germany
10ESHRE, Central Office, Meerstraat 60, BE-1852, Grimbergen, Belgium
11Carl von Ossietzky Universitat Oldenburg, University Hospital for Gynecology, DE-26129, Oldenburg, Germany

Tóm tắt

Abstract Study question What does this document on the surgical treatment of endometriosis jointly prepared by the European Society for Gynaecological Endoscopy (ESGE), ESHRE, and the World Endometriosis Society (WES) provide? Summary answer This document provides recommendations covering technical aspects of different methods of surgery for endometriomas in women of reproductive age. What is already known Endometriomas (ovarian endometriotic cysts) are a commonly diagnosed form of endometriosis, owing to the relative ease and accuracy of ultrasound diagnosis. They frequently present a clinical dilemma as to whether and how to treat them when found during imaging or incidentally during surgery. Previously published guidelines have provided recommendations based on the best available evidence, but without technical details on the management of endometriosis. Study design, size and duration A working group of ESGE, ESHRE and WES collaborated on writing recommendations on the practical aspects of endometrioma surgery. Participants/materials, setting and methods This document focused on endometrioma surgery. Further documents in this series will provide recommendations for surgery of deep and peritoneal endometriosis. Main results and the role of chance The document presents general recommendations for surgery of endometrioma and specific recommendations for cystectomy, ablation by laser or by plasma energy, electrocoagulation and a combination of these techniques applied together or with an interval between them. Limitations and reasons for caution Owing to the limited evidence available, recommendations are mostly based on clinical expertise. Wider implications of the findings These recommendations complement previous guidelines on the management of endometriosis. Study funding/competing interests The meetings of the working group were funded by ESGE, ESHRE and WES. CB declares to be a member of the independent data monitoring committee for a clinical study by ObsEva and receiving research grants from Bayer, Roche Diagnostics, MDNA Life Sciences and Volition. ES received honoraria for provision of training to healthcare professionals from Ethicon, Olympus and Gedeon Richter. The other authors declare that they have no conflict of interest.

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Tài liệu tham khảo

Ata B, Uncu G (2015) Impact of endometriomas and their removal on ovarian reserve. Curr Opin Obstet Gynecol 27:235–241

Brosens IA, Puttemans PJ, Deprest J (1994) The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril 61:1034–1038

Burney RO, Giudice LC (2012) Pathogenesis and pathophysiology of endometriosis. Fertil Steril 98:511–519

Busacca M, Vignali M (2003) Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol 15:321–326

Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N (2009) Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril 92:453–457

Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F (1996) Large ovarian endometriomas. Hum Reprod 11:641–646

Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A et al (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29:400–412

Giudice LC (2010) Clinical practice. Endometriosis. N Engl J Med 362:2389–2398

Hoo WL, Stavroulis A, Pateman K, Saridogan E, Cutner A, Pandis G, Tong EN, Jurkovic D (2014) Does ovarian suspension following laparoscopic surgery for endometriosis reduce postoperative adhesions? An RCT. Hum Reprod 29:670–676

Hughesdon PE (1957) The structure of endometrial cysts of the ovary. J Obstet Gynaecol Br Emp 64:481–487

Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier C (2013) Consensus on current management of endometriosis. Hum Reprod 28:1552–1568

Nezhat F, Nezhat C, Allan CJ, Metzger DA, Sears DL (1992) Clinical and histologic classification of endometriomas. Implications for a mechanism of pathogenesis. J Reprod Med 37:771–776

Nisenblat V, Bossuyt PM, Shaikh R, Farquhar C, Jordan V, Scheffers CS, Mol BW, Johnson N, Hull ML (2016) Blood biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev:CD012179

Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68:585–596

Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco NF, de Cicco NC, Jenkinson C, Kennedy SH, Zondervan KT, World Endometriosis Research Foundation Global Study of Women’s Health C (2011) Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 96:366–373 e368

Redwine DB (1999) Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril 72:310–315

Roman H, Auber M, Bourdel N, Martin C, Marpeau L, Puscasiu L (2013) Postoperative recurrence and fertility after endometrioma ablation using plasma energy: retrospective assessment of a 3-year experience. J Minim Invasive Gynecol 20:573–582

Roman H, Auber M, Mokdad C, Martin C, Diguet A, Marpeau L, Bourdel N (2011) Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive. Fertil Steril 96:1396–1400

Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I, Brodszky V, Canis M, Colombo GL, DeLeire T et al (2012) The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 27:1292–1299

Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L (2012) Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril 98:1531–1538

Somigliana E, Vigano P, Filippi F, Papaleo E, Benaglia L, Candiani M, Vercellini P (2015) Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod 30:1280–1286

Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL et al (2014) National German Guideline (S2k): guideline for the diagnosis and treatment of endometriosis: long version - AWMF registry no. 015-045. Geburtshilfe Frauenheilkd 74:1104–1118

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Gynecological Surgery

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