Recurrence rate and temporal characteristics of ovarian endometrioma after laparoscopic cystectomy: results of a 36month followup
Abstract
The objective: to evaluate the recurrence rate and temporal characteristics of ovarian endometrioma following laparoscopic surgical treatment in patients with stage III endometriosis and to compare the obtained results with contemporary scientific data. An additional aim was to analyze possible differences in recurrence rates depending on the method of coagulation of the cyst bed. Materials and methods. A retrospective analysis of clinical data from 82 patients aged 15 to 37 years who underwent surgical treatment for unilateral ovarian endometrioma at the LLC “Healthy Family Clinic Astramed” between 2019 and 2023 was performed. In all cases, the diagnosis corresponded to stage III endometriosis according to the classification of the American Society for Reproductive Medicine, ensuring homogeneity of the study population. At the stage of surgical treatment, patients were divided into two groups depending on the method used for coagulation of the cyst bed: bipolar coagulation and ultrasonic coagulation. This allocation was performed in order to further evaluate the influence of different hemostasis techniques on ovarian reserve parameters. All patients received postoperative hormonal therapy with dienogest at a dose of 2 mg daily. Postoperative follow-up included clinical assessment, review of medical records, and pelvic ultrasonography to detect recurrent formation of endometriomas. Results. The postoperative follow-up period lasted 36 months. During this period, recurrence of ovarian endometrioma was diagnosed in 12 patients, accounting for 14.6 % of the total cohort. The cumulative recurrence rate over the 36-month follow-up period was 14.6 %. No cases of recurrence were observed during the first 12 months after surgery. The first recurrence was diagnosed 14 months after surgical treatment. The majority of recurrences occurred between 18 and 36 months following surgery. Comparative analysis of recurrence rates between the groups treated with bipolar coagulation and ultrasonic coagulation of the cyst bed did not reveal statistically significant differences throughout the entire follow-up period. The obtained results are consistent with data reported in contemporary scientific literature. In particular, the systematic review and meta-analysis. Recurrence after surgery for endometrioma: a systematic review and meta-analysisdemonstrated that the recurrence rate of endometriomas after surgical treatment may reach 27% within 24 months, especially in the absence of postoperative hormonal therapy. Another meta analysis, Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis, showed that postoperative hormonal suppression significantly reduces the risk of endometriosis recurrence. The recurrence rate of 14.6% over 36 months observed in our study falls within the range reported in recent international studies. Conclusions. Recurrence of ovarian endometrioma remains an important clinical challenge in the management of endometriosis despite advances in surgical treatment. In most cases, recurrence occurs within the first 2–3 years after surgery. The use of postoperative hormonal therapy with dienogest at a dose of 2 mg allows recurrence rates comparable to those reported in contemporary scientific literature. The use of different cyst bed coagulation techniques (bipolar or ultrasonic) did not demonstrate differences in recurrence rates during the 36-month follow-up period.