Document Detail


Recurrence rate of endometrioma after laparoscopic cystectomy: a comparative randomized trial between post-operative hormonal suppression treatment or dietary therapy vs. placebo.
MedLine Citation:
PMID:  19665279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE(S): To assess the recurrence rate of endometrioma after laparoscopic cystectomy plus hormonal suppression treatment or plus dietary therapy compared to post-operative placebo. STUDY DESIGN: A randomized comparative trial was conducted on 259 consecutive women who underwent laparoscopic unilateral/bilateral cystectomy for endometrioma. Seven days after surgery, the patients were randomly allocated on the basis of a computer-generated randomization sequence, to one of four post-operative management arms as follows: placebo (n=65) or gonadotrophin-releasing hormone analogue (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n=65) or continuous low-dose monophasic oral contraceptives (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n=64) or dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n=65) for 6 months. At 18 months' follow-up after surgery, all patients were monitored with a clinical gynecologic examination, and a transvaginal ultrasonography for possible evidence of endometrioma recurrence. RESULT(S): At 18 months' transvaginal ultrasonographic follow-up after surgery, no significant recurrence rate of endometrioma was detected in women who received a postoperative course of hormonal suppression treatment or dietary therapy when compared with placebo (placebo vs. GnRH-a P=0.316, placebo vs. estroprogestin P=0.803, placebo vs. dietary therapy P=0.544). Second-look laparoscopy was performed on a clinical basis and confirmed the ultrasonographic suspicion of recurrence of endometrioma in all cases: 10 (16.6%) in the post-operative placebo group vs. 6 (10.3%) in the post-operative GnRH-a group vs. 9 (15.0%) in the post-operative continuous estroprogestin group vs. 11 (17.8%) in the post-operative dietary therapy group. Of 36 patients with recurrent ovarian endometriosis, 8 had recurrence on the treated ovary, 20 on the contralateral ovary that appeared to be normal at the time of the first-line surgery, and 8 on both the treated and untreated ovaries. Endometrioma recurrences were associated with moderate-to-severe painful symptoms in 14/36 patients (38.8%), while the remaining 22 (61.1%) patients were asymptomatic. CONCLUSION(S): A 6-month course of hormonal suppression treatment or dietary therapy after laparoscopic cystectomy had no significant effect on the recurrence rate of ovarian endometriosis when compared with surgery plus placebo. So, treatment of endometrioma can be carried out exclusively by laparoscopic cystectomy without post-operative therapy, if a complete excision of ovarian endometriosis has been assured.
Authors:
Francesco Sesti; Talia Capozzolo; Adalgisa Pietropolli; Massimiliano Marziali; Maria Rosa Bollea; Emilio Piccione
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2009-08-07
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  147     ISSN:  1872-7654     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-19     Completed Date:  2010-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  72-7     Citation Subset:  IM    
Affiliation:
Endometriosis Center, Section of Gynecology & Obstetrics, Department of Surgery, School of Medicine, Tor Vergata University Hospital, Viale Oxford, 81-00133 Rome, Italy. Francesco.Sesti@uniroma2.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Combined Modality Therapy
Contraceptives, Oral, Combined / therapeutic use*
Diet Therapy*
Dietary Supplements
Endometriosis / prevention & control*,  surgery*
Endometrium / ultrasonography
Ethinyl Estradiol / therapeutic use
Female
Follow-Up Studies
Gonadotropin-Releasing Hormone / analogs & derivatives
Gynecologic Surgical Procedures*
Humans
Laparoscopy
Leuprolide / therapeutic use
Minerals / therapeutic use
Norpregnenes / therapeutic use
Recurrence / prevention & control
Treatment Outcome
Uterine Diseases / prevention & control*,  surgery*
Vitamins / therapeutic use
Chemical
Reg. No./Substance:
0/Contraceptives, Oral, Combined; 0/Minerals; 0/Norpregnenes; 0/Vitamins; 33515-09-2/Gonadotropin-Releasing Hormone; 53714-56-0/Leuprolide; 57-63-6/Ethinyl Estradiol; 60282-87-3/Gestodene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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