Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the
Karl-Werner Schweppe1, Dieter Ring
1Department of Obstetrics and Gynaecology, Ammerland Clinic GmbH, Academic Teaching Hospital of the University of Göttingen, Westerstede, Germany. schweppe@ammerland-klinik.de
Objective:
In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurrence rate.
Design:
Retrospective analysis of operation charts and follow-up data.
Setting:
Department of gynecology, in a hospital-based endometriosis treatment center.
Patient(S):
Two hundred twenty premenopausal women.
Intervention(S):
Laparoscopic treatment for peritoneal endometriosis, stage I and II by revised American Society for Reproductive Medicine guidelines.
Main Outcome Measure(S):
During the follow-up period of 2 years, symptoms and gynecological and sonographic findings were documented. In case of suspected recurrence a repeat laparoscopy with biopsy was performed to prove the recurrent endometriosis macroscopically and histologically.
Result(S):
The total recurrence rate after 2 years was 9.6%. The recurrence rate of group III (15%) was twice as high as those of group I (7%) and group II (8%), as indicated by subjective complaints, clinical findings, macroscopy, and histology; no differences were found between groups I and II.
Conclusion(S):
Endoscopic surgery for the treatment of peritoneal endometriosis should not be performed in the luteal phase.
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