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Giornale Italiano di ostetricia e ginecologia

Proposal of “fertility-sparing” surgery technique for ovarian endometriosis

Methods, Techniques, Drugs, 178 - 183
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Endometriosis is a chronic disease defined by the presence of endometrial-like tissue outside the uterus. Ovarian endometriotic cysts (endometriomas) are found in 20% of patients with endometriosis and are frequently associated with a severe algic symptomatology.
There are many laparoscopic techniques for treatment, but most used are cystectomy by stripping or puncture with electrocoagulation of the cyst capsule. Generally, stripping procedure of ovarian cyst wall is followed by hemostasis by means of bipolar electrocoagulation or simple suturing of the residual ovarian parenchyma. This type of surgery represents a prospective damage of ovarian reserve. The damage is due to healthy or peri-cystic ovarian parenchyma alteration caused by an incautious stripping, an electro-hemostasis overdone or a too tightened hemostatic suture that implicate a tissue ischemia.
The aim of this study is to evaluate the effect of a laparoscopic techniques for treatment of ovarian endometriomas, that provide for a modular stripping by unsticking the cysts, a coagulation of vascular connection directly on the cystic capsule and the use of a hemostatic-sealant (FloSeal® - Baxter HC). For the post- surgery examination of ovarian reserve, we utilized an ultrasound marker: the antral follicle count (AFC).
We utilized this surgery procedure on 30 women between the ages of 21 and 38 years (E.M: 28,47) with a conceive desire. Women analyzed arise an ovarian endometrioma mono- or bilateral with 4 centimeters diameter as minimum. All of them suffering of dysmenorrhea, deep dyspareunia or chronic pelvic pain.
After 3 months from surgery, Transvaginal Ultrasonogram it has been done. The result of this exam was:
- Patient with unilateral Ovarian Endometrioma presents an AFC variation between 5 and 9 (Mean: 6.45);
- Patient with bilateral Endometrioma the AFC variation was between 4 and 7 (Mean: 5.42).
In conclusion, we retain that the technique we have structured and that we use in tackling the endometrioma surgically, respects the Ovarian Follicular Reserve to preserve the fertile ability of afflicted woman.

Vol. XL (No. 4) 2018 Ottobre - Dicembre

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