Data di Pubblicazione:
2010
Citazione:
The outcomes of repeat surgery for recurrent symptomatic endometriosis / N. Berlanda, P.P. Vercellini, L. Fedele. - In: CURRENT OPINION IN OBSTETRICS & GYNECOLOGY. - ISSN 1040-872X. - 22:4(2010), pp. 320-325. [10.1097/GCO.0b013e32833bea15]
Abstract:
Purpose of review
To evaluate the efficacy of second-line surgery in the management of recurrent
endometriosis.
Recent findings
Long-term probability of pain recurrence after repeat conservative surgery for recurrent
endometriosis varies between 20 and 40%. The association of presacral neurectomy
to the treatment of endometriosis might be effective in reducing midline pain; however,
no studies have evaluated this procedure among patients with recurrent disease.
The medium-term outcome of hysterectomy for endometriosis-associated pain is quite
satisfactory; nevertheless, probability of pain persistence after hysterectomy is 15% and
risk of pain worsening 3–5%, with a six times higher risk of further surgery in
patients with ovarian preservation as compared to ovarian removal. The conception rate
among women undergoing repetitive surgery for recurrent endometriosis associated
with infertility is 26%, whereas the overall crude pregnancy rate after a primary
procedure is 41%.
Summary
Repeat conservative surgery for pelvic pain associated with recurrent endometriosis has
the same efficacy and limitations as primary surgery. Conversely, after repeat
conservative surgery for infertility, the pregnancy rate is almost half the rate obtained
after primary surgery. More data are needed to define the best therapeutic option in
women with recurrent endometriosis, in terms of pain relief, pregnancy rate and
patient compliance.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
endometriosis; infertility; laparoscopic surgery; pelvic pain
Elenco autori:
N. Berlanda, P.P. Vercellini, L. Fedele
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