Wound endometriosis: risk factor evaluation and treatment.
BACKGROUND
Wound endometriosis is still a rare phenomenon. In this study, we tried to identify its risk factors and presented our experience in managing such disease.


METHODS
We studied twenty-three women with pathologically confirmed wound endometriosis after surgery between January 1990 and June 1999 retrospectively.


RESULTS
Patients were classified to three groups according to the types of operations including obstetric surgery (n = 6186), gynecologic surgery (n = 3231) and laparoscopic procedures (n = 2184), which made a significant difference in the occurrence rate of endometriosis (p = 0.04): 2.7 per 1000 obstetric surgeries, 1.5 per 1000 cases of gynecologic surgeries, and 0.5 per 1000 laparoscopic procedures. Obstetric surgery showed the relative risk of occurrence of wound endometriosis 7.71 (95%: 1.03-57.92) compared with laparoscopic procedures. The median time for occurrence of wound endometriosis in patients with normal preoperative CA-125 (< 15 mIU/ml), 760 days, was significantly longer than that in patients with abnormal preoperative CA-125 (> 15 mIU/ml) of 496 days (p = 0.03). Preoperative CA-125 level, patient's age, preoperative extent of endometriosis, or operative time made no significant contributions to the occurrence of wound endometriosis. Combination therapy of surgical excision and postoperative adjuvant therapy of GnRH-agonist or Danazol showed the better prognosis because it could decrease the recurrence of wound endometriosis (42.9% versus 11%, p = 0.01).


CONCLUSIONS
Obstetric surgery may be an important risk factor in contributing to wound endometriosis, and the aggressive behavior of endometriosis itself might also be a possible risk factor because it shortens the time of occurrence of wound endometriosis after surgery. Therapy might be dependent on individuals. Surgical excision with postoperative adjuvant therapy of either GnRH-agonist or Danazol might be valid, although its effectiveness needed proven in the future.
Wang
Peng-Hui
PH
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. phwang@vghtpe.gov.tw
Juang
Chi-Mou
CM
Chao
Hsiang-Tai
HT
Yu
Ken-Jen
KJ
Yuan
Chiou-Chung
CC
Ng
Heung-Tat
HT
D000328:Adult; D018394:CA-125 Antigen / Q000097:blood; D004715:Endometriosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D013513:Obstetric Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
D018394:CA-125 Antigen