title: Recurrence of endometriomas after laparoscopic removal: sonographic and clinical follow-up and indication for second surgery.
abstract: OBJECTIVE
  This study involved patients who, after laparoscopic surgery, had recurrence of endometriomas detected by sonography. The aim of this study was to evaluate the role of transvaginal sonography (TVS) in the management of recurrent endometriomas and to establish ultrasonographic criteria that would direct the therapy toward additional surgery versus medical or expectant management.
  
  
  METHODS
  Retrospective analysis of 62 reproductive-age women who showed recurrence of endometriomas on TVS after laparoscopic removal of an ovarian endometrioma by the stripping technique (Canadian Task Force classification II-1).
  
  
  METHODS
  Obstetrics and Gynecology Department, University of Rome Tor Vergata.
  
  
  METHODS
  Sixty-two patients with recurrent endometriomas after first-line treatment with laparoscopy.
  
  
  METHODS
  Ultrasonographic follow-up and/or second surgery.
  
  
  RESULTS
  Recurrence of an ovarian endometrioma was defined as the presence of ovarian cysts with the typical sonographic criteria of endometriomas and a diameter of more than 10 mm. The clinical and sonographic postoperative follow-up period lasted from 6 to 97 months (median 24.6) after the first procedure. Of 62 patients with recurrent endometriomas, 50 had recurrence on the treated ovary, 7 on the contralateral untreated ovary, and 5 on both the treated and untreated ovaries. Recurrence of endometriomas was associated with symptoms (pain or infertility) in 47 patients (76%), while the remaining 15 (24%) were asymptomatic. Of the 47 symptomatic patients with recurrence detected by TVS, a second procedure was performed in 15. Second surgery in these patients was indicated by the larger size of the recurrent cysts, a poor response to medical treatment, the presence on TVS of pelvic adhesions and nodules of deep endometriosis, and overall progression of the disease. Symptomatic patients who did not undergo a second procedure (32) had smaller recurrent endometriomas. However of the 31 symptomatic patients with large recurrent endometriomas (>3 cm), only 45% had repeat surgery.
  
  
  CONCLUSIONS
  Recurrent endometriomas, as detected by TVS, can remain asymptomatic and do not necessarily progress in size with or without medical treatment. The decision to reoperate depends less on the endometrioma's size than on symptoms, in particular severe pain, and failure of medical treatment. However such patients are also more likely to have signs of deep nodules and adnexal/bowel adhesions and larger endometriomas on TVS scan, thus predisposing them to require a second procedure.
authors.affiliation: Obstetrics and Gynecology Department, Università degli Studi di Roma Tor Vergata, Rome, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Exacoustos
authors.forename: Errico
authors.initials: E
authors.lastname: Zupi
authors.forename: Annalisa
authors.initials: A
authors.lastname: Amadio
authors.forename: Concetta
authors.initials: C
authors.lastname: Amoroso
authors.forename: Beata
authors.initials: B
authors.lastname: Szabolcs
authors.forename: Maria Elisabetta
authors.initials: ME
authors.lastname: Romanini
authors.forename: Domenico
authors.initials: D
authors.lastname: Arduini
mesh_terms: D000328:Adult; D000367:Age Factors; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D014463:Ultrasonography