title: Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery.
abstract: OBJECTIVE
  To evaluate the excised specimen with histologic analysis and to assess the antral follicle count (AFC) at follow-up. This is to determine whether excisional surgery for recurrent endometriomas is more harmful to ovarian tissue and to the ovarian reserve than first surgery.
  
  
  METHODS
  Prospective controlled study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Consecutive patients with pelvic pain and/or infertility undergoing laparoscopic excision of a monolateral ovarian endometrioma for the first time (17 patients) or for recurrence after previous surgery (11 patients).
  
  
  METHODS
  Laparoscopic excision of ovarian endometrioma and ultrasonographic evaluation 3 months after surgery.
  
  
  METHODS
  Cyst wall histologic evaluation (specimen thickness, presence and morphology of ovarian tissue) and evaluation of ovarian reserve with AFC and ovarian volumes of both the operated and contralateral, nonoperated ovary at follow-up.
  
  
  RESULTS
  The cyst wall specimen was significantly thicker in the recurrent endometrioma group than in the first surgery group (1.7 ± 0.3 mm vs. 1.1 ± 0.3 mm). Both main components of the cyst specimen (i.e., endometriosis tissue and ovarian tissue) were more represented in the recurrent endometrioma group than in the first surgery group. At sonographic follow-up, the operated ovary had a significantly lower AFC and volume than the contralateral nonoperated ovary in the recurrent endometrioma group, but not in the primary surgery group.
  
  
  CONCLUSIONS
  Surgery for recurrent endometriomas is associated with evidence of a higher loss of ovarian tissue and is more harmful to the ovarian reserve evaluated by AFC and ovarian volume, if compared with endometriomas operated for the first time. Indications to surgery for recurrent endometriomas should be reconsidered with caution.
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy. Electronic address: ludovico.muzii@uniroma1.it.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Muzii
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Achilli
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lecce
authors.affiliation: Department of Pathology, Campus BioMedico University, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Franceschetti
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Perniola
authors.affiliation: Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Pierluigi Benedetti
authors.initials: PB
authors.lastname: Panici
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D065851:Ovarian Reserve; D010053:Ovary / Q000293:injuries* / Q000473:pathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012008:Recurrence; D014463:Ultrasonography
keywords: Endometrioma; laparoscopic surgery; ovarian cyst excision; ovarian reserve; recurrence