Modern approaches to surgical management of endometrioma

Publication date: Available online 5 January 2019Source: Best Practice & Research Clinical Obstetrics & GynaecologyAuthor(s): S. Gordts, R. CampoAbstractFormation of the ovarian endometrioma consists of implantation, invagination of the ovarian cortex and adhesion formation. Progression is characterized by repeated injury and repair (ReTIAR) with degenerative changes. Already with a partially deprived ovarian reserve, as a consequence of the disease, surgical treatment carries a potential risk of further follicular deprivation. Surgery should therefor be performed with microsurgical precision by experienced hands.Early treatment can possibly prevent further progression. The adverse impact on ovarian reserve of the ablative approach has to be balanced against a lower recurrence rate of a cystectomy. Adapted surgical approaches like a two-step approach or a combination of excisional and ablative surgery has to be considered in case of large endometrioma. Further studies on the possibility and advantages of sclerotherapy are warranted. Fertility preservation by cryopreservation of ovarian cortex should be part of the informed consent with the patient.
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research