Coexistence of endometriomas with extraovarian endometriosis
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The study suggests that endometriomas usually occur with peritoneal endometriosis and that surgical therapy may be useful. It was published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

The aim of the study is to show the coexistence of the endometriomas with peritoneal and deep infiltrating endometriosis, as well as with the adhesions.

It's a randomized retrospective study. Patients treated for endometrioma were included. In total there were 1054 patients. 310 medical records were chosen at random without a special selection and the data were analyzed.

In the study, endometriomas were alone, which means without extraovarian endometriosis and/or adhesions, in only 2.3% of the cases. In the total population, 80.6% of the patients had peritoneal endometriosis, 43.2% of the patients had deep infiltrating endometriosis and 38% of the patients had peritoneal and deep infiltrating endometriosis.

--In the analysis, they found that in unilateral endometriomas there is no relationship between endometrioma size and adnexal adhesions.

--The risk of Douglas obliteration increases with the size of the endometriomas in unilateral endometriomas.

--In bilateral endometriomas, the risk of complex adhesions is independent of the size of the endometriomas and relevantly higher than in unilateral endometriomas.

--Unilateral adnexal adhesions occurred in bilateral endometriomas only in 13.7%.

To conclude, it must be taken into account here that endometriomas usually occur with peritoneal endometriosis and that surgical therapy may be useful. However, adhesions and DIE are to be expected with surgical treatment, which could make the operation more difficult. Especially in large and bilateral endometriomas, a high coexistence with extraovarian endometriomas and adhesions is observed. Therefore, surgery should be performed by an experienced surgeon.

Source: https://doi.org/10.1016/j.ejogrb.2021.05.044
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