Modern approaches to surgical and postsurgical medical management of patients with endometriosis

В. В. Камінський, Т. Ф Татарчук, І. З. Гладчук, М. Мюллер

Abstract


December 8, 2016 in Kyiv Advisory Board was held related to modern approaches to surgical and postsurgical medical management of patients with endometriosis. Endometriosis is a chronic estrogen-dependent gynecological disease which requires a life-long management plan with the goal of maximizing the use of medical treatment and avoiding repeated surgical procedures. The disease management tactics in patients with endometriosis are determined by the clinical symptoms and includes observation, medical treatment, surgical treatment (conservative, radical), using of the assisted reproductive technologies. To prevent endometriosis recurrence it is reasonable to use a combined approach – surgical methods and hormonal therapy.

In resolution surgical tactics of management of patients with endometriosis is described in detail based on clinical symptoms and appropriate conditions for this intervention, according to the unified clinical protocol “Management of patients with genital endometriosis” approved by Order of Ministry of Health of Ukraine No. 319 dated April 06, 2016.

Postsurgical prevention of endometriosis recurrence is an important stage of management of patients with endometriosis, as regardless of the proven efficacy of the surgical treatment, a risk of endometriosis lesions and pain recurrence is exist.

As noted in the resolution, currently no clear criteria for endometriosis recurrence evaluation are available. The hormonal therapy may maintain the positive effect of the surgical treatment for a long time and may minimize the risk of pain and endometrioid lesions recurrence. For secondary prevention of endometriosis recurrence and associated pain long-term hormonal therapy is recommended (> 6 months). A surgeon plays a key role in prescription of postsurgical medical treatment: he/she determines its strategy for the first 6 months after the surgery in alignment with the outpatient physician.

To treat the women with endometriosis and infertility, the surgeon should have the appropriate skills and experience. Cooperation with the centers of reproductive medicine is also mandatory. In persistent infertility (failure of long-term therapy) of non-defined origin and suspected endometriosis (presence of pain syndrome), it is reasonable to perform the laparoscopy to rule out the endometriosis as a cause of infertility and its surgical treatment. After surgery, the patients with the reproductive plans are recommended to prescribe dienogest for 3 months and in case of infiltrating endometriosis forms – at least for 6 months to minimize the inflammatory process. As its noted in resolution medical and surgical methods of endometriosis treatment should not be considered as competitive but as compatible, which increase the treatment efficacy and improve the disease prognosis.


Keywords


endometriosis; infertility; surgical methods; hormonal therapy; secondary prevention

References


Management of patients with endometriosis. Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care, approved by the Order of the Ministry of Health of Ukraine № 319 from 06.04.2016.

Sinaii Ninet, et al. “Differences in characteristics among 1,000 women with endometriosis based on extent of disease.” Fertil Steril 89.3 (2008): 538–45.

Schliep, K.C., et al. “Pain typology and incident endometriosis.” Hum Reprod 30.10 (2015): 2427–38.

McKinnon, B.D., Bertschi, D., Bersinger, N.A., Mueller, M.D. “Inflammation and nerve fiber interaction in endometriotic pain.” Trends Endocrinol Metab 26.1 (2015): 1–10.

Mettler, L., Ruprai, R., Alkatout, I. “Impact of medical and surgical treatment of endometriosis on the cure of endometriosis and pain.” Biomed Res Int (2014): 264653.

Kennedy S., et al. “ESHRE guideline for the diagnosis and treatment of endometriosis.” Hum Reprod 20 (2005): 2698–704.

Ulricha, U., De Wild, R.L. “New guidelines on diagnosis and treatment of endometriosis in German-speaking countries.” Gynecology and Minimally Invasive Therapy 5.1 (2016): 41–3.

Dunselman, G.A., et al. “ESHRE guideline: management of women with endometriosis.” Hum Reprod 29.3 (2014): 400–12.

Koga, K., et al. “Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis.” Fertility and Sterility 104.4 (2015): 793–801.

Johnson, N.P., Hummelshoj, L. “Consensus on Current Management of Endometriosis.” Hum Reprod 28.6 (2013): 1552–68.

Practice Committee of the American Society for Reproductive Medicine. “Treatment of pelvic pain associated with endometriosis.” Fertil Steril 90 Suppl 5 (2008): 260–9.

Leyland, N., et al. “Endometriosis: diagnosis and management.” J Obstet Gynaecol Can 32.7 Suppl 2 (2010): 1–32.

Fenton, A., Panay, N. “Does routine gynecological surgery contribute to an early menopause?” Climacteric 15.1 (2012): 1–2.

Koga, K., et al. “Recurrence of endometrioma after laparoscopic excision and its prevention by medical management.” Frontiers in Bioscience 5 (2013): 676–83.

Guo, S.W. ”Recurrence of endometriosis and its control.” Hum Reprod Update 15.4 (2009): 441–61.

Cocciaa, M.E., et al. “European Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain.” J Obst Gyn Repr Biol 157.1 (2011): 78–83.

Somigliana, E., et al. “Postoperative Medical Therapy After Surgical Treatment of Endometriosis: From Adjuvant Therapy to Tertiary Prevention.” J Minim Invasive Gynecol 21.3 (2014): 328–34.

Namnoum, A.B., et al. “Incidence of symptom recurrence after hysterectomy for endometriosis.” Fertil Steril 64.5 (1995): 898–902.

Busacca, M., et al. “Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis.” Am J Obst Gyn 195 (2006): 426–32.

Busacca, M., et al. “The current place of progestins in the treatment of endometriosis.” Expert Review of Obstetrics & Gynecology 7.2 (2012).

Ota, Y., et al. “Long-term administration of dienogest reduces recurrence after excision of endometrioma.” Journal of Endometriosis and Pelvic Pain Disorders 7.2 (2015): 63–7.

Schweppe, K.-W. “The current place of progestins in the treatment of endometriosis.” Expert Rev of Obstet Gynecol 7.2 (2012): 141–8.

Bahamondes, L., et al. “Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea.” Contraception 75 (2007) : 134–9.

Serdar, E., et al. “Role of Estrogen Receptor-β in Endometriosis.” Nat Med 18.7 (2012): 1016–8.

Chapron, C., et al. “Oral contraceptives and endometriosis: the past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis.” Hum Reprod 26.8 (2011): 2028–35.

Seracchioli, R. “Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom recurrence after conservative surgery for endometriosis.” Hum Reprod 24.11 (2009): 2729–35.

Seracchioli, R., et al. “Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial.” Fertil Steril 94.2 (2010): 464–71.


GOST Style Citations


1. Тактика ведення пацієнток із генітальним ендометріозом. Уніфікований клінічний протокол первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги, затверджений наказом МОЗ України від 06.04.2016 № 319.

2. Sinaii Ninet, et al. “Differences in characteristics among 1,000 women with endometriosis based on extent of disease.” Fertil Steril 89.3 (2008): 538–45.

3. Schliep, K.C., et al. “Pain typology and incident endometriosis.” Hum Reprod 30.10 (2015): 2427–38.

4. McKinnon, B.D., Bertschi, D., Bersinger, N.A., Mueller, M.D. “Inflammation and nerve fiber interaction in endometriotic pain.” Trends Endocrinol Metab 26.1 (2015): 1–10.

5. Mettler, L., Ruprai, R., Alkatout, I. “Impact of medical and surgical treatment of endometriosis on the cure of endometriosis and pain.” Biomed Res Int (2014): 264653.

6. Kennedy S., et al. “ESHRE guideline for the diagnosis and treatment of endometriosis.” Hum Reprod 20 (2005): 2698–704.

7. Ulricha, U., De Wild, R.L. “New guidelines on diagnosis and treatment of endometriosis in German-speaking countries.” Gynecology and Minimally Invasive Therapy 5.1 (2016): 41–3.

8. Dunselman, G.A., et al. “ESHRE guideline: management of women with endometriosis.” Hum Reprod 29.3 (2014): 400–12.

9. Koga, K., et al. “Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis.” Fertility and Sterility 104.4 (2015): 793–801.

10. Johnson, N.P., Hummelshoj, L. “Consensus on Current Management of Endometriosis.” Hum Reprod 28.6 (2013): 1552–68.

11. Practice Committee of the American Society for Reproductive Medicine. “Treatment of pelvic pain associated with endometriosis.” Fertil Steril 90 Suppl 5 (2008): 260–9.

12. Leyland, N., et al. “Endometriosis: diagnosis and management.” J Obstet Gynaecol Can 32.7 Suppl 2 (2010): 1–32.

13. Fenton, A., Panay, N. “Does routine gynecological surgery contribute to an early menopause?” Climacteric 15.1 (2012): 1–2.

14. Koga, K., et al. “Recurrence of endometrioma after laparoscopic excision and its prevention by medical management.” Frontiers in Bioscience 5 (2013): 676–83.

15. Guo, S.W. ”Recurrence of endometriosis and its control.” Hum Reprod Update 15.4 (2009): 441–61.

16. Cocciaa, M.E., et al. “European Long-term follow-up after laparoscopic treatment for endometriosis: multivariate analysis of predictive factors for recurrence of endometriotic lesions and pain.” J Obst Gyn Repr Biol 157.1 (2011): 78–83.

17. Somigliana, E., et al. “Postoperative Medical Therapy After Surgical Treatment of Endometriosis: From Adjuvant Therapy to Tertiary Prevention.” J Minim Invasive Gynecol 21.3 (2014): 328–34.

18. Namnoum, A.B., et al. “Incidence of symptom recurrence after hysterectomy for endometriosis.” Fertil Steril 64.5 (1995): 898–902.

19. Busacca, M., et al. “Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis.” Am J Obst Gyn 195 (2006): 426–32.

20. Busacca, M., et al. “The current place of progestins in the treatment of endometriosis.” Expert Review of Obstetrics & Gynecology 7.2 (2012).

21. Ota, Y., et al. “Long-term administration of dienogest reduces recurrence after excision of endometrioma.” Journal of Endometriosis and Pelvic Pain Disorders 7.2 (2015): 63–7.

22. Schweppe, K.-W. “The current place of progestins in the treatment of endometriosis.” Expert Rev of Obstet Gynecol 7.2 (2012): 141–8.

23. Bahamondes, L., et al. “Use of the levonorgestrel-releasing intrauterine system in women with endometriosis, chronic pelvic pain and dysmenorrhea.” Contraception 75 (2007) : 134–9.

24. Serdar, E., et al. “Role of Estrogen Receptor-β in Endometriosis.” Nat Med 18.7 (2012): 1016–8.

25. Chapron, C., et al. “Oral contraceptives and endometriosis: the past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis.” Hum Reprod 26.8 (2011): 2028–35.

26. Seracchioli, R. “Post-operative use of oral contraceptive pills for prevention of anatomical relapse or symptom recurrence after conservative surgery for endometriosis.” Hum Reprod 24.11 (2009): 2729–35.

27. Seracchioli, R., et al. “Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial.” Fertil Steril 94.2 (2010): 464–71.





DOI: http://dx.doi.org/10.18370/2309-4117.2017.34.8-14

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