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Park, Lee, and Chung: The role of gonadotrophin releasing hormone agonist for the treatment of scar endometriosis
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(12): 947-952.

Published online: 18 December 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.12.947

The role of gonadotrophin releasing hormone agonist for the treatment of scar endometriosis

So Yun Park, MD, Sa Ra Lee, MD, Hye Won Chung, MD

Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author: Sa Ra Lee, MD, PhD. Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea. Tel: +82-2-2650-6011, Fax: +82-2-2647-9860, sarahmd@ewha.ac.kr

Received 29 May 2012       Revised 14 October 2012       Accepted 17 October 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To investigate the characteristics and to define the most effective diagnosis and treatment option for the scar endometriosis resulting from abdominal incision or episiotomy.

Methods

Medical records of thirty women with scar endometriosis who underwent mass excision between 1996 and 2008 in our hospital were reviewed retrospectively. Data on the age, parity, surgical history, symptom, menstrual history, characteristics of the mass, preoperative diagnosis, treatment method and recurrence were analyzed.

Results

Scar endometriosis were developed after Cesarean section in 24 patients and episiotomy in 6 patients. Nearly all patients presented with a palpable mass with or without cyclic pain and mean duration of symptom was 23.8 months. Preoperative imaging study was performed in 14 patients, however there was no one whose preoperative imaging result was endometriosis. All scar endometriosis was completely excised with surrounding tissue. Gonadotrophin releasing hormone (GnRH) agonist was administered in 13 patients pre- or postoperatively. Recurrence of scar endometriosis after wide mass excision was noted in 4 patients (13.3%) who did not receive GnRH agonist therapy pre- or postoperatively.

Conclusion

This study supports that scar endometriosis is a result of the transplantation of endometrial tissue during procedures. The contribution of the imaging studies seems to be limited, so surgeon could perform mass excision for diagnosis and treatment with clinical history and physical exam without performing imaging study especially in for small scar endometriosis. Surgical excision accompanied by pre-, or postoperative GnRH agonist therapy may be helpful option for the prevention of recurrence however, we could not find any statistical significance in the effectiveness of GnRH agonist treatment.

Keywords: Endometriosis, Excision, Recurrence, GnRH agonist

Figures and Tables

Table 1
Clinical characteristics of scar endometriosis patients
kjog-55-947-i001

Values are presented as mean or number (%).

C-section, Cesarean section; VD, vaginal delivery with episiotomy.

aInterval time, months from last Cesarean section and episiotomy to symptom of scar endometriosis.

Table 2
Characteristics of scar endometriosis
kjog-55-947-i002

Values are presented as number (%).

US, ultrasonography; CT, computed tomography.

aSize of mass (mm2), width of mass (mm) × height of mass (mm).

Table 3
Recurrence rate according to combined GnRH-agonist treatment
kjog-55-947-i003

P-value=0.10 by Fisher's exact test. The recurrence rate between patients who underwent GnRH-agonist therapy and patients who did not underwent GnRH-agonist therapy pre- or postoperatively.

GnRH-agonist, gonadotrophin-releasing hormone agonist.

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