Schweppe, K. W., & Ring, D. (2002). Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle. Fertility and Sterility, 78(4), 763-766. https://doi.org/10.1016/s0015-0282(02)03431-3
Schweppe KW, Ring D. Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle. Fertil Steril. 2002;78(4):763-766. doi:10.1016/s0015-0282(02)03431-3
Schweppe, Karl-Werner, and Dieter Ring. "Peritoneal defects and the development of endometriosis in relation to the timing of endoscopic surgery during the menstrual cycle." Fertility and Sterility, vol. 78, no. 4, 2002, pp. 763-766.
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Stage I-II endometriosis recurred twice as often after luteal surgery
Minimal-to-mild endometriosis came back about twice as often after luteal-phase surgery, a chart review at one hospital found. Of 220 women, about 15 out of 100 operated on days 22 to 28 had biopsy-proven recurrence within 2 years. About 8 out of 100 had it after follicular-phase surgery. About 7 out of 100 had it after periovulatory-phase surgery.
Key Findings
The total recurrence rate after 2 years was 9.6% among the 220 women.
Biopsy-confirmed recurrence at 24 months: 10 of 67 women (14.9%) in the luteal phase, 5 of 62 (8.1%) in the follicular phase, and 6 of 91 (6.6%) in the periovulatory phase.
The luteal group had a significantly higher recurrence rate as early as 6 months and throughout the 2 years. The follicular and periovulatory groups did not differ.
Macroscopy and microscopy agreed in 89% of laparoscopic findings overall: 91% in the luteal phase, 89% in the follicular phase and 87% in the periovulatory phase.
With three exceptions, all visual recurrences occurred as peritoneal disease, in the original sites and in additional peritoneal sites.
Interpretation
This chart review followed 220 women with stage I or II endometriosis for two years after surgery. Doctors sorted each woman into one of three groups by the cycle phase of her operation, using her period dates and hormone blood tests taken before the procedure. The authors think injury near a period helps stray endometrial cells take hold on the pelvic lining, and that this adds to whatever is already driving the disease. The findings support larger studies of surgery timing and how this disease comes back over time in the years that follow treatment.
RRM Context
The authors say surgery works best early in the cycle, before menstrual flow begins. Restorative reproductive medicine treats a woman's cycle as useful clinical information for planning her care. Here, cycle phase at the time of surgery was linked with whether disease came back. The authors say the overall 9.6% rate matches what other published reports have found in similar patient groups.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
In vitro studies demonstrated that implantation on membranes (peritoneum, amniotic membranes) can take place if there are defects on the surface of the membranes. If these mechanisms play a role for the development of endometriosis in vivo, then patients with surgical treatment of peritoneal endometriosis in the luteal phase must have a high recurrence rate.
Design
Retrospective analysis of operation charts and follow-up data.
Setting
Department of gynecology, in a hospital-based endometriosis treatment center.
Patients
Two hundred twenty premenopausal women.
Interventions
Laparoscopic treatment for peritoneal endometriosis, stage I and II by revised American Society for Reproductive Medicine guidelines.
Main Outcome Measures
During the follow-up period of 2 years, symptoms and gynecological and sonographic findings were documented. In case of suspected recurrence a repeat laparoscopy with biopsy was performed to prove the recurrent endometriosis macroscopically and histologically.
Results
The total recurrence rate after 2 years was 9.6%. The recurrence rate of group III (15%) was twice as high as those of group I (7%) and group II (8%), as indicated by subjective complaints, clinical findings, macroscopy, and histology; no differences were found between groups I and II.
Conclusions
Endoscopic surgery for the treatment of peritoneal endometriosis should not be performed in the luteal phase.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.
Endometriosis › Surgical Treatment › Recurrence After Surgery · Reproductive Surgery › Laparoscopy › Technique · General Gynecology › Clinical Practice › Practice Patterns
Karl-Werner Schweppe, Dieter Ring
K Schweppe, D Ring
PMID 12372453 12372453 DOI 10.1016/s0015-0282(02)03431-3 10.1016/s0015-0282(02)03431-3 Schweppe et al. 2002, Schweppe 2002
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