Surgical treatment of the external genital endometriosis as a risk factor for reducing young women`s
AbstractBackground. Endometriosis is a common multi-faceted disease that affects young women who often do not realize their reproductive function. At the same time, the incidence of external genital endometriosis (EGE), including endometriomas, which can cause surgery, including urgent, is increasing, and in 40% of patients, endometriomas are associated with infertility. The above-mentioned causes the risk of irreversible injury to the ovarian tissue and threatens to reduce the reproductive potential of such patients in the future.
Aim. To study the features of treatment of patients with EGE in a gynecological hospital in the context of a possible risk of reducing the ovarian reserve.
Material and methods. A retrospective analysis of 40 409 medical histories of patients of the gynecological Department for 2013-2019 was performed, among which the study group was formed-women with verified EGE who received surgical treatment (n=216).The structure of morbidity of patients with EGE, their gynecological history, features of medical documentation, preoperative preparation, the volume of surgery and the types of energy used in the surgical treatment of these patients in the context of a possible decrease in the ovarian reserve were analyzed. Standard methods of descriptive statistics were used for statistical processing of the data array. Differences between indicators were considered reliable at p<0.05.
Results. It was found that patients with EGE are mostly women of reproductive age who have not yet realized their reproductive function (average age - 31.9±3.6 years). Most of them are already at risk of reduced reproductive potential, due to the high prevalence of body mass deficiency (DMT) (81.4%) and concomitant inflammatory and proliferative gynecological diseases. It was found that in every third patient, EGE is combined with adenomyosis (31.4%), in 11.5% - with infertility. The structure of EGE was dominated by endometriomas of various stages (87%), including 22.9% with bilateral localization. One in five (22.0%) patients with endometriomas underwent emergency surgery. One in four patients had a history of surgery on the uterine appendages, and 28.8% were admitted for surgical treatment of recurrent ECI.
Conclusion. Despite the fact that all patients with EGE who are admitted to the gynecological hospital are operated with laparoscopic access, the revealed features of their surgical treatment indicate a high probability of negative iatrogenic effects on the ovarian reserve. This is due to the high frequency of emergency surgical interventions, including for acute abdominal syndrome - in surgical operating rooms, where there is no dominance of the ovarian reserve preservation paradigm and aggressive hemostasis methods can be used. Urgent care is associated with routine underestimation of the risk of reduced reproductive potential (lack of intraoperative assessment of the EGE stage according to the R-AFS classification and calculation of the fertility index), however, even after planned operations, only 8.8% of patients receive recommendations for anti-relapse medication at the hospital discharge stage.
A perspective way to reduce the risk of organ-carrying operations and endometriosis - associated infertility in young women is to justify their targeted stratification by risk groups with the subsequent development and implementation of personalized pre-conception programs.
Keywords:external genital endometriosis, endometrioma, surgical treatment, reproductive potential, ovarian reserve
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Khamoshina M.B., Abitova M.Z., Orazov M.R., Orazmuradov A.A., Demina O.A., Ismailzade S.Ya., Babaeva E.I. Surgical treatment of the external genital endometriosis as a risk factor for reducing young womens reproductive potential (based on the materials of the gynecological hospital). Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2020; 8 (3). Supplement: 55-60. DOI: 10.24411/2303-9698-2020-13909 (in Russian)
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