SURGICAL SCAR ENDOMETRIOMA

Relatively few instances of surgical scar endometrioma have been repor ted. Herein we review 24 patients treated for this condition at the in stitutions at which we work between 1972 and 1992. The age of the pati ents ranged from 17 to 47 years, with an average age of 31.7 years. Su rgical scar endometriomas occurred after operations including cesarean section (19 patients), appendectomy (two patients), episiotomy (two p atients) and hysterectomy (one patient). The interval between prior su rgical treatment and the onset of symptoms ranged from one to 20 years , with an average of 4.8 years. All patients were treated by wide exci sion. Seventeen of 24 patients were available for follow-up evaluation . The interval between excision and follow-up evaluation ranged from 1 .2 to 14.0 years, with an average of 6.4 years. None of the patients h ad recurrence of surgical scar endometrioma. Patients with the classic presentation of a painful surgical scar mass that increases in size o r tenderness during menstruation need no further evaluation of the les ion before excision. Ultrasonographic examination and fine needle aspi ration biopsy should be used preoperatively in women who have a consta ntly painful or asymptomatic mass in a surgical scar. Because medical management yields poor results, wide excision of surgical scar endomet riomas is the treatment of choice.