P-328 Comparison of operated ruptured and non-ruptured endometriomas
Authors: Erturun A.G , Dilbaz B 
Published: June 2022

Abstract

Study question
Are there differences between cases of ruptured and non-ruptured endometrioma?

Summary answer
Laboratory and clinical differences were detected between the patients who had surgery for ruptured endometrioma with the patients who had an unruptured endometrioma.

What is known already
Today, 20-50% of women with infertility problems have endometriosis. The incidence of endometrioma in patients with endometriosis is between 17-44%. Endometrioma is characterized by the presence of ectopic endometrial tissue in the form of cyst formation in the ovary. No value has yet been found to predict endometrioma rupture.

Study design, size, duration
Our study was conducted at Republic of Turkey Ministry of Health, Health Science University Etlik Zübeyde Hanım Gynecology Training and Research Hospital Infertility Clinic and all patients who were operated for endometrioma and had a histopathology report confirming the presence of endometrioma between January 2014 and December 2020 were included. It is a retrospective study.

Participants/materials, setting, methods
In this study, demographic characteristics, intraoperative findings, laboratory values and follow-up recommendations of two groups compared. The patients' age, presence of sexual activity or infertility, gravidity, abortion, accompanying systemic disease, operations, drug use, and symptoms were recorded. Preoperative and postoperative complete blood count, Cancer antigen125 (CA125), Cancer antigen19-9 (CA19-9), Cancer antigen15-3 (CA15-3), Carcinoembryonic antigen (CEA), alpha fetoprotein, anti mullerian hormone, fibrinogen, C-reactive protein (CRP) values of the patients were obtained.

Main results and the role of chance
The mean age of the patients recruited was 29.31±6.35(min:16-max:48). Endometrioma was intact in 146 (80.7%) of 181 patients, while endometrioma rupture was observed in 35 (19.3%) patients. C-reactive protein(p=.003), CA125(p&lt;.001), CA19-9(p=.016), CA15-3(p=.001), CEA(p=.002) and MPV(mean platalet volume) values in the preoperative period of patients with rupture (p=.001) and postoperative CA125(p=.033), MPV(p=.001) and neutrofil/lymphocyte (NLR)(p=.034) values were found to be significantly higher than patients without rupture. The lymphocyte (p=.029) and eosinophil (p=.015) values in the postoperative period were found to be significantly lower than the patients without rupture. In our study, the rate of rupture in patients with sexual activity (11.9%) was found to be significantly lower than the rate of rupture (30.6%) in patients without sexual activity (p=.002). The rate of rupture in patients with a history of infertility (11.4%) was found to be significantly lower than the rate of rupture in patients without infertility (25.5%) (p=.017). In patients with a history of infertility, the duration of infertility in patients with rupture was found to be significantly lower than in patients without rupture (p=.006). The presence of accompanying pathology in ruptured patients was found to be 30 (52.6%) significantly higher than 5 (4.1%) rupture cases without additional pathology (p&lt;.001).

Limitations, reasons for caution
The limitations of the study are the retrospective design, the evaluation of only patients who have undergone surgery, and it was performed in a single center.

Wider implications of the findings
Our study has the largest sample size and includes details not found in other studies in the literature, with a detailed examination of the patients' data. We think that our study will make important contributions to the literature in predicting endometrioma rupture.

Trial registration number
2021/76