Differentiated approaches to the development of prolonged treatment regimens for patients with endometriosis in the postoperative period
- Authors: Bezhenar V.F.1, Kuzmina N.S.1, Kruglov S.Y.1, Gramatikova A.G.1, Izorkina V.A.1, Medvedeva I.V.1, Demidov A.D.1, Strukova D.S.1, Fedosova D.V.1, Barnash I.A.1
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Affiliations:
- Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
- Issue: No 9 (2024)
- Pages: 140-148
- Section: Exchange of Experience
- URL: https://journals.eco-vector.com/0300-9092/article/view/637385
- DOI: https://doi.org/10.18565/aig.2024.203
- ID: 637385
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Abstract
Objective: To analyze the characteristics of the management of patients with endometriosis who underwent surgery in the gynecological department over two years in order to develop personalized therapy for endometriosis; to analyze the preferable duration of use of dydrogesterone as effective anti-relapse therapy for endometriosis.
Materials and methods: The retrospective study included 292 patients of reproductive age (16-49 years old) diagnosed with endometriosis. The patients underwent laparoscopic treatment for endometriosis at the Clinic of Obstetrics and Gynecology of Pavlov First Saint Petersburg State Medical University, Russia from 2021 to 2023. The preferable duration of treatment was discussed on the basis of retrospective analysis and clinical case series.
Results: Endometriomas were found in 176/292 (60.3%) patients and were significantly more frequent in groups with stage III and IV endometriosis (p<0.0001). Peritoneal endometriosis was detected more often intraoperatively in patients with stage I and II endometriosis (p=0.000002). All patients received long-term hormone-modulating therapy when there were indications and no contraindications. Recurrence of endometriosis was noted in women who received combined oral contraceptives and dienogest as they had poor tolerance to therapy.
Conclusion: Surgical treatment for endometriosis should be performed only when indicated and during intraoperative staging of the disease. Taking into account the risks of complications and decreased quality of life in case of repeated surgical intervention for recurrent endometriosis and possible reproductive plans of the patient, further treatment in the form of personalized drug therapy is advisable. Effective and safe therapy of endometriosis with dydrogesterone can be recommended to the patient for a long time, more than 48 months, which allows to minimize the risk of recurrence of the disease.
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About the authors
Vitaly F. Bezhenar
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Author for correspondence.
Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929
Dr. Med. Sci., Professor, Head of the Departments of Obstetrics, Gynecology and Neonatology/Reproductology, Head of the Clinic of Obstetrics and Gynecology; Main Supernumerary Specialist Obstetrician-Gynecologist of the Health Committee of St. Petersburg
Russian Federation, St. PetersburgNatalya S. Kuzmina
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: dok.kuzmina@gmail.com
ORCID iD: 0000-0002-8404-1859
PhD, Head of the Oncology Department No. 7, Teaching Assistant at the Department of Obstetrics, Gynecology and Neonatology
Russian Federation, St. PetersburgSviatoslav Yu. Kruglov
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: skruglov89@mai.ru
ORCID iD: 0000-0001-7399-3398
PhD, Teaching Assistant at the Department of Obstetrics Gynecology and Reproductology
Russian Federation, St. PetersburgAna G. Gramatikova
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: frau.gramatikova@yandex.ru
ORCID iD: 0000-0001-7463-1831
PhD student at the Department of Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgVera A. Izorkina
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: izorkina.vera@yandex.ru
ORCID iD: 0000-0002-1316-5280
Teaching Аssistant at the Department of Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgIrina V. Medvedeva
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: iriska18.05@mail.ru
ORCID iD: 0000-0002-5625-7855
Obstetrician-Gynecologist at the Oncology Department No. 7
Russian Federation, St. PetersburgAleksandr D. Demidov
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: alexander.demidov.1997@gmail.com
ORCID iD: 0009-0006-7618-7272
PhD student at Department the Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgDaria S. Strukova
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: dashastr97@inbox.ru
ORCID iD: 0009-0008-1597-0946
PhD student at the Department the Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgDariia V. Fedosova
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: fedosova.dariya@yandex.ru
ORCID iD: 0000-0003-1030-6110
PhD student at the Department the Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgIlarion A. Barnash
Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Email: Barnash.LA@yandex.com
ORCID iD: 0009-0006-9177-7166
PhD student at the Department the Obstetrics, Gynecology and Reproductology
Russian Federation, St. PetersburgReferences
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