**6. Pharmacological treatment**

Medical management of the endometriosis by drugs as danazol, GnRH-analogues, progestagens or oral contraceptives, results usually in the temporary relief of pain (53). Opinions concerning combined therapy are different. According to Horton et al. (29) there are no data to support postoperative hormonal therapy. Sometimes might be useful preoperative treatment by GnRH-analogues for three months to diminish the tumour size

Endometrial Tumors in Postoperative Scars - Pathogenesis, Diagnostics and Treatment 95

Hyperestrogenismus, even relative, seems to be also a risk factor of endometriosis, though there is a lack of valuable literature data confirming it in relation to scar endometriomas.

The important risk factor is the genetic one. Lattuada et al. (37) reported that the frequency of the PROGINS allele T2 in affected women was 17,2% compared with 11% in controls. They are of opinion that the progesterone receptor mutation increases the risk of endometriosis morbidity two fold. Teng et al. (56) discussing their results mentioned that the antiapoptotic function of the survivin gene may play an important role in endometriotic

First of all one should avoid unnecessary cesarean sections (41, 59). To prevent the iatrogenic inoculation of the endometrium into the surgical wound during the cesarean section it is strongly recommended to protect the abdominal wall by a quadrangular bandage during curettage of an uterine cavity after removal of the placenta, discard immediately after cleaning the uterine cavity swabs or sponges, not to reuse the suture material used to suturing of the uterus during the closure of the abdominal wall. The surgical wound should be thoroughly cleaned and irrigated by saline before final closure, especially at the operators side in Pfannenstiel incision (16, 55). Zhu et al. (59) recommend

Performing another surgical procedures lifting the uterus outside of the pelvis before making uterine incision and removing a functional corpus luteum during hysterectomy may reduce the likelihood of arising the scar endometriosis (11,29). Before endometrial cystectomy all the cystic content should be sucked out, the incision of the abdominal wall covered by swabs and before closure abdominal cavity and incision thoroughly flushed by

Wicherek et al. (57) clearly demonstrated, that cesarean section performed before spontaneous onset of labor significantly increases the risk of abdominal wall scar endometriosis thanks to higher immunotolerance. This might also explain higher rate of endometriomas in scars after cesarean section comparing to episiotomy.scars. Thus, if it is possible, the decision on cesarean section should be delayed till the natural onset of the

It should be avoided estrogen monotherapy in obese patients, becuse such treatment

A prolonged breast feeding is well known protecting factor because of causing

Administering of antioxidant agents and proper diet (3) seem to be to some extent helpful,

The typical complications of scar endometriosis are relatively high recurrence rate, malignancy and anatomical defects. Olejek et al. (43) reported a very high recurrence rate – 8

augments the risk of rising and malignant degeneration of endometriotic lesions (7).

hypoestrogenic status that does not support endometriosis development.

so as endometriosis coexists with local inflammatory reaction.

during suturing the myometrium to avoid penetration of endometrium.

implant survival and invasion.

**8. Prophylaxis** 

saline (59).

labour.

**9. Complications** 

(1). On the other hand Zhu et al. (59) in a part of their patients administered postoperative analogues of GnRH. Ding and Hsu (16) prescribed danazol for six months postoperatively. Korczyński and Sobkiewicz (35) are of opinion, that pharmacological treatment can be applied in some cases as a complementary therapy. Kurotsuchi et al. (36) suggest that GnRH-agonist therapy might be an alternative to surgical treatment.

The presence of aromatase activity in endometriotic lesions might be a new target of therapeutical actions. Oner et al. (45) in an animal model showed significant regression of endometriotic implants by letrozol and metformin. Moreover, in the metformin group thanks to its antiproliferative and anti-inflammatory properties the authors observed less adhesions.

Basing on the results from animal studies it seems be effective in future to treat and prevent endometriosis by vaccination using immunomodulators like RESAN, DETOX or BCG (54).

New therapeutical options mentioned by Skrzypczak (53) may represent statins and selective progesterone receptor modulators.

Antioxidants and nonsteroidal antiinflammatory drugs are considered as a possible additive therapeutical options (3).
