**8. Prophylaxis**

94 Endometriosis - Basic Concepts and Current Research Trends

(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

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

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

Antioxidants and nonsteroidal antiinflammatory drugs are considered as a possible additive

The most evident risk factor for the scar endometriosis are obstetrical surgical procedures, especially cesarean section (38,41). It is believed that the opening of uterine cavity mainly during cesarean section causes the risk of decidualized endometrium implantation (10,29,53,57). The risk of scar endometriosis is significantly higher, when the cesarean section is performed before the term (44,56,57), though Nominato et al. (41) does not confirm this suggestion. There is no correlation between the parity, number of cesarean sections and the disease prevalence (38) but de Oliveira et al. (44) are of opinion that low parity may

The risk of scar endometrioma is augmented when not proper operative techniques are used (not closing the visceral and parietal peritoneum, using of the same surgical material during opening and closing uterus and abdominal wall, failure to shielding the wound during lack of placenta extraction with subsequent curettage and thorough washing before definitive

On the other hand, as it is mentioned by Zhu et al. (59) endometriosis in the postoperative scar may occur not only after operations that need not open the uterus (for example tubal

Pelvic endometriosis seems to be the risk factor of arising scar endometriosis when treated by laparoscopy (10,29). The laparoscopic procedure may cause transportation of endometrial cells in the abdominal wall in women with a predisposition to endometriosis. Agarval and Fong (1) found that spontaneous cutaneous endometriosis was associated with

Non-surgical risk factors of scar endometrioma are also alcohol consumption and increased

GnRH-agonist therapy might be an alternative to surgical treatment.

selective progesterone receptor modulators.

therapeutical options (3).

**7. Risk factors** 

increase the risk.

closure) (38,55).

operations).

more severe pelvic disease.

menstrual flow (44).

adhesions.

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 during suturing the myometrium to avoid penetration of endometrium.

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 saline (59).

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 labour.

It should be avoided estrogen monotherapy in obese patients, becuse such treatment augments the risk of rising and malignant degeneration of endometriotic lesions (7).

A prolonged breast feeding is well known protecting factor because of causing hypoestrogenic status that does not support endometriosis development.

Administering of antioxidant agents and proper diet (3) seem to be to some extent helpful, so as endometriosis coexists with local inflammatory reaction.
