Women of reproductive age endogenous intoxication level assessment after surgical treatment of endometriosis

Abstract

Endometriosis develops and progresses under conditions of initial endogenous intoxication (EI) and negative changes in the body's reactivity. Surgical treatment is accompanied by tissue destruction at the site of trauma, aseptic inflammation, pathological protein catabolism, and massive cell death, which may lead to the development of a syndrome of mutual aggravation.

Aim - to determine the level of EI in women of reproductive age with endometriomas, depending on the surgical treatment method.

Materials and methods. A laparoscopic surgical treatment was performed on 120 reproductive-aged patients with ovarian endometriomas. The Group I consisted of 60 women who underwent bipolar coagulation (BPC) of the ovarian medullary layer, while the Group II included 60 women who received BPC of both the medullary and cortical layers. The EI level was assessed postoperatively based on the clinical course during the postoperative period, general blood test indicators, and biochemical markers of tissue destruction products (TDP).

Results. In the postoperative period, patients in the Group I showed lower levels of TDP such as medium-mass molecules (MMM₂₈₀, MMM₂₅₄), acid-soluble fractions of nucleic acids (ASFNA), malondialdehydes of thiobarbituric acid (TBA), and a 2.2 times higher endotoxic index (ETI) than women in the Group II.

Conclusions. After laparoscopic surgery with BPC of the ovarian medullary layer, the EI level showed less significant manifestations, as confirmed by a 1.3-fold decrease in MMM₂₈₀, MMM₂₅₄, and ASFNA levels, a 1.2-fold decrease in TBA levels, and a 2.2-fold increase in ETI levels. The most sensitive and early markers of tissue destruction in reproductive-aged women with endometriomas after laparoscopic surgery with BPC are ASFNA and TBA. Among patients who underwent laparoscopic surgery with BPC of the medullary layer, leukocytosis was 1.3 times less common, the number of patients with elevated C-reactive protein levels was 1.2 times lower, and the rehabilitation period was reduced by 1.2 times compared to patients who received BPC of both the medullary and cortical layers of the ovary.

The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all patients.

The authors declare no conflict of interest.