- Email: [email protected]
2445 Appendiceal Pathology in Women with Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
S185
serve as an important stepping stone in raising awareness and introducing educational campaigns to improve the utility and adoption of this essential preoperative and diagnostic tool.
Setting: A 26 year old female patient, who complained of primary dysmenorrhea, associated with changes in her cathartic frequency. The pain persisted despite treatment with Dienogest. MRI was performed, which showed left pyelocaliceal dilation as well as a 5 cm endometriotic nodule which involved the sigmoid. A ureteral catheter was placed and surgery was planned. Interventions: We used a minimally invasive approach to perform ureterolysis and shaving of the intestinal nodule. Conclusion: Hospital discharge was made the day after the procedure.
Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION T 1974 Is the World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonisation Project (EPHECT) Questionnaire a Good Triaging Tool for Women with Ovarian and Posterior Compartment Endometriosis? Vanza K,1,* Leonardi M,1 Espada M,2 Condous G1. 1Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney, NSW, Australia; 2Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Sydney, NSW, Australia *Corresponding author. Study Objective: We aim to demonstrate whether the WERF EPHect Questionnaire can be used as a triaging tool to determine which women, based upon symptoms, are more likely to have ovarian and posterior compartment endometriosis on ultrasound. Design: Prospective observational study (July 2018 to March 2019). Setting: The WERF EPHect Questionnaires were emailed to women with possible endometriosis booked in for a ’deep endometriosis’ (DE) ultrasound at two specialized ultrasound centers. Patients or Participants: Women with a history of pelvic pain, dysmenorrhoea, dyspareunia and dyschezia were included. Interventions: The DE ultrasounds were performed by advanced sonologists as per the IDEA consensus opinion. A subsection of the questionnaire focusing on bowel symptoms (during menses and in the preceding 3 months) was compared to DE ultrasound findings. Logistic regression analysis was performed to assess the correlation between online responses and ultrasound findings. Measurements and Main Results: 217 women were emailed the online questionnaire; 136/217 (62%) responded prior to their DE ultrasound. The ultrasound prevalence of ovarian endometriomas, rectal DE and complete pouch of Douglas (POD) obliteration on ultrasound were 24%, 18% and 18%, respectively. There was no significant difference in the prevalence of disease in the respondents versus non-respondents (47%/47% posterior compartment, 31%/24% ovarian, respectively (p-value<0.05)). Older age, blood and mucus in stool and fullness and bloating were significant predictors of ovarian disease. Older age and blood in stool were predictive of posterior compartment disease, specifically rectal DE and POD obliteration. Conclusion: When the WERF EPHect Questionnaire is applied, bowel symptoms have the potential to be utilized as a triaging tool to determine which women require DE ultrasounds. A structured international symptomatology survey may be able to better target the utility of the DE ultrasound. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION A 1684 Urinary Tract Endometriosis: Ureterolysis Rosas P,1,* Viglierchio VT,1 Garcia Marchi~ nena P2. 1Gynecology, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina; 2Urology, Hospital Italiano Buenos Aires, Buenos Aires, Argentina *Corresponding author. Video Objective: Present an infrequent pathology of gynecological pelvic surgery, expose the clinical case and the theoretical framework in an educational way and show the surgical resolution made.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION B 1907 Hydronephrosis- Ureteral Squeezed by Deep Infiltrating Endometriosis Lesions Zheng Y,1,* Chen Y,2 Yi X1. 1Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; 2Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China *Corresponding author. Video Objective: To present a successful remission of hydronephrosis, with laparoscopic surgery of complete excision for DIE lesion, and end-toend anastomosis of left ureter. Setting: A 42-year-old female patient was diagnosed with left hydronephrosis 2 years ago, with slightly renal dysfunction. She complained secondary dysmenorrheal for 2 years, and a 3-cm ovarian cyst was also detected in the pelvis. In the past 2 years, she experienced Double-J catheterization twice, but recurrence occurred rapidly after extraction of D-J catheter. This year, the ultrasound examination showed an endometrial cyst with the size 41*40*29 mm, and left renal effusion with left upper ureteral dilatation. Pelvic CT shared the same finding. A laparoscopic removal of endometriosis lesions was presented (a 5-min video with key steps described). Interventions: During the surgery, after extensive enterodialysis, a chocolate-looked cyst was exposed with the size 4*5cm, which was tightly adhered with the tissues nearby. The Dauglus Porch was completely blocked. Deep endometriotic lesion wrapped the left ureter tightly, which was hard and limited the movement of ureter. Ultrasonic knife and scissors were used to remove the D.I.E. lesions, and then a narrowed ring of ureter was observed, which was only 0.3cm in diameter, and 1cm in length. The upper part of the ureter was extremely dilated, which was about 1cm in diameter. End-to-end anastomosis was performed after segmental resection of the narrowed ureter. A Double “J” catheter was inserted via cystoscopy. Postoperative left hydronephrosis was completely relieved. Postoperative pathological diagnosis: D.I.E. of left ureter, and ovarian endometrioid cyst. The patient received GnRH-a injection postoperatively. Conclusion: Patients complained refractory hydronephrosis, with endometriosis-related symptoms, like severe dysmenorrhea should be altered to the diagnosis of ureteral DIE. Multidisciplinary teamwork, precise exposure of the pelvic anatomy, and complete resection of DIE lesions would be crucial for the diagnosis and treatment of DIE. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION C 2445 Appendiceal Pathology in Women with Endometriosis LIU LA,1,* Seckin SI,2 Goldstein KP,1 Seckin TA3. 1GYN, Lenox Hill Hospital, New York, NY; 2Icahn School of Medicine at Mount Sinai West/ St. Luke’s, New York, NY; 3Lenox Hill Hospital, New York, NY *Corresponding author.
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Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Study Objective: To report the prevalence of abnormal appendiceal pathology in women with pelvic pain and pathology-confirmed pelvic endometriosis. Design: Retrospective case series. Setting: Tertiary care referral center. Patients or Participants: Forty patients with pelvic pain undergoing laparoscopy for possible endometriosis with concomitant laparoscopic appendectomy during a 5 month period. Interventions: Laparoscopic excision of suspected endometriosis with concomitant laparoscopic appendectomy on patients with visible abnormalities of the appendix. Measurements and Main Results: Forty patients underwent laparoscopic excision of suspected endometriosis with visible abnormalities involving the appendix and were treated with concomitant laparoscopic appendectomy. Of this subgroup, thirty-eight patients had pelvic endometriosis and eighteen patients (47.3%) had appendiceal pathology: seven (18%) with pathology-confirmed appendiceal endometriosis, three (7.9%) with carcinoid neuroendocrine tumor, two (5.3%) with acute appendicitis, two (5.3%) with mild acute inflammation, two (5.3%) with lymphoid hyperplasia, and two (5.3%) with fibrous obliteration. The prevalence of appendiceal pathology in patients with pelvic endometriosis was 47.3%. Conclusion: Appendiceal pathology may be a contributing factor to pelvic pain in women with endometriosis and should be routinely inspected for visible abnormalities.
patients with multiple prior surgeries (range 2 to >5) more frequently had small for gestational age infants (32% vs. 14%, p=0.015), which was independent of gestational age. There were no significant differences in obstetric outcomes (gestational age, delivery method or newborn weight) by type of endometriosis surgery. Conclusion: More extensive surgical history, as evidenced by multiple prior endometriosis surgeries, was associated with having infants who were small for gestational age.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION D 2756 Obstetric Outcomes in a Contemporary Cohort of Women with Endometriosis at an Academic Medical Center Orlando M,1,* Blat C,1 Rosenstein M,1 Opoku-Anane J2. 1Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA; 2Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA *Corresponding author. Study Objective: Previous literature shows that women with endometriosis have higher rates of adverse pregnancy outcomes compared to the general population, including preterm birth, fetal growth restriction, and cesarean section. We aim to identify disease-specific risk factors and surgical treatments that impact obstetric outcomes. Design: Retrospective cohort study. Setting: Academic medical center. Patients or Participants: Women who delivered at our institution from January 2002 to December 2018 with ICD-9/10 codes of endometriosis. Interventions: We obtained demographic characteristics and pregnancy information from a prospectively-maintained dataset, and linked this to gynecologic data, including symptoms, infertility treatments, lesion types (superficial, deeply-infiltrative [DIE], endometrioma, adenomyosis), and prior surgeries for endometriosis—dichotomous variables for diagnostic laparoscopy, ablation/fulguration, ovarian cystectomy, superficial excision, and excision of DIE. Patients were stratified by gynecologic characteristics, and obstetric outcomes compared across groups. Measurements and Main Results: Of 148 deliveries, 54 (36%) had superficial endometriosis, 14 (9.5%) DIE, 75 (51%) endometriomas, and 13 (8.8%) adenomyosis. Compared to other lesions, adenomyosis was associated with prior miscarriage (62% vs. 22%, p=0.004). Almost threequarters (72%) of patients had undergone previous surgery, including 68% diagnostic laparoscopy, 22% ablation, 28% cystectomy, 8.8% superficial excision, and 4.1% DIE excision. 38% had previously been diagnosed with infertility, while 28% conceived through in vitro fertilization. Women with DIE more often delivered via cesarean section (71% vs. 40%, p=0.044). Compared to patients with zero or one prior surgery, the 25
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION E 2171 Need for Fertility Preservation in Woman with Endometriosis Bubak-Dawidziuk JB*. Gynecology and Oncological Gynecology Department, Holy Family Hospital, Warsaw, Poland *Corresponding author. Study Objective: To evaluate the impact of endometriosis for ovarian reserve via measurements of serum anti-M€ullerian hormone, follicle stimulating hormone, estradiol and to indicate groups of patients where fertility preservation should be considered. Design: From August 2017 to July 2018 a prospective cohort study was performed. It included 50 patients below 35 years with confirmed endometriosis who were followed by laparoscopic surgery. AMH, FSH and Estradiol levels were assessed before and approximately one month after surgery. The stage of endometriosis was evaluated by rAFS and rEnzian classification. Setting: N/A. Patients or Participants: N/A. Interventions: All patients filled in a questionnaire of medical history and previous treatment. Afterwards they underwent laparoscopic removal of all endometriotic lesions. Post operatively they were divided into groups using rAFS and rEnzian classification. Measurements and Main Results: The AMH level of operated patients was importantly reduced after surgery (from 2.95 § 2.14 [mean § SD] at baseline to 1.05 § 1.56 at follow-up). There was a statistically significant correlation between the rate of serum AMH decline and stage of endometriosis according to rAFS classification (p=0,014). The decline was about 0,31 § 0,8 [mean § SD]; 0,08 § 0,64; 1,68 §1,44; 1,38§ 1,9 respectively in group I, II, III, IV. In addition, patients with bilateral ovarian endometriomas showed the highest decline of AMH levels compared with unilateral ovarian endometriosis (about 2,16 § 2,45 in bilateral group; about 1,42 §1,31 in unilateral endometriosis). However, also patients who were not observed with cysts had a decreased level of AMH after surgery about 0,44 § 1,2. FSH and Estradiol levels were not statistically significant. Conclusion: The rate of serum AMH is significant indicator of ovarian reserve. It should be marked before all endometriosis surgeries as its level might be declined even in minimal and mild stages. Since it is reduced postoperatively all patients with endometriosis should be offered fertility preservation techniques. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION F 2406 The Role of Exercise in Decreasing Ongoing Pain in the Post-Excision Endometriosis Population Sarrel S*. Sarrel Physical Therapy, New York, NY *Corresponding author. Study Objective: Endometriosis is a painful disease affecting quality of life in nearly 176 million women worldwide. Even post excision of endometriosis patients may continue to experience pain across multiple systems
S185
serve as an important stepping stone in raising awareness and introducing educational campaigns to improve the utility and adoption of this essential preoperative and diagnostic tool.
Setting: A 26 year old female patient, who complained of primary dysmenorrhea, associated with changes in her cathartic frequency. The pain persisted despite treatment with Dienogest. MRI was performed, which showed left pyelocaliceal dilation as well as a 5 cm endometriotic nodule which involved the sigmoid. A ureteral catheter was placed and surgery was planned. Interventions: We used a minimally invasive approach to perform ureterolysis and shaving of the intestinal nodule. Conclusion: Hospital discharge was made the day after the procedure.
Virtual Poster Session 3: Endometriosis (10:10 AM − 10:20 AM) 10:10 AM: STATION T 1974 Is the World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonisation Project (EPHECT) Questionnaire a Good Triaging Tool for Women with Ovarian and Posterior Compartment Endometriosis? Vanza K,1,* Leonardi M,1 Espada M,2 Condous G1. 1Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Hospital, Sydney, NSW, Australia; 2Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Sydney, NSW, Australia *Corresponding author. Study Objective: We aim to demonstrate whether the WERF EPHect Questionnaire can be used as a triaging tool to determine which women, based upon symptoms, are more likely to have ovarian and posterior compartment endometriosis on ultrasound. Design: Prospective observational study (July 2018 to March 2019). Setting: The WERF EPHect Questionnaires were emailed to women with possible endometriosis booked in for a ’deep endometriosis’ (DE) ultrasound at two specialized ultrasound centers. Patients or Participants: Women with a history of pelvic pain, dysmenorrhoea, dyspareunia and dyschezia were included. Interventions: The DE ultrasounds were performed by advanced sonologists as per the IDEA consensus opinion. A subsection of the questionnaire focusing on bowel symptoms (during menses and in the preceding 3 months) was compared to DE ultrasound findings. Logistic regression analysis was performed to assess the correlation between online responses and ultrasound findings. Measurements and Main Results: 217 women were emailed the online questionnaire; 136/217 (62%) responded prior to their DE ultrasound. The ultrasound prevalence of ovarian endometriomas, rectal DE and complete pouch of Douglas (POD) obliteration on ultrasound were 24%, 18% and 18%, respectively. There was no significant difference in the prevalence of disease in the respondents versus non-respondents (47%/47% posterior compartment, 31%/24% ovarian, respectively (p-value<0.05)). Older age, blood and mucus in stool and fullness and bloating were significant predictors of ovarian disease. Older age and blood in stool were predictive of posterior compartment disease, specifically rectal DE and POD obliteration. Conclusion: When the WERF EPHect Questionnaire is applied, bowel symptoms have the potential to be utilized as a triaging tool to determine which women require DE ultrasounds. A structured international symptomatology survey may be able to better target the utility of the DE ultrasound. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION A 1684 Urinary Tract Endometriosis: Ureterolysis Rosas P,1,* Viglierchio VT,1 Garcia Marchi~ nena P2. 1Gynecology, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina; 2Urology, Hospital Italiano Buenos Aires, Buenos Aires, Argentina *Corresponding author. Video Objective: Present an infrequent pathology of gynecological pelvic surgery, expose the clinical case and the theoretical framework in an educational way and show the surgical resolution made.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION B 1907 Hydronephrosis- Ureteral Squeezed by Deep Infiltrating Endometriosis Lesions Zheng Y,1,* Chen Y,2 Yi X1. 1Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China; 2Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China *Corresponding author. Video Objective: To present a successful remission of hydronephrosis, with laparoscopic surgery of complete excision for DIE lesion, and end-toend anastomosis of left ureter. Setting: A 42-year-old female patient was diagnosed with left hydronephrosis 2 years ago, with slightly renal dysfunction. She complained secondary dysmenorrheal for 2 years, and a 3-cm ovarian cyst was also detected in the pelvis. In the past 2 years, she experienced Double-J catheterization twice, but recurrence occurred rapidly after extraction of D-J catheter. This year, the ultrasound examination showed an endometrial cyst with the size 41*40*29 mm, and left renal effusion with left upper ureteral dilatation. Pelvic CT shared the same finding. A laparoscopic removal of endometriosis lesions was presented (a 5-min video with key steps described). Interventions: During the surgery, after extensive enterodialysis, a chocolate-looked cyst was exposed with the size 4*5cm, which was tightly adhered with the tissues nearby. The Dauglus Porch was completely blocked. Deep endometriotic lesion wrapped the left ureter tightly, which was hard and limited the movement of ureter. Ultrasonic knife and scissors were used to remove the D.I.E. lesions, and then a narrowed ring of ureter was observed, which was only 0.3cm in diameter, and 1cm in length. The upper part of the ureter was extremely dilated, which was about 1cm in diameter. End-to-end anastomosis was performed after segmental resection of the narrowed ureter. A Double “J” catheter was inserted via cystoscopy. Postoperative left hydronephrosis was completely relieved. Postoperative pathological diagnosis: D.I.E. of left ureter, and ovarian endometrioid cyst. The patient received GnRH-a injection postoperatively. Conclusion: Patients complained refractory hydronephrosis, with endometriosis-related symptoms, like severe dysmenorrhea should be altered to the diagnosis of ureteral DIE. Multidisciplinary teamwork, precise exposure of the pelvic anatomy, and complete resection of DIE lesions would be crucial for the diagnosis and treatment of DIE. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION C 2445 Appendiceal Pathology in Women with Endometriosis LIU LA,1,* Seckin SI,2 Goldstein KP,1 Seckin TA3. 1GYN, Lenox Hill Hospital, New York, NY; 2Icahn School of Medicine at Mount Sinai West/ St. Luke’s, New York, NY; 3Lenox Hill Hospital, New York, NY *Corresponding author.
S186
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
Study Objective: To report the prevalence of abnormal appendiceal pathology in women with pelvic pain and pathology-confirmed pelvic endometriosis. Design: Retrospective case series. Setting: Tertiary care referral center. Patients or Participants: Forty patients with pelvic pain undergoing laparoscopy for possible endometriosis with concomitant laparoscopic appendectomy during a 5 month period. Interventions: Laparoscopic excision of suspected endometriosis with concomitant laparoscopic appendectomy on patients with visible abnormalities of the appendix. Measurements and Main Results: Forty patients underwent laparoscopic excision of suspected endometriosis with visible abnormalities involving the appendix and were treated with concomitant laparoscopic appendectomy. Of this subgroup, thirty-eight patients had pelvic endometriosis and eighteen patients (47.3%) had appendiceal pathology: seven (18%) with pathology-confirmed appendiceal endometriosis, three (7.9%) with carcinoid neuroendocrine tumor, two (5.3%) with acute appendicitis, two (5.3%) with mild acute inflammation, two (5.3%) with lymphoid hyperplasia, and two (5.3%) with fibrous obliteration. The prevalence of appendiceal pathology in patients with pelvic endometriosis was 47.3%. Conclusion: Appendiceal pathology may be a contributing factor to pelvic pain in women with endometriosis and should be routinely inspected for visible abnormalities.
patients with multiple prior surgeries (range 2 to >5) more frequently had small for gestational age infants (32% vs. 14%, p=0.015), which was independent of gestational age. There were no significant differences in obstetric outcomes (gestational age, delivery method or newborn weight) by type of endometriosis surgery. Conclusion: More extensive surgical history, as evidenced by multiple prior endometriosis surgeries, was associated with having infants who were small for gestational age.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION D 2756 Obstetric Outcomes in a Contemporary Cohort of Women with Endometriosis at an Academic Medical Center Orlando M,1,* Blat C,1 Rosenstein M,1 Opoku-Anane J2. 1Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA; 2Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA *Corresponding author. Study Objective: Previous literature shows that women with endometriosis have higher rates of adverse pregnancy outcomes compared to the general population, including preterm birth, fetal growth restriction, and cesarean section. We aim to identify disease-specific risk factors and surgical treatments that impact obstetric outcomes. Design: Retrospective cohort study. Setting: Academic medical center. Patients or Participants: Women who delivered at our institution from January 2002 to December 2018 with ICD-9/10 codes of endometriosis. Interventions: We obtained demographic characteristics and pregnancy information from a prospectively-maintained dataset, and linked this to gynecologic data, including symptoms, infertility treatments, lesion types (superficial, deeply-infiltrative [DIE], endometrioma, adenomyosis), and prior surgeries for endometriosis—dichotomous variables for diagnostic laparoscopy, ablation/fulguration, ovarian cystectomy, superficial excision, and excision of DIE. Patients were stratified by gynecologic characteristics, and obstetric outcomes compared across groups. Measurements and Main Results: Of 148 deliveries, 54 (36%) had superficial endometriosis, 14 (9.5%) DIE, 75 (51%) endometriomas, and 13 (8.8%) adenomyosis. Compared to other lesions, adenomyosis was associated with prior miscarriage (62% vs. 22%, p=0.004). Almost threequarters (72%) of patients had undergone previous surgery, including 68% diagnostic laparoscopy, 22% ablation, 28% cystectomy, 8.8% superficial excision, and 4.1% DIE excision. 38% had previously been diagnosed with infertility, while 28% conceived through in vitro fertilization. Women with DIE more often delivered via cesarean section (71% vs. 40%, p=0.044). Compared to patients with zero or one prior surgery, the 25
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION E 2171 Need for Fertility Preservation in Woman with Endometriosis Bubak-Dawidziuk JB*. Gynecology and Oncological Gynecology Department, Holy Family Hospital, Warsaw, Poland *Corresponding author. Study Objective: To evaluate the impact of endometriosis for ovarian reserve via measurements of serum anti-M€ullerian hormone, follicle stimulating hormone, estradiol and to indicate groups of patients where fertility preservation should be considered. Design: From August 2017 to July 2018 a prospective cohort study was performed. It included 50 patients below 35 years with confirmed endometriosis who were followed by laparoscopic surgery. AMH, FSH and Estradiol levels were assessed before and approximately one month after surgery. The stage of endometriosis was evaluated by rAFS and rEnzian classification. Setting: N/A. Patients or Participants: N/A. Interventions: All patients filled in a questionnaire of medical history and previous treatment. Afterwards they underwent laparoscopic removal of all endometriotic lesions. Post operatively they were divided into groups using rAFS and rEnzian classification. Measurements and Main Results: The AMH level of operated patients was importantly reduced after surgery (from 2.95 § 2.14 [mean § SD] at baseline to 1.05 § 1.56 at follow-up). There was a statistically significant correlation between the rate of serum AMH decline and stage of endometriosis according to rAFS classification (p=0,014). The decline was about 0,31 § 0,8 [mean § SD]; 0,08 § 0,64; 1,68 §1,44; 1,38§ 1,9 respectively in group I, II, III, IV. In addition, patients with bilateral ovarian endometriomas showed the highest decline of AMH levels compared with unilateral ovarian endometriosis (about 2,16 § 2,45 in bilateral group; about 1,42 §1,31 in unilateral endometriosis). However, also patients who were not observed with cysts had a decreased level of AMH after surgery about 0,44 § 1,2. FSH and Estradiol levels were not statistically significant. Conclusion: The rate of serum AMH is significant indicator of ovarian reserve. It should be marked before all endometriosis surgeries as its level might be declined even in minimal and mild stages. Since it is reduced postoperatively all patients with endometriosis should be offered fertility preservation techniques. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION F 2406 The Role of Exercise in Decreasing Ongoing Pain in the Post-Excision Endometriosis Population Sarrel S*. Sarrel Physical Therapy, New York, NY *Corresponding author. Study Objective: Endometriosis is a painful disease affecting quality of life in nearly 176 million women worldwide. Even post excision of endometriosis patients may continue to experience pain across multiple systems