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Neveu ME, Scetbun E, Fernandez H, Capmas P. Hysteroscopic Enlargement Metroplasty for Hypoplasic Uterus. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allègre L, Callewaert G, Alonso S, Cornille A, Fernandez H, Eglin G, de Tayrac R. Long-term outcomes of a randomized controlled trial comparing trans-obturator vaginal mesh with native tissue repair in the treatment of anterior vaginal wall prolapse. Int Urogynecol J 2019; 31:745-753. [DOI: 10.1007/s00192-019-04073-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
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de Léotoing L, Chaize G, Fernandes J, Toth D, Descamps P, Dubernard G, Lafon T, Lamarsalle L, Fernandez H. The surgical treatment of idiopathic abnormal uterine bleeding: An analysis of 88 000 patients from the French exhaustive national hospital discharge database from 2009 to 2015. PLoS One 2019; 14:e0217579. [PMID: 31185019 PMCID: PMC6559634 DOI: 10.1371/journal.pone.0217579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of the study was to compare success rates, complications and management costs of different surgical techniques for abnormal uterine bleeding (AUB). Methods This was a retrospective analysis of the French national hospital discharge database. All hospital stays with a diagnostic code for AUB and an appropriate surgical procedure code between 2009 and 2015 inclusive were identified, concerning 109,884 women overall. Outcomes were compared between second generation procedures (2G surgery), first-generation procedures (1G surgery), curettage and hysterectomy. Clinical outcomes were treatment failure and complications during the follow-up period. Costs were attributed using standard French hospital tariffs. Results 7,863 women underwent a 2G procedure (7.2%), 39,935 a 1G procedure, (36.3%), 38,923 curettage (35.4%) and 23,163 hysterectomy (21.1%). Failure rates at 18 months were 9.9% for 2G surgery, 12.7% for 1G surgery, 20.6% for curettage and 2.8% for hysterectomy. Complication rates at 18 months were 1.9% for 2G surgery, 1.5% for 1G surgery, 1.4% for curettage and 5.3% for hysterectomy. Median 18-month costs were € 1 173 for 2G surgery, € 1 059 for 1G surgery, € 782 for curettage and € 3 090 for hysterectomy. Conclusion Curettage has the highest failure rate. Hysterectomy has the lowest failure rate but the highest complication rate and is also the most expensive. Despite good clinical outcomes and relatively low cost, 1G and 2G procedures are not widely used. Current guidelines for treatment of AUB are not respected, the recommended 2G procedures being only used in <10% of cases.
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Cosson M, Fernandez H. [Is vaginal mesh surgery still possible for prolapse treatment?]. ACTA ACUST UNITED AC 2019; 47:487-488. [PMID: 31003017 DOI: 10.1016/j.gofs.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 11/16/2022]
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Newman J, Mullan C, Geib M, Stevens G, Majure D, Hussain S, Fernandez H, Hartman A, Lima B. Regional and Socioeconomic Distribution, Healthcare Utilization, and In-Hospital Mortality of Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Heaney C, Fernandez H, Lima B, Taylor J, Vuthoori R, Navarro J, Davidson K, Jelcic Y, Majure D, Kennedy K, Stevens G, Maybaum S. Subjective Assessment Underestimates Frailty in Patients with Heart Failure Referred for Advanced Therapies. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Navarro J, Miller E, Heaney C, Vuthoori R, Majure D, Lin K, Wang P, Kennedy K, Fernandez H, Lima B, Maybaum S. Reduction in Plasma Macrophage Migration Inhibitory Factor and Angiopoietin-2 Levels during Venoarterial Extracorporeal Membrane Oxygenation Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Szmulewicz C, Neveu ME, Vigoureux S, Fernandez H, Capmas P. Emergency vaginal cervico-isthmic cerclage. J Gynecol Obstet Hum Reprod 2019; 48:391-394. [PMID: 30905851 DOI: 10.1016/j.jogoh.2019.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cervical cerclage is the principal treatment for women with a cervical insufficiency, which is a predominant factor in second trimester loss and preterm birth. A cervico-isthmic cerclage is recommended in case of a previous failure of McDonald cerclage or in case of an absent portio vaginalis of the cervix. In women who have prolapsed membranes at or beyond a dilated external cervical os before 24 weeks of gestation, an emergency cerclage can sometimes be performed. The aim of this study is to report our experience with emergency transvaginal cervico-isthmic cerclage. STUDY DESIGN This is a retrospective, single-centre study conducted between 2009 and 2017 of women who received a transvaginal cervico-isthmic emergency cerclage. Emergency cerclage was defined as cerclage performed on women who had prolapsed membranes at or beyong a dilated external cervical os before 24 weeks of gestation. The exclusion criteria were twin pregnancy, preterm rupture of membranes, and clinical or biological signs of infection. RESULTS Three women were included. One woman had a history of failure of emergency McDonald cerclage during her previous pregnancy. The two other women had a failure of McDonald cerclage during index pregnancy. All women presented prolapsed membranes at or beyond a dilated external cervical os as defined for an emergency cerclage. The emergency cerclage was performed at a mean gestational age of 21.5 weeks of gestation. The average gestational age of delivery was 38.5 weeks of gestation by caesarean section. CONCLUSION Despite the small number of women, this study shows that this type of cerclage was effective in pregnancy prolongation for women at high risk of preterm birth in case of McDonald cerclage failure. Nevertheless, this technique requires a trained surgical team. A randomised trial should be performed to evaluate the need for emergency vaginal cervico-isthmic cerclage.
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Vigoureux S, Capmas P, Fernandez H. Surgical variance between post-conceptional and pre-conceptional minimally invasive trans-abdominal cerclage placement. Am J Obstet Gynecol 2019; 220:289-290. [PMID: 30837066 DOI: 10.1016/j.ajog.2018.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/18/2018] [Indexed: 11/18/2022]
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Fernandez H. Erratum à l’article « Acétate d’Ulipristal et SPRM : une nouvelle entité pour définir de nouvelles stratégies thérapeutiques pour les fibromes symptomatiques » [Gynecol. Obstet. Fertil. Senol. 46 (2018) 671–672]. ACTA ACUST UNITED AC 2019; 47:90. [PMID: 30595529 DOI: 10.1016/j.gofs.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Capmas P, Lobersztajn A, Duminil L, Barral T, Pourcelot AG, Fernandez H. Operative hysteroscopy for retained products of conception: Efficacy and subsequent fertility. J Gynecol Obstet Hum Reprod 2018; 48:151-154. [PMID: 30553048 DOI: 10.1016/j.jogoh.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/20/2022]
Abstract
Retained product of conception complicates nearly 1% of pregnancies and can lead to synechiae and compromise ulterior fertility. The aim of this study is to evaluate efficiency of operative hysteroscopy in management of retained products of conception (RPOC). Secondary objectives are assessments of intra-uterine adhesions rate and later fertility. This unicentric retrospective study includes women who undertook an operative hysteroscopy for retained products of conception between January 2012 and March 2014. Assessment of the efficiency of operative hysteroscopy is defined by a complete resection of retained products of conception confirmed by office hysteroscopy. One hundred fourteen women were included in the study. Efficiency of operative hysteroscopy for retained products of conception is 91% for women with a postoperative office hysteroscopy. The authors observed a 7.5% rate of postoperative intra-uterine adhesions. Fertility rate was 83% (30 women out of 36 with a desired pregnancy). Hysteroscopic resection of retained products of conception is an efficient procedure and seems to be a real alternative.
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Sauvan M, Pourcelot AG, Fournet S, Fernandez H, Capmas P. Office hysteroscopy for postmenopausal women: Feasibility and correlation with transvaginal ultrasound. J Gynecol Obstet Hum Reprod 2018; 47:505-510. [DOI: 10.1016/j.jogoh.2018.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
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Capmas P, Letendre I, Leray C, Deffieux X, Duminil L, Subtil D, Fernandez H. Erratum to "Vaginal cervico-isthmic cerclage versus McDonald cerclage in women with a previous failure of prophylactic cerclage: A retrospective study" [Eur. J. Obst. Gynecol. Reprod. Biol. 216 (September 2017) 27-32]. Eur J Obstet Gynecol Reprod Biol 2018; 231:288. [PMID: 30482554 DOI: 10.1016/j.ejogrb.2018.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fernandez H, Ardaens K, Queval I, Solignac C. Impact of Uterine Fibroids on Quality of Life: A National Cross-Sectional Survey. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vigoureux S, Neveu ME, Capmas P, Levaillant JM, Senat MV, Fernandez H. Re: Three-dimensional ultrasound imaging of intra-abdominal cervical-isthmus cerclage. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:124-125. [PMID: 29974594 DOI: 10.1002/uog.19088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
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Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B, Bornsztein N, Boujenah J, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip CA, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier JM, Yazbeck C, Bourdel N, Canis M. Management of endometriosis: CNGOF/HAS clinical practice guidelines - Short version. J Gynecol Obstet Hum Reprod 2018; 47:265-274. [PMID: 29920379 DOI: 10.1016/j.jogoh.2018.06.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
Abstract
First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.
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Ferry P, Bertherat P, Gauthier A, Villet R, Del Piano F, Hamid D, Fernandez H, Broux PL, Salet-Lizée D, Vincens E, Ntshaykolo P, Debodinance P, Pocholle P, Thirouard Y, de Tayrac R. Transvaginal treatment of anterior and apical genital prolapses using an Ultra lightweight mesh: Restorelle ® Direct Fix™. A retrospective study on feasibility and morbidity. J Gynecol Obstet Hum Reprod 2018; 47:443-449. [PMID: 29920380 DOI: 10.1016/j.jogoh.2018.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Vaginal mesh safety information is limited, especially concerning single incision techniques using ultra lightweight meshes for the treatment of anterior pelvic organ prolapse (POP). OBJECTIVE To determine the intraoperative and postoperative complication rates after anterior POP repair involving an ultralight mesh (19g/m2): Restorelle® Direct Fix™. METHODS A case series of 218 consecutive patients, operated on between January 2013 and December 2016 in ten tertiary and secondary care centres, was retrospectively analyzed. Eligible patients had POP vaginal repair (recurrent or not) planned with anterior Restorelle® Direct Fix™ mesh (with or without posterior mesh). Surgical complications were graded using the Clavien-Dindo classification. RESULTS Intraoperative complications were bladder wound (0.5%), rectal wound (0.5%), ureteral injuries (0.9%). 98.2% of the patient did not have per operative complications. We observed one fail of procedure. Early complications mainly included urinary retention (8.7%) urinary tract infections (5.5%) and haematoma (2.7%). One haematoma required surgical treatment and another, embolization. 80.7% of the patient did not have complications during hospitalization and 80.3% did not have complication at the follow up visit. None of the analyzed factors (age, body mass index, surgical history, grade of prolapse or concomitant procedure) was significantly associated with the risk of perioperative complications. A total of 2.8% patients had grade III complications according Clavien Dindo. None had grade IV or V. CONCLUSIONS This multicentre case-series on the early experience of the use of anterior Restorelle® Direct Fix™ mesh showed a satisfactory technical feasibility and a low rate of grade III complications according Clavien Dindo. Long term studies are necessary to assess anterior Restorelle® Direct Fix™ mesh performances and to appraise patient satisfaction feedback.
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Thellier E, Levaillant JM, Pourcelot AG, Houllier M, Fernandez H, Capmas P. Are 3D ultrasound and office hysteroscopy useful for the assessment of uterine cavity after late foetal loss? J Gynecol Obstet Hum Reprod 2018; 47:183-186. [DOI: 10.1016/j.jogoh.2018.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 01/01/2023]
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Capmas P, Pourcelot AG, Fernandez H. Are synechiae a complication of laparotomic myomectomy? Reprod Biomed Online 2018; 36:450-454. [DOI: 10.1016/j.rbmo.2018.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/16/2022]
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Collinet P, Fritel X, Revel-Delhom C, Ballester M, Bolze PA, Borghese B, Bornsztein N, Boujenah J, Bourdel N, Brillac T, Chabbert-Buffet N, Chauffour C, Clary N, Cohen J, Decanter C, Denouël A, Dubernard G, Fauconnier A, Fernandez H, Gauthier T, Golfier F, Huchon C, Legendre G, Loriau J, Mathieu-d'Argent E, Merlot B, Niro J, Panel P, Paparel P, Philip CA, Ploteau S, Poncelet C, Rabischong B, Roman H, Rubod C, Santulli P, Sauvan M, Thomassin-Naggara I, Torre A, Wattier JM, Yazbeck C, Canis M. [Management of endometriosis: CNGOF-HAS practice guidelines (short version)]. ACTA ACUST UNITED AC 2018; 46:144-155. [PMID: 29550339 DOI: 10.1016/j.gofs.2018.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 10/17/2022]
Abstract
First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.
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Geoffron S, Cohen J, Sauvan M, Legendre G, Wattier JM, Daraï E, Fernandez H, Chabbert-Buffet N. [Endometriosis medical treatment: Hormonal treatment for the management of pain and endometriotic lesions recurrence. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530557 DOI: 10.1016/j.gofs.2018.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS). As a second line, desogestrel progestin only pills, etonogestrel implants, GnRH analogs (GnRHa) with add back therapy and dienogest can be offered. Add back therapy should include estrogens to prevent bone loss and improve quality of life, it can be introduced before the third month of treatment to prevent side effects. The literature does not support preoperative hormonal treatment for the sole purpose of reducing complications or recurrence, or facilitating surgical procedures. After surgical treatment, hormonal treatment is recommended to prevent pain recurrence and improve quality of life. COCs or LNG IUS are recommended as a first line. To prevent recurrence of endometriomas COC is advised and maintained as long as tolerance is good in the absence of pregnancy plans. In case of dysmenorrhea, postoperative COC should be used in a continuous scheme. GnRHa are not recommended in the sole purpose of reducing endometrioma recurrence risk.
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Legendre G, Delbos L, Hudon E, Chabbert-Buffet N, Geoffron S, Sauvan M, Fernandez H, Bouet PE, Descamps P. [New medical treatments for painful endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29530558 DOI: 10.1016/j.gofs.2018.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this work is to evaluate the place of new treatments in the management of endometriosis outside the context of infertility. METHODS A review of the literature was conducted by consulting Medline data until July 2017. RESULTS Dienogest is effective compared to placebo in short term (NP2) and long term (NP4) for the treatment of painful endometriosis. In comparison with GnRH agonists, dienogest is also effective in terms of decreased pain and improved quality of life in non-operated patients (NP2) as well as for recurrence of lesions and symptomatology postoperatively (NP2). Data on GnRH antagonists, selective progesterone receptor modulators as well as selective inhibitors (anti-TNF-α, matrix metalloprotease inhibitors, angiogenesis growth factor inhibitors) are insufficient to provide evidence of interest in clinical practice for the management of painful endometriosis (NP3). CONCLUSION Dienogest is recommended as second-line therapy for the management of painful endometriosis (Grade B). Because of lack of evidence, aromatase inhibitors, elagolix, SERM, SPRM and anti-TNF-α are not recommended for the management of painful endometriosis (Grade C).
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Sauvan M, Chabbert-Buffet N, Canis M, Collinet P, Fritel X, Geoffron S, Legendre G, Wattier JM, Fernandez H. [Medical treatment for the management of painful endometriosis without infertility: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:267-272. [PMID: 29510966 DOI: 10.1016/j.gofs.2018.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To provide clinical practice guidelines for the management of painful endometriosis in women without infertility. METHODS Systematic review of the literature literature since 2006, level of evidence rating, external proofreading and grading of the recommendation grade by an expert group according to HAS methodology. RESULTS Combined hormonal contraceptives (COP) and the levonorgestrel-releasing intra-uterin system (LNG-IUS) are recommended as first-line hormonal therapies for the treatment of painful endometriosis (grade B). Second-line therapy relies on oral desogestrel microprogestative, etonogestrel-releasing implant, GnRH analogs (GnRHa) and dienogest (grade C). It is recommended to use add-back therapy containing estrogen in association with GnRHa (grade B). After endometriosis surgery, hormonal treatment relying on COP or LNG-IUS is recommended to prevent pain recurrence (grade B). COP is recommended to reduce the risk of endometrioma recurrence after surgery (grade B) but the prescription of GnRHa is not recommended (grade C). Continuous COP is recommended in case of dysmenorrhea (grade B). GnRHa is not recommended as first line endometriosis treatment for adolescent girl because of the risk of bone demineralization (grade B). The management of endometriosis-induced chronic pain requires an interdisciplinary evaluation. Physical therapies improving the quality of life such as yoga, relaxation or osteopathy can be proposed (expert agreement). Promising medical alternatives are currently under preclinical and clinical evaluation.
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San Antonio R, Chipa-Ccasani F, Trucco E, Peralta O, Fernandez H, Apolo J, Niebla M, Borras R, Arbelo E, Guasch E, Berruezo A, Brugada J, Mont L, Tolosana JM. 545Failure-free survival of the Riata implantable cardioverter-defibrillator lead after a very long-term follow-up. Europace 2018. [DOI: 10.1093/europace/euy015.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Caixal Vila G, Benito E, Alarcon F, Borras R, Cozzari J, Munoz M, Perea R, Chipa F, Fernandez H, Tolosana JM, Berruezo A, Arbelo E, Guasch E, Matiello M, Mont L. P826How to improve the success of atrial fibrillation ablation. Evaluation of cardiac magnetic resonance and fractionated electrograms in first ablation procedures. Europace 2018. [DOI: 10.1093/europace/euy015.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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