101
|
Contribution of Computed Tomography Enema and Magnetic Resonance Imaging to Diagnose Multifocal and Multicentric Bowel Lesions in Patients With Colorectal Endometriosis. J Minim Invasive Gynecol 2015; 22:776-84. [DOI: 10.1016/j.jmig.2015.02.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/07/2023]
|
102
|
Fadhlaoui A, Gillon T, Lebbi I, Bouquet de Jolinière J, Feki A. Endometriosis and Vesico-Sphincteral Disorders. Front Surg 2015; 2:23. [PMID: 26157800 PMCID: PMC4476201 DOI: 10.3389/fsurg.2015.00023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/29/2015] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this mini review is to determine the relationship between endometriosis and urinary tract symptoms and to investigate the consequences of surgical treatment of mild to severe endometriosis, especially deep lesions, on the vesico-sphincteral function (lower urinary tract function). Materials and methods We performed a literature review by searching the MEDLINE database for articles published between 2000 and 2014, limiting the searches to the words: urinary tract, vesico-sphincteral, dysfunction, endometriosis, symptoms, and surgery. Results The incidence of vesico-sphincteral symptoms in endometriosis varies from 3.4 up to 15.4%. The frequency of such symptoms seems to be under estimated because of a lack of specific questionnaire including urinary symptoms. Urodynamic evaluation could help to detect unsuspected abnormalities. It seems that endometriosis surgery (particularly deep infiltrating lesions) is a purveyor of de novo urinary dysfunction, with an incidence varying from 6.8 up to 17.5%. Nerve sparing processes such as neuro-navigators or neuro-stimulators seem to be promising techniques to avoid postoperative urinary tract dysfunction. Conclusion A precise anamnesis and the use of specific validated questionnaires (IPSS and BFLUTS) improve the screening of vesico-sphincteral symptoms in case of endometriosis. No recommendation can be found in the literature about the place of urodynamic evaluation. Most publications lack of proof and therefore do not allow making recommendations about optimal treatment of endometriotic lesions to avoid urinary tract disorders.
Collapse
Affiliation(s)
- Anis Fadhlaoui
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland ; Service de Gynécologie Obstetrique et de Médecine de la reproduction de l'Hôpital Aziza Othmana , Tunis , Tunisia ; Faculté de Médecine de Tunis , Tunis , Tunisia
| | - Tessa Gillon
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
| | - Issam Lebbi
- Obstetric Gynecology and Fertility Private Clinic, Dream Center , Tunis , Tunisia
| | | | - Anis Feki
- Service de Gynécologie Obstétrique, HFR Fribourg - Hôpital Cantonal , Fribourg , Switzerland
| |
Collapse
|
103
|
Blencowe NS, Boddy AP, Harris A, Hanna T, Whiting P, Cook JA, Blazeby JM. Systematic review of intervention design and delivery in pragmatic and explanatory surgical randomized clinical trials. Br J Surg 2015; 102:1037-47. [PMID: 26041565 DOI: 10.1002/bjs.9808] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/13/2015] [Accepted: 02/17/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical interventions are complex, with multiple components that require consideration in trial reporting. This review examines the reporting of details of surgical interventions in randomized clinical trials (RCTs) within the context of explanatory and pragmatic study designs. METHODS Systematic searches identified RCTs of surgical interventions published in 2010 and 2011. Included studies were categorized as predominantly explanatory or pragmatic. The extent of intervention details in the reports were compared with the CONSORT statement for reporting trials of non-pharmacological treatments (CONSORT-NPT). CONSORT-NPT recommends reporting the descriptions of surgical interventions, whether they were standardized and adhered to (items 4a, 4b and 4c). Reporting of the context of intervention delivery (items 3 and 15) and operator expertise (item 15) were assessed. RESULTS Of 4541 abstracts and 131 full-text articles, 80 were included (of which 39 were classified as predominantly pragmatic), reporting 160 interventions. Descriptions of 129 interventions (80.6 per cent) were provided. Standardization was mentioned for 47 (29.4 per cent) of the 160 interventions, and 22 articles (28 per cent) reported measurement of adherence to at least one aspect of the intervention. Seventy-one papers (89 per cent) provided some information about context. For one-third of interventions (55, 34.4 per cent), some data were provided regarding the expertise of personnel involved. Reporting standards were similar in trials classified as pragmatic or explanatory. CONCLUSION The lack of detail in trial reports about surgical interventions creates difficulties in understanding which operations were actually evaluated. Methods for designing and reporting surgical interventions in RCTs, contributing to the quality of the overall study design, are required. This should allow better implementation of trial results into practice.
Collapse
Affiliation(s)
- N S Blencowe
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| | - A P Boddy
- Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - A Harris
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Hanna
- National Institute for Health Research Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospital and University of Liverpool, Liverpool, UK
| | - P Whiting
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J A Cook
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.,Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol, UK
| |
Collapse
|
104
|
Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, Fieuws S, de Buck van Overstraeten A, D'Hoore A. How do patients score cosmesis after laparoscopic natural orifice specimen extraction colectomy? Colorectal Dis 2015; 17:536-41. [PMID: 25546712 DOI: 10.1111/codi.12885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/23/2014] [Indexed: 12/31/2022]
Abstract
AIM Laparoscopic colorectal resection results in improved cosmetic outcome and better presumed body image. Laparoscopic NOSE colectomy omits an incision for specimen extraction and is supposed to further improve postoperative cosmesis. This study aimed to assess the cosmetic benefit. METHOD Forty-nine patients who underwent a NOSE colectomy for bowel endometriosis from September 2009 to September 2013 were matched for age, American Society of Anesthesiologists (ASA) grade and body mass index (BMI) with patients who underwent a conventional laparoscopic colectomy for the same indication. Patients were asked to complete a questionnaire consisting of a body scale and a cosmetic scale and the Patient Scar Assessment Questionnaire (PSAQ) including five subscales (appearance, symptoms, scar consciousness, satisfaction with appearance and satisfaction with symptoms). RESULTS Patient demographics were similar between both groups. Patients were assessed at a median postoperative follow-up of 41 months in the NOSE colectomy group and 35 months in the conventional resection group. The median body image questionnaire score was 15 for NOSE colectomy and 18 for conventional resection (P = 0.027). The respective median PSAQ scores were 56 and 71 (P = 0.002). There was a good relationship between the PSAQ score and the body image questionnaire (Spearman correlation coefficient 0.82). CONCLUSION Depending on the scoring system used, the cosmetic outcome may be better after NOSE colectomy than conventional laparoscopy in patients having surgery for endometriosis. The comprehensive body image questionnaire, being shorter and easier to use, could be a valid tool for assessing cosmesis after NOSE procedures.
Collapse
Affiliation(s)
- A M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - C Meuleman
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - T D'Hooghe
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - S Fieuws
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, University Hospital Leuven, Leuven, Belgium
| | | | - A D'Hoore
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| |
Collapse
|
105
|
|
106
|
Abstract
BACKGROUND The development of modern videoendoscopy enables surgeons to perform laparoscopic resection of colonic cancer. AIM This manuscript evaluated the literature concerning clinically relevant differences in the short and long-term course after laparoscopic or conventional resection of colonic cancer. METHODS An investigation of meta-analyses from randomized controlled clinical trials comparing laparoscopic and conventional surgery for colonic cancer was carried out. RESULTS The incidence of intraoperative complications was higher during laparoscopic surgery, the duration of surgery was increased and blood loss was less when compared to open surgery. Overall morbidity and the incidence of surgical complications were decreased after laparoscopic surgery. General morbidity and mortality were not different after laparoscopic or open resection of colonic cancer. Duration of hospital stay was shorter but was also associated with the type of perioperative care (i.e. traditional or enhanced recovery). Following minimally invasive or conventional resection, the incidence of tumor recurrence (local and distant) and the duration of survival (overall and disease-free) showed no differences. Wound implantations were rare after both operative techniques but with a tendency to occur more often after laparoscopic than open resection. CONCLUSION Laparoscopic resection of colonic cancer has clinically relevant short-term benefits for the patients and long-term results are not different from open colectomy. However, most of the patients included in randomized controlled trials underwent right or left colectomy and sigmoid or rectosigmoid resections. Data with a high level of evidence concerning carcinomas of the flexures or the transverse colon do not exist. Suitable patients with colonic cancer should undergo laparoscopic resection by experienced surgeons.
Collapse
|
107
|
Daraï C, Deboute O, Zacharopoulou C, Laas E, Canlorbe G, Belghiti J, Zilberman S, Ballester M, Daraï E. Impact of osteopathic manipulative therapy on quality of life of patients with deep infiltrating endometriosis with colorectal involvement: results of a pilot study. Eur J Obstet Gynecol Reprod Biol 2015; 188:70-3. [DOI: 10.1016/j.ejogrb.2015.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 02/21/2015] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
|
108
|
“Clinical Outcome After Radical Excision of Moderate-severe Endometriosis With or Without Bowel Resection and Reanastomosis. Ann Surg 2015; 261:e133-4. [DOI: 10.1097/sla.0000000000000999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
109
|
Nyangoh Timoh K, Canlorbe G, Verollet D, Peyrat L, Ballester M, Amarenco G, Darai E. Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 190:31-5. [PMID: 25966436 DOI: 10.1016/j.ejogrb.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Around 5% of women experience persistent voiding dysfunction after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement. The gold standard to manage persistent voiding dysfunction is intermittent self-catherization, but this treatment may reduce quality of life of the patients due to care constraints. The objective of our study was to assess the contribution of sacral neuromodulation (SNM) in the management of persistent voiding dysfunction secondary to surgery for DIE with colorectal resection. STUDY DESIGN Five patients referred for persistent voiding dysfunction after surgery for DIE with colorectal resection were included and fitted with a temporary SNM system to test for feasibility. This consisted of placing an electrode unilaterally next to the S3 sacral nerve root and connecting it to an external pacemaker. The patients wore the electrode and the external neurostimulator for 21 days and kept a voiding diary. The SNM test was considered positive when a 50% decrease in self-catheterization was achieved after removal of the electrode. The system was implanted permanently in patients with a positive SNM test. Urodynamic tests were performed before and after the SNM test. RESULTS Two of the five patients had a positive SNM test and were implanted permanently. At 40 months the first patient had completely stopped self-catheterization and the second patient was performing self-catheterization twice a day with a post voiding residue volume of less than 100ml at 52 months. CONCLUSION SNM could be a curative technique in some patients with persistent voiding dysfunction after surgery for DIE. Further studies are required to better select patients who might benefit from SNM testing and subsequent device implantation.
Collapse
Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Geoffroy Canlorbe
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Delphine Verollet
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Laurence Peyrat
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France; Department of Urology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Gérard Amarenco
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Emile Darai
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| |
Collapse
|
110
|
Impact of Surgical Excision of Deep Infiltrating Bowel Endometriosis on Health-Related Quality of Life: Review of Current Literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2015. [DOI: 10.5301/je.5000207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The aim of this study was to systematically review the impact of surgical excision of deep infiltrating endometriosis involving the bowel, on health-related quality of life, based on the currently available literature. Methods A systematic review was completed of English-language publications in the last 10 years, which had assessed the impact of surgical excision on quality of life in patients with deep infiltrating endometriosis of the bowel using standardized, validated quality-of-life questionnaires. Results Fourteen studies were identified. Standardized questionnaires used to assess the therapeutic impact on quality of life were the SF-36, SF-12, EHP-30, EQ-5D and 15D. Overall, women with bowel endometriosis scored lower on quality-of-life measures than the general population. Regardless of which standardized, validated questionnaire was used, surgical treatment had a positive impact on health-related quality of life. Conclusions Endometriosis, in particular deep infiltrating endometriosis of the bowel, has a profound impact on the quality of life of women diagnosed with the condition. Though surgical excision has a positive short-term impact, studies are needed to assess the long-term impact on quality of life in this lifelong, chronic, recurring condition.
Collapse
|
111
|
External Validation of the SF-36 Quality-of-Life Questionnaire in Italian and Brazilian Populations to Select Patients With Colorectal Endometriosis for Surgery. J Minim Invasive Gynecol 2015; 22:378-83. [DOI: 10.1016/j.jmig.2014.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 11/22/2022]
|
112
|
Persistent urinary retention after surgery for deep infiltrating endometriosis: a multi-center series of 16 cases. Arch Gynecol Obstet 2014; 291:1333-9. [DOI: 10.1007/s00404-014-3588-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
|
113
|
Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A. Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol 2014; 20:15616-15623. [PMID: 25400445 PMCID: PMC4229526 DOI: 10.3748/wjg.v20.i42.15616] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding. Differential diagnosis must be made in case of irritable bowel syndrome, solitary rectal ulcer syndrome, and a rectal tumor. A precise diagnosis about the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. Long-term outcomes, following bowel resection for severe endometriosis, regarding pain and recurrence rate are good with a pregnancy rate of 50%.
Collapse
|
114
|
Surgical and Clinical Impact of Extraserosal Pelvic Fascia Removal in Segmental Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2014; 21:1041-8. [DOI: 10.1016/j.jmig.2014.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 11/22/2022]
|
115
|
Place de la robotique dans l’endométriose pelvienne profonde : à propos du registre de la SERGS. ACTA ACUST UNITED AC 2014; 42:744-8. [DOI: 10.1016/j.gyobfe.2014.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022]
|
116
|
Touboul C, Ballester M, Dubernard G, Zilberman S, Thomin A, Daraï E. Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery. Surg Endosc 2014; 29:1879-87. [PMID: 25294552 DOI: 10.1007/s00464-014-3880-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/02/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate the long-term symptoms, quality of life (QOL), and fertility after colorectal resection for endometriosis. METHODS Extended analysis of a randomized controlled trial including 52 patients with colorectal endometriosis, comparing laparoscopically assisted to open colorectal resection. All included patients were invited to complete questionnaires evaluating the presence and intensity of symptoms and QOL using the SF-36 and fertility at a mean (SD) follow-up of 50.7 (13.8) months. We compared symptoms intensity and QOL before and after surgery at short- (mean follow-up of 19 months) and long-term (mean follow-up of 51 months). RESULTS Persistent improvement in QOL was noted after surgery without differences between short and long term. Self-catheterization >6 months was the sole factor decreasing the long-term QOL (P = 0.02). No difference in symptoms and QOL was noted according to the route. Among the 28 patients (53.8%) wishing to conceive, 12 (42.9%) conceived within a mean (SD) time of 17 (13) months. No difference in fertility including pregnancy after IVF was noted between the routes, but spontaneous pregnancy occurred only after laparoscopy (P = 0.016). CONCLUSIONS Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.
Collapse
Affiliation(s)
- Cyril Touboul
- Department of Obstetrics and Gynecology, GRC-UPMC 6 (Centre Expert En Endometriose (C3E)), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris VI, Paris, France,
| | | | | | | | | | | |
Collapse
|
117
|
Bellinger J, Munoz-Bongrand N, Pariente B, Baudry C, Chirica M, Gornet JM, Allez M, Cattan P. Endoscopic and Clinical Recurrences After Laparoscopic or Open Ileocolic Resection in Crohn's Disease. J Laparoendosc Adv Surg Tech A 2014; 24:617-22. [DOI: 10.1089/lap.2014.0121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Justine Bellinger
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| | - Nicolas Munoz-Bongrand
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| | - Benjamin Pariente
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Clotilde Baudry
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Mircea Chirica
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| | - Jean-Marc Gornet
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Matthieu Allez
- Department of Gastro-enterology, Hôpital Saint-Louis, University Paris VII Denis-Diderot, Paris, France
| | - Pierre Cattan
- Department of General, Digestive, and Endocrine Surgery, University Paris VII Denis-Diderot, Paris, France
| |
Collapse
|
118
|
Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
Collapse
Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| |
Collapse
|
119
|
Cosma S, Ceccaroni M, Benedetto C. A pseudoneoplastic finding of deep endometriosis: laparoscopic triple segmental bowel resection. Wideochir Inne Tech Maloinwazyjne 2014; 9:463-7. [PMID: 25337175 PMCID: PMC4198630 DOI: 10.5114/wiitm.2014.41617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/05/2013] [Accepted: 11/05/2013] [Indexed: 11/17/2022] Open
Abstract
Bowel endometriosis affects 3-37% of patients with endometriosis, involving more frequently the rectum and the rectosigmoid junction. Severe endometriosis with bowel involvement is often refractory to standard medical therapy. For these reasons, surgery for bowel treatment is frequently needed. We report the case of a 36-year-old woman with deep endometriosis of the pelvis, triple segmental bowel involvement (recto-sigma, ileum-cecum, transverse colon) and massive endometriotic ascites with secondary Glisson's capsule inflammation, refractory to medical therapy. A laparoscopic triple segmental bowel resection and complete fertility sparing excision of pelvic endometriotic lesions was performed. At 48 months of follow-up, the woman was asymptomatic, with no evidence of recurrence of disease or ascites. Laparoscopic segmental bowel resection, including multiple section, is feasible in selected symptomatic patients with consequent improved quality of life, morbidity rates similar to those achieved by laparotomy and with a less detrimental effect on fertility.
Collapse
Affiliation(s)
- Stefano Cosma
- Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Marcello Ceccaroni
- Department of Gynecology and Obstetrics, Gynecologic Oncology Division, International School of Surgical Anatomy, European Gynecology Endoscopy School, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Chiara Benedetto
- Department of Gynecology and Obstetrics, Sant'Anna Hospital, University of Turin, Turin, Italy
| |
Collapse
|
120
|
Sajid MS, Bhatti MI, Sains P, Baig MK. Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies. Gastroenterol Rep (Oxf) 2014; 2:251-61. [PMID: 25146342 PMCID: PMC4219147 DOI: 10.1093/gastro/gou053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections (LCR). METHODS Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated. RESULTS There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR. The most common approaches were periumbilical midline incision (1260 reported case in the literature), transverse incision (583 reported cases in the literature) in the right- or left iliac fossa, depending on the side of colonic resection, and Pfannensteil incision (293 reported cases in the literature). Periumbilical midline incision was associated with the higher risk of developing incisional hernia (odds ratio 53.72; 95% confidence interval 7.48-386.04; Z = 3.96; P = 0.0001). In terms of surgical site infection (SSI), there was no difference between the three common approaches to specimen retrieval. Transanal and transvaginal approaches were associated with higher risk of SSI. CONCLUSIONS Midline, transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR. Midline incision was associated with higher risk of incisional hernia. Risk of SSI was similar in all three common approaches. The transanal and transvaginal approaches pose a higher risk of SSI. These conclusions are based on the combined outcome of published case series, case reports and comparative studies. Randomized, controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.
Collapse
Affiliation(s)
- Muhammad S Sajid
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| | - Muhammad I Bhatti
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| | - Parv Sains
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| | - Mirza K Baig
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, UK and Department of General Surgery, Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust, Kings Lynn, UK
| |
Collapse
|
121
|
Akladios C, Messori P, Faller E, Puga M, Afors K, Leroy J, Wattiez A. Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? J Minim Invasive Gynecol 2014; 22:103-9. [PMID: 25109779 DOI: 10.1016/j.jmig.2014.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To verify the hypothesis that in most patients bowel segmental resection to treat endometriosis can be safely performed without creation of a stoma and to discuss the limitations of this statement. DESIGN Retrospective study (Canadian Task Force classification III). SETTING Tertiary referral center. PATIENTS Forty-one women with sigmoid and rectal endometriotic lesions who underwent segmental resection. INTERVENTION Segmental resection procedures performed between 2004 and 2011. Patient demographic, operative, and postoperative data were compared. MEASUREMENTS AND MAIN RESULTS Sigmoid resection was performed in 6 patients (15%), and rectal anterior resection in 35 patients (high in 21 patients [51%], and low, i.e., <10 cm from the anal verge, in 14 [34%]). In 4 patients a temporary ileostomy was created. There was 1 anastomotic leak (2.4%), in a patient with an unprotected anastomosis, which was treated via laparoscopic surgery and creation of a temporary ileostomy. Other postoperative complications included hemoperitoneum, pelvic abscess, pelvic collection, and a ureteral vaginal fistula, in 1 patient each (all 2.4%). CONCLUSION A protective stoma may be averted in low anastomosis if it is >5 cm from the anal verge and there are no adverse intraoperative events.
Collapse
Affiliation(s)
- Cherif Akladios
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France.
| | - Pietro Messori
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Marco Puga
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Karolina Afors
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Joel Leroy
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Arnaud Wattiez
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| |
Collapse
|
122
|
Ballester M, Dubernard G, Wafo E, Bellon L, Amarenco G, Belghiti J, Daraï E. Evaluation of urinary dysfunction by urodynamic tests, electromyography and quality of life questionnaire before and after surgery for deep infiltrating endometriosis. Eur J Obstet Gynecol Reprod Biol 2014; 179:135-40. [DOI: 10.1016/j.ejogrb.2014.05.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/19/2014] [Accepted: 05/28/2014] [Indexed: 11/27/2022]
|
123
|
Cecal endometriosis presenting as acute appendicitis. Case Rep Surg 2014; 2014:519631. [PMID: 25126441 PMCID: PMC4120490 DOI: 10.1155/2014/519631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 06/19/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of our paper is to show the diagnosis of Coecal endometriosis as an infrequent reason of right iliac fossa pain. cecal endometriosis manifesting with right lower quadrant pain is difficult to diagnose, and it may even sometimes require laparotomy for diagnosis and treatment. We report here a case of cecal endometriosis causing clinically resembled acute appendicitis. In our patient, a diagnosis of cecal endometriosis was made postoperatively by microscopic examination of excised right colon, and the patient symptoms and general condition were improved after the surgery (open right hemicolectomy and ileocolic anastomosis).
Collapse
|
124
|
Silveira da Cunha Araújo R, Abdalla Ayroza Ribeiro HS, Sekula VG, da Costa Porto BT, Ayroza Galvão Ribeiro PA. Long-Term Outcomes on Quality of Life in Women Submitted to Laparoscopic Treatment for Bowel Endometriosis. J Minim Invasive Gynecol 2014; 21:682-8. [DOI: 10.1016/j.jmig.2014.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 02/01/2023]
|
125
|
Vercellini P, Consonni D, Barbara G, Buggio L, Frattaruolo MP, Somigliana E. Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod Biomed Online 2014; 28:704-13. [DOI: 10.1016/j.rbmo.2014.02.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 02/03/2023]
|
126
|
Belghiti J, Ballester M, Zilberman S, Thomin A, Zacharopoulou C, Bazot M, Thomassin-Naggara I, Daraï E. Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2014; 21:472-9. [DOI: 10.1016/j.jmig.2013.12.094] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
|
127
|
Long-term outcome after laparoscopic bowel resections for deep infiltrating endometriosis: a single-center experience after 900 cases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:463058. [PMID: 24877097 PMCID: PMC4022010 DOI: 10.1155/2014/463058] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 04/01/2014] [Indexed: 11/18/2022]
Abstract
Background. Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed. Materials and Methods. From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86%) a questionnaire was administered. Patients were divided into 3 groups on the strength of the operation date. Postoperative diarrhea, constipation, rectal bleeding, tenesmus, dyschezia, dysuria, dyspareunia, fertility, and recurrence of disease were assessed. Results. The median follow-up was 54 months (range 1–120). All the evaluated symptoms significantly improved over time, with P = 0.0001 for dyspareunia, constipation, and pelvic pain and P = 0.004 for diarrhea. Nonsignificant improvement was reported for dysuria and rectal bleeding (with P = 0.452 and P = 0.097, resp.). Conclusions. The present results confirm that bowel resections for endometriosis are correlated with an acceptable complication rate even at long-term follow-up and that symptoms significantly improve over time, except for rectal bleeding and dysuria, the latter associated with a neurological damage.
Collapse
|
128
|
Duffy JMN, Arambage K, Correa FJS, Olive D, Farquhar C, Garry R, Barlow DH, Jacobson TZ. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 2014:CD011031. [PMID: 24696265 DOI: 10.1002/14651858.cd011031.pub2] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity and is associated with pain and subfertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. OBJECTIVES To assess the effectiveness and safety of laparoscopic surgery in the treatment of painful symptoms and subfertility associated with endometriosis. SEARCH METHODS This review has drawn on the search strategy developed by the Cochrane Menstrual Disorders and Subfertility Group including searching CENTRAL, MEDLINE, EMBASE, PsycINFO, and trial registries from inception to July 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) were selected in which the effectiveness and safety of laparoscopic surgery used to treat pain or subfertility associated with endometriosis was compared with any other laparoscopic or robotic intervention, holistic or medical treatment or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS Selection of studies, assessment of trial quality and extraction of relevant data were performed independently by two review authors with disagreements resolved by a third review author. The quality of evidence was evaluated using GRADE methods. MAIN RESULTS Ten RCTs were included in the review. The studies randomised 973 participants experiencing pain or subfertility associated with endometriosis. Five RCTs compared laparoscopic ablation or excision versus diagnostic laparoscopy only. Two RCTs compared laparoscopic excision versus diagnostic laparoscopy only. Two RCTs compared laparoscopic excision versus ablation. One RCT compared laparoscopic ablation versus diagnostic laparoscopy and injectable gonadotropin-releasing hormone analogue (GnRHa) (goserelin) with add-back therapy. Common limitations in the primary studies included lack of clearly-described blinding, failure to fully describe methods of randomisation and allocation concealment, and risk of attrition bias.Laparoscopic surgery was associated with decreased overall pain (measured as 'pain better or improved') compared with diagnostic laparoscopy, both at six months (odds ratio (OR) 6.58, 95% CI 3.31 to 13.10, 3 RCTs, 171 participants, I(2) = 0%, moderate quality evidence) and at 12 months (OR 10.00, 95% CI 3.21 to 31.17, 1 RCT, 69 participants, low quality evidence). Compared with diagnostic laparoscopy, laparoscopic surgery was also associated with an increased live birth or ongoing pregnancy rate (OR 1.94, 95% CI 1.20 to 3.16, P = 0.007, 2 RCTs, 382 participants, I(2) = 0%, moderate quality evidence) and increased clinical pregnancy rate (OR 1.89, 95% CI 1.25 to 2.86, P = 0.003, 3 RCTs, 528 participants, I(2) = 0%, moderate quality evidence). Two studies collected data on adverse events (including infection, vascular and visceral injury and conversion to laparotomy) and reported no events in either arm. Other studies did not report this outcome. The similar effect of laparoscopic surgery and diagnostic laparotomy on the rate of miscarriage per pregnancy was imprecise (OR 0.94, 95% CI 0.35 to 2.54, 2 studies, 112 women, moderate quality evidence).When laparoscopic ablation was compared with diagnostic laparoscopy plus medical therapy (GnRHa plus add-back therapy), more women in the ablation group reported that they were pain free at 12 months (OR 5.63, 95% CI 1.18 to 26.85, 1 RCT, 35 participants, low quality evidence).The difference between laparoscopic ablation and laparoscopic excision in the proportion of women reporting overall pain relief at 12 months on a VAS 0 to 10 pain scale was 0 (95% CI -1.22 to 1.22, P = 1.00, 1 RCT, 103 participants, low quality evidence). AUTHORS' CONCLUSIONS There is moderate quality evidence that laparoscopic surgery to treat mild and moderate endometriosis reduces overall pain and increases live birth or ongoing pregnancy rates. There is low quality evidence that laparoscopic excision and ablation were similarly effective in relieving pain, although there was only one relevant study. More research is needed considering severe endometriosis, different types of pain associated with endometriosis (for example dysmenorrhoea (pain with menstruation)) and comparing laparoscopic interventions with holistic and medical interventions. There was insufficient evidence on adverse events to allow any conclusions to be drawn regarding safety.
Collapse
Affiliation(s)
- James M N Duffy
- Women's Health Research Unit, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 58 Turner Street, London, Greater London, UK, E1 2AB
| | | | | | | | | | | | | | | |
Collapse
|
129
|
Collinet P, Leguevaque P, Neme RM, Cela V, Barton-Smith P, Hébert T, Hanssens S, Nishi H, Nisolle M. Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc 2014; 28:2474-9. [DOI: 10.1007/s00464-014-3480-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/03/2014] [Indexed: 12/21/2022]
|
130
|
Multidisciplinary laparoscopic treatment for bowel endometriosis. Best Pract Res Clin Gastroenterol 2014; 28:53-67. [PMID: 24485255 DOI: 10.1016/j.bpg.2013.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/02/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%.
Collapse
|
131
|
Minas V, Dada T. Laparoscopic treatment of endometriosis and effects on quality of life: A retrospective study using the short form EHP-5 endometriosis specific questionnaire. J OBSTET GYNAECOL 2014; 34:336-40. [DOI: 10.3109/01443615.2013.874409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
132
|
Fleisch MC, Hepp P, Kaleta T, Schulte Am Esch J, Rein D, Fehm T, Beyer I. Feasibility and first long-term results after laparoscopic rectal segment resection and vaginal specimen retrieval for deep infiltrating endometriosis. Arch Gynecol Obstet 2014; 289:1241-7. [PMID: 24407554 DOI: 10.1007/s00404-014-3146-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Radical resection of deep infiltrating endometriosis (DIE), including bladder and bowel resection, provides relief from pain in symptomatic patients. The laparoscopic approach to treatment is well established for bowel resection but normally requires additional abdominal incisions for specimen retrieval. Here we describe our technique of laparoscopically assisted rectal resection and transvaginal specimen retrieval (LARRT) and provide follow-up information on pain scores and complications. MATERIALS AND METHODS Retrospective observational monocentric study on all DIE patients with rectal infiltration treated between 2008 and 2010 with LATRR at our department. Follow-up was obtained for at least 3 years, including baseline 1-year and 3-year pain scores. RESULTS We identified four patients undergoing LARRT available for follow-up. DIE was confirmed by histology in all cases. There were no intraoperative complications. Two patients had transient postoperative urinary retention, one patient developed recto-vaginal fistula and required transient colostomy. One patient suffered from persistent vaginal dryness. All patients, however, reported persistent pain relief, including at the end of follow-up period. CONCLUSION LARRT is a feasible variation of laparoscopic bowel resection for DIE with rectal infiltration. In our study it has promising results with respect to pain control. Larger studies will, however, be required to determine the safety of this procedure.
Collapse
Affiliation(s)
- M C Fleisch
- Department of Obstetrics and Gynecology, Heinrich-Heine-University Medical Centre, Moorenstr 5, 40225, Duesseldorf, Germany,
| | | | | | | | | | | | | |
Collapse
|
133
|
Roman H, Bridoux V, Tuech JJ, Marpeau L, da Costa C, Savoye G, Puscasiu L. Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol 2013; 209:524-30. [PMID: 23583209 DOI: 10.1016/j.ajog.2013.04.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/25/2013] [Accepted: 04/04/2013] [Indexed: 01/28/2023]
Abstract
The relationship between deep fibrotic endometriosis of the rectum and digestive symptoms as well as the impact of surgical treatment on digestive complaints appears increasingly complex. With the exception of cases in which the disease leads to rectal stenosis, it seems likely that certain digestive symptoms are a result of cyclic inflammatory phenomena leading to irritation of the digestive tract and not necessarily the result of actual involvement of the rectum by the disease itself because they frequently occur in women free of rectal nodules. Functional or inflammatory bowel diseases and rectal hypersensitivity may be associated with pelvic endometriosis and consequently joepardize the hypothetical causal relationship between the presence of a rectal nodule and digestive complaints. Women treated surgically for rectal endometriosis may continue to experience postoperative digestive complaints, such as constipation. Despite successful surgery free of intra- and postoperative complications and significant improvement in well-being and pelvic pain, several unpleasant digestive symptoms may be incompletely cured by the surgery. Furthermore, de novo postoperative digestive complaints may occur after rectal surgery. Retrospective data suggest that performing colorectal resection is related to less favorable digestive functional outcomes than the use of conservative procedures such as shaving or full-thickness disc excision. These hypotheses need to be confirmed by prospective randomized trials comparing rectal radical and conservative approaches. Bearing in mind the complex relationship between rectal nodules, digestive symptoms and rectal surgery, particular care must be taken in the preoperative assessment of digestive function and in choosing the most suitable surgical procedure.
Collapse
|
134
|
Management of rectosigmoid obstruction due to severe bowel endometriosis. Updates Surg 2013; 66:59-64. [DOI: 10.1007/s13304-013-0240-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 11/14/2013] [Indexed: 01/07/2023]
|
135
|
Évolution des symptômes et de la qualité de vie des patientes après chirurgie de l’endométriose digestive. ACTA ACUST UNITED AC 2013; 41:627-34. [DOI: 10.1016/j.gyobfe.2013.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Indexed: 11/22/2022]
|
136
|
Yang Q, Xiu P, Qi X, Yi G, Xu L. Surgical margins and short-term results of laparoscopic total mesorectal excision for low rectal cancer. JSLS 2013; 17:212-8. [PMID: 23925014 PMCID: PMC3771787 DOI: 10.4293/108680813x13654754534675] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
It is suggested that laparoscopic total mesorectal excision of low-lying rectal cancer has advantages over an open procedure with less blood loss, reduced hospital stay, and a shorter disability period. Complete macroscopic surgical resection appears to be aided by improved pelvic view offered by laparoscopy. Background and Objectives: The confines of the narrow bony pelvis make laparoscopic surgery more challenging in the treatment of low rectal cancer. Macroscopic evaluation of the completeness of the mesorectum provides detailed information about the quality of surgery. This study was performed to observe the short-term outcomes and evaluate the macroscopic quality of specimens acquired from laparoscopic total mesorectal excision versus open total mesorectal excision in patients with low rectal cancer. Methods: A total of 177 patients with low rectal cancer underwent total mesorectal excision by either a laparoscopic (n = 87) or open (n = 90) approach. In all cases the surgical time, blood loss, intraoperative and postoperative complications, postoperative bowel opening, and hospital stay were assessed. Special attention was given to the macroscopic judgment concerning the cut edge of peritoneal reflection, Denonvilliers fascia, completeness of the mesorectum, and bowel wall below the mesorectum. Results: The surgical time was 160 ± 40 minutes in the laparoscopic group. It was not significantly different from that in the open group (P = .782). The operative blood loss was 28 ± 5 mL in the group undergoing laparoscopic surgery and 80 ± 20 mL in the group undergoing open surgery (P < .01). Intraoperative injuries to the pelvic autonomic nervous system were recorded in 4 cases in the laparoscopic group compared with 12 cases in the open group (P < .05). The incidences of chest infection and anastomotic leakage were similar between the 2 approaches. The postoperative bowel opening time was 2.1 ± 1.5 days in the laparoscopic group and 3.5 ± 1.6 days in the open group (P < .01), whereas the hospital stay was 5.2 ± 1.8 days and 7.0 ± 2.1 days, respectively (P < .01). Intact Denonvilliers fascia and complete total mesorectal excision were more likely to be achieved by the laparoscopic approach than the open approach (P < .01). Colorectal anastomoses were located significantly lower in the laparoscopic group than in the open group (P < .01). Conclusion: Laparoscopic total mesorectal excision has consistent advantages over open total mesorectal excision, including similar surgical time, less blood loss, reduced hospital stay, and shorter disability period. A complete macroscopic specimen is more likely to be acquired by laparoscopy because of the better pelvic view offered by the approach.
Collapse
Affiliation(s)
- Qingqiang Yang
- Department of General Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou, China.
| | | | | | | | | |
Collapse
|
137
|
Acién P, Núñez C, Quereda F, Velasco I, Valiente M, Vidal V. Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement? Int J Womens Health 2013; 5:449-55. [PMID: 23935389 PMCID: PMC3735280 DOI: 10.2147/ijwh.s46519] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The purpose of this paper is to report the long-term results of surgery without bowel resection in patients suffering from deep infiltrating endometriosis with rectovaginal or colorectal involvement. METHODS This retrospective observational study identified 42 patients suffering with deep infiltrating endometriosis who underwent surgery. Conservative surgery was performed in 23 women (only one of them with bowel resection), and 19 women underwent a hysterectomy and bilateral salpingo-oophorectomy (HBSO). In the conservative surgery group, a later HBSO was performed in eight patients as a second operation. Pregnancies, recurrences, reoperations, use of hormone replacement therapy, and outcomes during long-term follow-up were analyzed. RESULTS The average follow-up duration was 7 ± 5.7 years in conservative surgery cases. Only one patient was treated with sigmoid bowel resection in 1997 and had complications. In this conservative surgery group, 13 patients (56%) received medical treatment after surgery, 10 patients wanted to get pregnant (of whom seven [70%] were successful), and eight patients underwent a subsequent HBSO because of recurrent symptoms and/or endometrioma. Therefore, HBSO was performed in 27 patients, of whom 14 (51.8%) used hormone replacement therapy for 5.6 ± 3.6 years. No recurrences or complications were observed in patients after HBSO with or without hormone replacement therapy. CONCLUSION Good clinical results can be obtained by performing only conservative surgery and/or HBSO without bowel resection, an alternative that could reduce the number of colorectal resections that are performed very frequently nowadays. After HBSO, patients may use hormone replacement therapy for several years with total satisfaction and well-being.
Collapse
Affiliation(s)
- Pedro Acién
- Department of Obstetrics and Gynecology, San Juan University Hospital, Spain ; Department/Division of Gynecology, School of Medicine, Miguel Hernandez University, Campus of San Juan, Spain ; Institute of Gynecology PAA, Alicante, Spain
| | | | | | | | | | | |
Collapse
|
138
|
Quality of Life Assessment Using EuroQOL EQ-5D Questionnaire in Patients with Deep Infiltrating Endometriosis: The Relation with Symptoms and Locations. Int J Chronic Dis 2013; 2013:452134. [PMID: 26464845 PMCID: PMC4590926 DOI: 10.1155/2013/452134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 07/06/2013] [Accepted: 07/07/2013] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to evaluate the quality of life (QOL) of patients with
deep infiltrating endometriosis (DIE) using EuroQOL (EQ-5D) and its correlation
with symptoms and locations of endometriotic lesions.
One hundred and fifty-nine patients referred for DIE from January 2011 to April 2011
were prospectively invited to complete questionnaires evaluating symptoms
associated with endometriosis as well as the EQ-5D questionnaire and health state.
Patients also had locations of DIE evaluated by clinical examination and magnetic
resonance imaging (MRI).
All 159 patients completed the questionnaires. Item response rate was 91.1%. The
most intense symptoms were dysmenorrhea (7.1/10), painful defecation (6.3/10), and
fatigue (6.0/10). Mean (SD) scores were 77 (14) for the EQ-5D questionnaire and
63.4 (21) for the health state. A relation was observed between the EQ-5D
questionnaire and the presence of dysmenorrhea, dyspareunia, cyclic pelvic pain,
painful defecation, and diarrhea or constipation. Vaginal and rectal infiltrations were
significantly associated with altered EQ-5D and health state scores.
The EQ-5D questionnaire is easy to complete and well related to symptoms of DIE.
Rectal and vaginal infiltrations were found to be determinant factors of altered QOL
by the EQ-5D questionnaire and health state.
Collapse
|
139
|
Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 2013; 99:1695-704. [PMID: 23465818 DOI: 10.1016/j.fertnstert.2013.01.131] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/05/2013] [Accepted: 01/21/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision. DESIGN "Before and after" comparative retrospective study. SETTING University tertiary referral center. PATIENT(S) Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum. INTERVENTION(S) Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted. MAIN OUTCOMES MEASURE(S) Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score. RESULT(S) Preoperative patient characteristics, rectal nodule features, and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life Score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency. CONCLUSION(S) It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection.
Collapse
|
140
|
Hidaka T, Nakashima A, Hashimoto Y, Saito S. Effects of laparoscopic radical surgery for deep endometriosis on endometriosis-related pelvic pain. MINIM INVASIV THER 2013; 21:355-61. [PMID: 22985066 DOI: 10.3109/13645706.2011.617758] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Deep endometriosis is associated with severe painful symptoms that sometimes impair the quality of life in women of reproductive age. Medical therapy does not provide for adequate pain relief, and an effective management option to reduce pelvic pain appears to be complete laparoscopic removal of as many endometriotic lesions as possible. In this study, we investigated the usefulness and risks of radical laparoscopic removal of deep endometriosis for patients diagnosed as stage III/IV endometriosis during laparoscopic surgery. Forty-seven consecutive patients undergoing conservative laparoscopic surgery alone (adhesiotomy and cystectomy of ovarian endometriosis but not removal of deep endometriotic lesion; non-DEL removal group) and 151 consecutive patients undergoing radical laparoscopic removal of deep endometriotic lesions combined with conservative surgery (DEL removal group) were compared. As a result, significant improvements in pain were obtained in both groups, however, the degree of improvement was significantly higher and the rate of recurrence was significantly lower in the DEL removal group. The addition of radical removal of deep endometriotic lesions to conservative laparoscopic surgery markedly reduces the severity of dysmenorrhea and the rate of recurrent pelvic pain. Although the surgical procedure is technically demanding, the levels of peri-operative complications and morbidity are acceptable.
Collapse
Affiliation(s)
- Takao Hidaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, Toyama, Japan.
| | | | | | | |
Collapse
|
141
|
Laparoscopic disc excision of rectum for endometriosis: neither a "crapshoot" nor a compromise. Dis Colon Rectum 2013; 56:e34. [PMID: 23392162 DOI: 10.1097/dcr.0b013e3182805f3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
142
|
Fratelli N, Scioscia M, Bassi E, Musola M, Minelli L, Trivella G. Transvaginal sonography for preoperative assessment of deep endometriosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:69-75. [PMID: 23233390 DOI: 10.1002/jcu.22018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/24/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To determinate transvaginal scan (TVS) accuracy in the preoperative evaluation of deep endometriosis in a large cohort of patients with subsequent laparoscopic assessment. METHODS A retrospective study was performed in a tertiary referral center for endometriosis. Transvaginal scan reports were retrieved from an electronic database of all patients who underwent laparoscopy for pelvic pain or infertility in 2009. The accuracy of TVS was assessed for 10 different sites of pelvic endometriosis. RESULTS Four hundred twenty women were included in the study. Sensitivity and specificity of TVS were 61% and 99%, respectively, for bladder endometriosis, 52% and 96% for endometriosis of rectovaginal septum, 65% and 99% for rectum endometriosis, and 69% and 98% for endometriosis of the sigmoid colon. CONCLUSIONS TVS appears to be useful for the detection of endometriosis located in the bladder and involving the sigmoid colon, the rectovaginal septum, and the rectum.
Collapse
Affiliation(s)
- Nicola Fratelli
- Department of Obstetrics and Gynaecology, Sacro Cuore Don Calabria General Hospital, Negrar, Italy.
| | | | | | | | | | | |
Collapse
|
143
|
Zilberman S, Ballester M, Touboul C, Chéreau E, Sèbe P, Bazot M, Daraï E. Partial Colpectomy is a Risk Factor for Urologic Complications of Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2013; 20:49-55. [DOI: 10.1016/j.jmig.2012.08.775] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/18/2012] [Accepted: 08/23/2012] [Indexed: 11/17/2022]
|
144
|
Kössi J, Setälä M, Mäkinen J, Härkki P, Luostarinen M. Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis 2013; 15:102-8. [PMID: 22642851 DOI: 10.1111/j.1463-1318.2012.03111.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Endometriosis is relatively common condition in fertile women and may affect the alimentary tract. Laparoscopic rectosigmoid resection for endometriosis has been found to be both feasible and safe. The aim of the present study was to prospectively evaluate the quality of life and sexual function of patients who have undergone rectosigmoid resection for endometriosis. METHOD All patients undergoing rectal or sigmoid resection for endometriosis in two specialist hospitals were prospectively recruited in the study. Details regarding demography, endometriosis-related symptoms, procedure and postoperative recovery were collected. One year after the operation patients were sent a postal questionnaire asking about endometriosis-related symptoms, quality of life and sexual functioning. The 15D Questionnaire and McCoy Female Sexuality Questionnaire were used for this purpose. RESULTS A total of 26 patients responded to the 15D questionnaire. Endometriosis-related bowel symptoms decreased significantly after the operation. The responses showed improvements in the overall score and scores for five different dimensions (usual activities, P = 0.04; discomfort and symptoms, P < 0.001; distress, P < 0.001; vitality, P < 0.001; sexual activity, P < 0.001). Sexual satisfaction was greater 1 year after the operation (P = 0.01). Sexual problems and partner satisfaction scores had not changed significantly. CONCLUSION Laparoscopic rectal and sigmoid resection for endometriosis significantly reduce endometriosis-related symptoms and improve quality of life and sexual well-being.
Collapse
Affiliation(s)
- J Kössi
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.
| | | | | | | | | |
Collapse
|
145
|
Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet Gynecol 2012; 24:245-52. [PMID: 22729087 DOI: 10.1097/gco.0b013e3283556285] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To present the clinical outcome after laparoscopic radical excision of deeply infiltrative endometriosis (DIE) with colorectal extension and laparoscopic segmental bowel resection. RECENT FINDINGS In three different studies including mostly patients with recurrent DIE with colorectal extension, we showed that radical reconstructive CO2 laser laparoscopic resection of DIE with colorectal extension in a multidisciplinary setting resulted in a low complication rate, a low cumulative reintervention and recurrence rate and a high cumulative pregnancy rate, also when bowel resection reanastomosis was performed. In a systematic review to assess the clinical outcome of surgical treatment of DIE with colorectal involvement, data were reported in such a way that comparison of different surgical techniques was not possible. A checklist is proposed to achieve standardized reporting of presenting symptoms, preoperative tests, inclusion criteria, preoperative and postoperative care, complications, follow-up, patient-centered assessment of pain and quality of life, fertility and recurrence corrected for postoperative use of hormonal suppression or infertility treatment. SUMMARY CO2 laser laparoscopic radical excision of DIE with colorectal extension and laparoscopic segmental bowel resection in centers of expertise is associated with good clinical outcome. To make real progress, international agreement is needed on terms and definitions used in surgical endometriosis research.
Collapse
|
146
|
Vimercati A, Achilarre MT, Scardapane A, Lorusso F, Ceci O, Mangiatordi G, Angelelli G, Van Herendael B, Selvaggi L, Bettocchi S. Accuracy of transvaginal sonography and contrast-enhanced magnetic resonance-colonography for the presurgical staging of deep infiltrating endometriosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:592-603. [PMID: 22535651 DOI: 10.1002/uog.11179] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the accuracy of transvaginal sonography (TVS) and contrast-enhanced magnetic resonance-colonography (CE-MR-C) for the presurgical assessment of deep infiltrating endometriosis (DIE). METHODS Ninety women were enrolled prospectively for suspicion of DIE. All patients underwent TVS and CE-MR-C, with each operator blinded to the results of the other exam, before laparoscopy. The sites of DIE examined by both imaging techniques were: rectovaginal septum, pouch of Douglas, uterosacral ligaments, vesicouterine pouch, bowel, bladder and vagina. The presence of adhesions and the involvement of adnexa and of a previous abdominal scar, when there was clinical suspicion, were also evaluated. TVS and CE-MR-C findings were compared with laparoscopic and histological results. RESULTS Endometriosis was confirmed by laparoscopy in 95.6% (86/90) of cases. In 82.2% (74/90) of patients there was DIE. The global accuracy for TVS in the detection of DIE was 89.2%, sensitivity was 81.1%, specificity was 94.2%, positive predictive value was 89.6%, negative predictive value was 89.0%, the positive likelihood ratio was 13.9 and the negative likelihood ratio was 0.2. For CE-MR-C, these values were 87.2%, 71.1%, 97.1%, 93.7%, 84.6%, 24.4 and 0.3, respectively. CE-MR-C allowed diagnosis of all cases of bowel involvement; the accuracy for infiltration and stenosis was 100%. The accuracy of TVS for rectosigmoid nodules was 91.1% and that for infiltration was 88.9%. CONCLUSIONS Both TVS and CE-MR-C showed satisfactory results for the presurgical assessment of DIE. TVS appears to be a powerful, simple, feasible, cost-effective tool for preoperative staging of DIE. CE-MR-C is an 'X-ray free' technique, which could be reserved for cases with deep infiltrating rectosigmoid lesions and for the prediction of stenosis and involvement of the upper part of the colon and small intestine.
Collapse
Affiliation(s)
- A Vimercati
- Department of Gynecology Obstetrics and Neonatology (DiGON), I Operative Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
147
|
Jia SZ, Leng JH, Shi JH, Sun PR, Lang JH. Health-related quality of life in women with endometriosis: a systematic review. J Ovarian Res 2012; 5:29. [PMID: 23078813 PMCID: PMC3507705 DOI: 10.1186/1757-2215-5-29] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/01/2012] [Indexed: 12/24/2022] Open
Abstract
Endometriosis has critical implications for women's quality of life. However, an overview of the current knowledge of this issue is limited. The objective of this systematic review was to determine the extent of endometriosis and its treatment upon women's health-related quality of life (HRQoL). PubMed, Embase, PsycoINFO, CINAHL and the Cochrane Clinical Trials were searched up to May 2012, and only studies using standardized instruments to evaluate HRQoL in women with endometriosis were selected. Our electronic searches identified 591 citations, of which 39 studies satisfied the inclusion criteria including nine qualitative studies and 30 treatment-related studies. Findings showed that endometriosis impaired women's HRQoL. Pain was strongly related to a poor HRQoL, and medical or surgical treatment could partially restore this impairment. No conclusive evidence was available on whether endometriosis imposed an additional impairment in HRQoL per se, apart from the decrease caused by chronic pelvic pain, or on the superiority of various hormonal suppression agents. The impacts of disease extent, duration and fertility status upon HRQoL were inconsistent. In summary, HRQoL was impaired in women with endometriosis, and medical or surgical treatment to alleviate pain could partially restore this impairment.
Collapse
Affiliation(s)
- Shuang-Zheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking, Union Medical College, P, R, China.
| | | | | | | | | |
Collapse
|
148
|
Wolthuis AM, Van Geluwe B, Fieuws S, Penninckx F, D'Hoore A. Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. Colorectal Dis 2012; 14:1183-8. [PMID: 22022977 DOI: 10.1111/j.1463-1318.2011.02869.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM A systematic review was performed to identify differences in surgical technique, postoperative morbidity, length of hospital stay and safety for procedures involving left-sided laparoscopic colectomy with natural orifice specimen extraction. METHOD A PubMed search was performed to retrieve studies reporting on left-sided laparoscopic colorectal resection with transrectal specimen extraction. The quality of the different reports was assessed according to the Newcastle-Ottawa Scale. Six studies were included and all but one were cohort studies. Studies on transanal, transvaginal or transcolonic specimen extraction were excluded, as were reports on paediatric surgery. RESULTS Six papers (including 94 patients) fulfilled the search criteria. The techniques reported were not standardized and this technical heterogeneity hampered pooled analysis. A meta-analysis could also not be performed because of differences in inter-study methods, study population and results. All studies showed, nevertheless, that the technique is feasible with low morbidity and short postoperative hospital stay. No anal dysfunction was reported. CONCLUSION To date, the evidence in favour of left-sided laparoscopic colectomy with transrectal specimen extraction is weak (level IV-V). Future clinical research should focus on standardization of the technique. Randomized controlled trials are necessary to show the superiority of this approach with regard to postoperative pain and morbidity, hospital stay, recovery, function and cosmesis.
Collapse
Affiliation(s)
- A M Wolthuis
- Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Leuven, Belgium.
| | | | | | | | | |
Collapse
|
149
|
Abstract
BACKGROUND Rectal endometriosis can cause debilitating symptoms. Rectal resection in this setting has been shown to improve symptoms; however, there remain some reservations about this intervention because of the risk of complications such as anastomotic leak and rectovaginal fistula. OBJECTIVE The aim of this study is to review our experience with rectal resection in patients with rectal endometriosis. DATA SOURCES Hospital records and prospectively maintained electronic databases of an endogynecologist and colorectal surgeon were reviewed. STUDY SELECTION This is a retrospective study of consecutive patients who underwent rectal resection for endometriosis from 2001 to 2010. INTERVENTIONS All patients underwent either disc or segmental resection of the rectum. MAIN OUTCOME MEASURES Outcomes of interest were operative complications and recurrence requiring surgical reintervention. RESULTS Ninety-one patients underwent 92 resections for endometriosis. Sixty-five (71%) were disc resections, 25 (27%) were segmental resections, and 1 patient underwent both disc and segmental resections. Eighty-one (88%) procedures were completed laparoscopically. Patients requiring segmental resection had more extensive disease, and this was associated with open conversion (p ≤ 0.0001). Average duration of procedure was 209 minutes. Three patients (3%) required defunctioning ileostomies. Intramural endometriosis was confirmed in 96.7% of specimens. Complications occurred in 13 patients (15%); 4 were minor. Three patients had small pelvic collections treated with antibiotics, 5 patients required transfusion for bleeding (3 intraoperative, 2 anastomotic bleeds that settled conservatively), and 1 patient sustained ureteric injury that was reimplanted with no sequelae. None had anastomotic leak or rectovaginal fistula. Ten patients (11%) required reintervention for recurrent symptoms. Of these, 8 (8.8%) patients were found to have recurrent endometriosis. No correlation could be found between involved margins on pathology and need for redo surgery. LIMITATIONS : This study is limited by its retrospective nature. CONCLUSIONS Laparoscopic rectal resection for deeply infiltrative endometriosis is feasible and safe, and it provides durable symptom control with acceptable recurrence rates.
Collapse
|
150
|
Fritzer N, Tammaa A, Salzer H, Hudelist G. Effects of Surgical Excision of Endometriosis regarding Quality of Life and Psychological Well-Being: A Review. WOMENS HEALTH 2012; 8:427-35. [DOI: 10.2217/whe.12.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the present work is to give a critical and detailed reflection on the effects of surgical resection of deep infiltrating endometriosis regarding reduction of symptoms, psychological well-being and quality of life. The current evidence strongly supports the effectiveness of radical laparoscopic resection in relieving endometriosis-associated symptoms and enhancing psychological well-being. In addition, studies suggest a general improvement of quality of life, however, further studies are needed to support this observation.
Collapse
Affiliation(s)
- Nadja Fritzer
- Institute of Psychology, Alps-Adria University Klagenfurt, Austria
| | - Ayman Tammaa
- Endometriosis & Pelvic Pain Clinic, Wilhelminen Hospital Vienna, Montleartstraße 37, 1160 Vienna, Austria
| | - Heinrich Salzer
- Endometriosis & Pelvic Pain Clinic, Wilhelminen Hospital Vienna, Montleartstraße 37, 1160 Vienna, Austria
| | - Gernot Hudelist
- Endometriosis & Pelvic Pain Clinic, Wilhelminen Hospital Vienna, Montleartstraße 37, 1160 Vienna, Austria
- Österreichische Gesellschaft für Endokrinologische Onkologie, Vienna, Austria
| |
Collapse
|