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Miller GC, Sokolova A, Bettington ML, Rosty C, Brown IS. Colorectal endometriosis - a challenging, often overlooked cause of colorectal pathology: a clinicopathological review of 114 cases. Pathology 2024; 56:795-803. [PMID: 39025725 DOI: 10.1016/j.pathol.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/21/2024] [Accepted: 04/05/2024] [Indexed: 07/20/2024]
Abstract
The colon is the most common site for endometriosis outside the genital tract. It has a varied presentation and can mimic numerous other conditions, both clinically and pathologically. We investigated the clinicopathological features of a series of colorectal endometriosis with a particular emphasis on the features seen in cases with colonic mucosal involvement. A total of 114 consecutive cases of colorectal endometriosis were reviewed. Forty-eight percent did not have a prior diagnosis of endometriosis and in 34 patients (30%) the endometriosis was determined as the cause for the presentation. Mucosal involvement was present in 31 specimens. Features of chronic colitis were seen in the adjacent mucosa in 90% of cases whilst there were glandular changes mimicking adenocarcinoma in two cases (1.8%). Fifty percent of cases with mucosal involvement also showed glands with a hybrid intestinal-endometrial phenotype by morphology and/or by immunohistochemistry. Endometriosis is an important mimic of other conditions.
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Affiliation(s)
- Gregory C Miller
- Envoi Specialist Pathologists, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Anna Sokolova
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Mark L Bettington
- Envoi Specialist Pathologists, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Ian S Brown
- Envoi Specialist Pathologists, Brisbane, Qld, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
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Dubernard G, Maissiat E, Legendre G, Dennis T, Capmas P, Warembourg S, Descamps P, Chavrier F, Roman H, Fernandez H, Nguyen-Ba E, Merlot B, Rousset P, Lafon C, Philip CA. Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients. Hum Reprod 2024; 39:1673-1683. [PMID: 38914481 PMCID: PMC11291952 DOI: 10.1093/humrep/deae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/14/2024] [Indexed: 06/26/2024] Open
Abstract
STUDY QUESTION Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? SUMMARY ANSWER This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien-Dindo Grade III complications overall, and namely no rectovaginal fistulae. WHAT IS KNOWN ALREADY A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced. STUDY DESIGN, SIZE, DURATION A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien-Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment. MAIN RESULTS AND THE ROLE OF CHANCE The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien-Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P < 0.001) with a 28% decrease in volume. LIMITATIONS, REASONS FOR CAUTION The main objective was safety and not effectiveness. The study was not randomized and there was no control group. WIDER IMPLICATIONS OF THE FINDINGS HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT04494568.
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Affiliation(s)
- G Dubernard
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| | - E Maissiat
- Department of Radiology, Croix-Rousse University Hospital, Lyon, France
| | - G Legendre
- Department of Gynaecology and Obstetrics, Angers University Hospital, Angers, France
| | - T Dennis
- Department of Gynaecology, Tivoli-Ducos Clinic, Bordeaux, France
| | - P Capmas
- Department of Gynaecology and Obstetrics, Kremlin-Bicêtre University Hospital, Paris, France
| | - S Warembourg
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - P Descamps
- Department of Gynaecology and Obstetrics, Angers University Hospital, Angers, France
| | - F Chavrier
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| | - H Roman
- Department of Gynaecology, Tivoli-Ducos Clinic, Bordeaux, France
| | - H Fernandez
- Department of Gynaecology and Obstetrics, Kremlin-Bicêtre University Hospital, Paris, France
| | - E Nguyen-Ba
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - B Merlot
- Department of Gynaecology, Tivoli-Ducos Clinic, Bordeaux, France
| | - P Rousset
- Department of Radiology, South Lyon University Hospital, Lyon, France
| | - C Lafon
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
| | - Charles-André Philip
- Department of Gynaecology and Obstetrics, Croix-Rousse University Hospital, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
- Laboratory of Therapeutic Applications of Ultrasound, Claude Bernard University, Lyon, France
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Schneyer RJ, Hamilton KM, Meyer R, Nasseri YY, Siedhoff MT. Surgical treatment of colorectal endometriosis: an updated review. Curr Opin Obstet Gynecol 2024; 36:239-246. [PMID: 38743685 DOI: 10.1097/gco.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis. RECENT FINDINGS The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design. SUMMARY The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made.
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Affiliation(s)
- Rebecca J Schneyer
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kacey M Hamilton
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Yosef Y Nasseri
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew T Siedhoff
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Raimondo D, Ianieri MM, Raffone A, Ferla S, Raspollini A, Virgilio A, Govoni F, Pavone M, Neola D, Guida M, Del Governatore M, Scambia G, Seracchioli R. Feasibility of Intraoperative Proctosigmoidoscopy After Discoid Bowel Resection for Deep Infiltrating Endometriosis: A Pilot Multicenter Study. J Minim Invasive Gynecol 2024; 31:680-687. [PMID: 38761918 DOI: 10.1016/j.jmig.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
STUDY OBJECTIVE Although surgery is the gold standard treatment for pain refractory to medical management or partial occlusion owing to rectosigmoid endometriosis, surgical resection can be associated with major perioperative complications. From general surgery experience, intraoperative proctosigmoidoscopy has shown encouraging results as a feasible, safe, and effective technique in reducing the risk of complications related to intestinal anastomosis after segmental resection. Unfortunately, there are no studies evaluating its role after discoid resection for rectosigmoid endometriosis. DESIGN A pilot, multicentric, observational, prospective, cohort study. SETTING Two academic hospitals, from March 1 to December 31, 2022. PATIENTS We enrolled all consecutive fertile-age patients affected by symptomatic endometriosis scheduled for laparoscopic discoid bowel resection. Inclusion criteria were (1) age between 18 and 50 years, (2) diagnosis of rectosigmoid endometriosis performed by transvaginal ultrasound and/or magnetic resonance imaging, and (3) women scheduled for laparoscopic discoid bowel resection of endometriosis at low risk of segmental resection. INTERVENTIONS During data analysis, enrolled patients were divided into 2 study groups for comparisons based on whether or not the intraoperative proctosigmoidoscopy was performed upon surgeons' discretion after discoid resection for treating endometriosis, in addition to standard integrity tests. Primary outcome was the rate of intraoperative proctosigmoidoscopy success. Secondary study outcomes were the differences between the intraoperative proctosigmoidoscopy group and the nonintraoperative proctosigmoidoscopy group in (1) mean of total operative time and (2) rate of perioperative complications. MEASUREMENTS AND MAIN RESULTS A total of 28 patients were enrolled and equally distributed in the 2 groups. The rate of intraoperative proctosigmoidoscopy success was 86%. No significant difference was reported between the 2 groups in terms of total operative time (p = .1) and intraoperative and postoperative complications (p = .5 and p = 1, respectively), with no surgical complication related to intraoperative proctosigmoidoscopy. CONCLUSION Intraoperative proctosigmoidoscopy seems as a feasible and non-time-consuming intraoperative procedure in women undergone discoid resection for rectosigmoid endometriosis. Larger studies with longer follow-up period are necessary to confirm our findings and assess clinical benefits over standard procedure.
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Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Ferla, Raspollini, Virgilio, Govoni, and Seracchioli), Bologna, Italy
| | - Manuel Maria Ianieri
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Drs. Ianieri, Pavone, Scambia, and Seracchioli), Rome, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II (Drs. Raffone, Neola, and Guida), Naples, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna (Drs. Raffone, Ferla, Raspollini, and Virgilio), Bologna, Italy.
| | - Stefano Ferla
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Ferla, Raspollini, Virgilio, Govoni, and Seracchioli), Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna (Drs. Raffone, Ferla, Raspollini, and Virgilio), Bologna, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Ferla, Raspollini, Virgilio, Govoni, and Seracchioli), Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna (Drs. Raffone, Ferla, Raspollini, and Virgilio), Bologna, Italy
| | - Agnese Virgilio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Ferla, Raspollini, Virgilio, Govoni, and Seracchioli), Bologna, Italy; Department of Medical and Surgical Sciences (DIMEC), University of Bologna (Drs. Raffone, Ferla, Raspollini, and Virgilio), Bologna, Italy
| | - Francesca Govoni
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Ferla, Raspollini, Virgilio, Govoni, and Seracchioli), Bologna, Italy
| | - Matteo Pavone
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Drs. Ianieri, Pavone, Scambia, and Seracchioli), Rome, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II (Drs. Raffone, Neola, and Guida), Naples, Italy
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II (Drs. Raffone, Neola, and Guida), Naples, Italy
| | - Marco Del Governatore
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Dr. del Governatore), Bologna, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Drs. Ianieri, Pavone, Scambia, and Seracchioli), Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna (Drs. Raimondo, Ferla, Raspollini, Virgilio, Govoni, and Seracchioli), Bologna, Italy; Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Drs. Ianieri, Pavone, Scambia, and Seracchioli), Rome, Italy
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Dolci C, Kerbage Y, Ruffolo AF, Candiani M, Gandon A, Rubod C. Protective defunctioning stoma in bowel segmental resection at the time of total hysterectomy for endometriosis: when less is more. Arch Gynecol Obstet 2024:10.1007/s00404-024-07629-5. [PMID: 38995389 DOI: 10.1007/s00404-024-07629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To compare postoperative complications in women undergoing total hysterectomy with segmental resection (TH-SR) for intestinal endometriosis with or without protective defunctioning stoma (PDS) confection. METHODS Retrospective cohort study conducted at the Gynecologic department of University Hospital of Lille (France) from January 2008 to January 2022 in patients undergone TH-SR for bowel endometriosis. RESULTS 100 women were considered for the analysis. PDS were performed in 56 women. The rate of rectal resections was significantly higher in the PDS group (p = 0.03). The mean operative time, AAGL scores and length of hospital stay were significantly higher in the PDS group (p = 0.002). The rate of grade III complication according to Clavien-Dindo classification was higher in the PDS group (p = 0.03). Among digestive complications, one case of anastomosis leakage (1.8%) and one case of recto-vaginal fistula (2.3%) was recorded in the non-PDS group, 4 cases of anastomosis stenosis were recorded in the PDS group (7.1%). Persisting bladder atony requiring self-catheterization over one month was the most common disturb (4.6% in the non-PDS group and 7.1% in the PDS group, p = 0.58). The distance of digestive lesion from anal margin was the only risk factor for digestive complications, persistent bladder atony, Clavien-Dindo IIIA and IIIB complications at the multivariate analysis (p = 0.04 and p = 0.06 respectively). CONCLUSION No statistically significant differences were found in the rate of digestive complications in case of total hysterectomy and concomitant segmental resection when performing or not preventing stoma.
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Affiliation(s)
- Carolina Dolci
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France.
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Yohan Kerbage
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59000, Lille, France
| | | | - Massimo Candiani
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Anne Gandon
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
| | - Chrystèle Rubod
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59000, Lille, France
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Keckstein S, Dippon J, Hudelist G, Koninckx P, Condous G, Schroeder L, Keckstein J. Sonomorphologic Changes in Colorectal Deep Endometriosis: The Long-Term Impact of Age and Hormonal Treatment. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:285-292. [PMID: 38101445 DOI: 10.1055/a-2209-5653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
PURPOSE The progression of deep endometriosis (DE) in women of reproductive age is highly variable. This study aimed to analyze the sonomorphological changes of rectal endometriosis over long periods of time and the influence of hormonal treatment. METHODS This retrospective study included premenopausal women with rectal DE treated conservatively between 2002 and 2021. The lesion length and thickness of the nodule were evaluated at regular intervals over time. We created statistical models with mixed effects to identify potential factors influencing lesion progression and regression. RESULTS 38 patients were monitored over a mean period of 7.2 (± 4.2) years with a mean of 3.1 (± 2.1) check-ups within the observation period. We detected a significant increase in lesion length until the end of the fourth decade of life. In addition, we found a substantial decrease in the length and thickness of the nodule depending on the length of hormonal treatment. CONCLUSION In conservatively managed patients with rectal endometriosis, without hormonal therapy, lesion size can exhibit a moderate increase up to the end of the fourth decade of life, after which it appears to stabilize. This increase does not follow a linear pattern. Hormonal therapy is crucial in impeding further progression, resulting in either a cessation or a regression of lesion growth.
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Affiliation(s)
- Simon Keckstein
- Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany
| | - Juergen Dippon
- Institute for Stochastics and Applications, University of Stuttgart, Stuttgart, Germany
| | | | - Philippe Koninckx
- Department for Gynecology, Latifa Hospital, Dubai, United Arab Emirates
| | - George Condous
- Acute Gynecology, Early Pregnancy & Advanced Endoscopic Surgery Unit, University of Sydney - Sydney Medical School Nepean, Sydney, Australia
| | - Lennard Schroeder
- Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany
| | - Joerg Keckstein
- (SEF), Stiftung Endometrioseforschung, Westerstede, Germany
- Gynecological Clinic, Gynecological Clinic Drs Keckstein, Villach, Austria
- Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany
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Bourdon M, Peigné M, Maignien C, de Villardi de Montlaur D, Solignac C, Darné B, Languille S, Bendifallah S, Santulli P. Impact of Endometriosis Surgery on In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes: a Systematic Review and Meta-analysis. Reprod Sci 2024; 31:1431-1455. [PMID: 38168857 DOI: 10.1007/s43032-023-01421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
Endometriosis-related infertility remains a therapeutic challenge. A burning issue in this field of research is determining whether pre-assisted reproductive technology (ART) surgery may be of some benefit in terms of reproductive outcomes. This systematic review and meta-analysis aimed at comparing ongoing pregnancy rates (OPR) and/or live birth rates (LBR) in patients who underwent endometriosis surgery before ART (IVF/ICSI) in comparison with patients who underwent first-line ART (IVF/ICSI). Searches were conducted from January 1990 to June 2021 on PubMed, Embase, and Cochrane Library using the following search terms: endometriosis, surgery, reproductive outcomes, and IVF/ICSI. The primary outcomes were OPR or LBR. A total of 19 studies were included in the meta-analysis. No statistically significant differences in LBR [0.91[0.63, 1.30]; I2 = 66%; n = 11], OPR [1.28[0.66, 2.49]; I2 = 60%; n = 3], and early pregnancy loss rate [0.88[0.62, 1.25]; I2 = 0%; n = 7] per cycle were found when comparing patients who underwent endometriosis surgery before IVF/ICSI and those who did not. After the exclusion of the studies with high risks of bias, the LBR per cycle was significantly reduced in the case of surgical treatment before IVF/ICSI [0.53[0.33, 0.86]; I2 = 30%; n = 4]. These data urge the clinician to carefully weigh the pros and cons before referring infertile patients with endometriosis to surgery before IVF, highlighting the key role of multidisciplinary referral centers.
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Affiliation(s)
- M Bourdon
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Université de Paris Cité, Faculté de Santé, Paris, France
- Department 3I "Infection, Immunité Et Inflammation", Institut Cochin, INSERM U1016, Paris, France
| | - M Peigné
- Department of Reproductive Médecine and Fertility Preservation, AP-HP, Hopital Jean Verdier, Université Sorbonne Paris Nord, Faculté de Santé, Bondy, France
| | - C Maignien
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Université de Paris Cité, Faculté de Santé, Paris, France
| | | | - C Solignac
- Gedeon Richter France, 75008, Paris, France
| | - B Darné
- Monitoring Force, 78600, Maisons-Laffitte, France
| | - S Languille
- Monitoring Force, 78600, Maisons-Laffitte, France
| | - S Bendifallah
- Department of Gynecology Obstetrics and Reproductive Medicine, AP-HP, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Faculté de Santé, Paris, France
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Université de Paris Cité, Faculté de Santé, Paris, France.
- Department 3I "Infection, Immunité Et Inflammation", Institut Cochin, INSERM U1016, Paris, France.
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8
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Canturk MM, D'Ancona G, François MO, Roman H. Robotic Management of Recurrent Rectal Endometriosis After Previous Segmental Bowel Resection. J Minim Invasive Gynecol 2024; 31:176-177. [PMID: 38043860 DOI: 10.1016/j.jmig.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To describe the management of recurrent bowel endometriosis after previous colorectal resection. DESIGN Surgical video article. The local institutional board review was omitted due to the narration of surgical management. Patient consent was obtained. SETTING A tertiary referral center. The patient first underwent segmental bowel resection for deep infiltrating endometriosis of the rectum in the ENDORE randomized controlled trial in 2012 and then received a total hysterectomy in 2018. Five years later, she presented with recurrent nodules in the rectovaginal, left parametrium, and abdominal wall after discontinuing medical suppressive treatment. INTERVENTION Laparoscopic management using robotic assistance was employed to complete excision of the rectovaginal nodule. Disc excision was performed to remove rectal infiltration. The procedure started with rectal shaving and excision of vaginal infiltration . A traction stitch was placed over the limits of the rectal shaving area. The general surgeon placed a 28 mm circular anal stapler transanally and performed complete excision of the shaved rectal area. Anastomotic perfusion was checked with indocyanine green. A methylene blue enema test was conducted to rule out anastomotic leakage. Outcomes were favorable, with systematic self-catheterization during 5 postoperative weeks. No specific symptoms were related to the other 2 nodules, which were not removed. CONCLUSION Rectal recurrences may occur long after colorectal resection and outside the limits of the previous surgery site. To accurately assess this risk, long-term follow-up of patients is mandatory.. Postoperative medical amenorrhea may play a role in recurrence prevention. Surgical management of recurrences may be challenging and focus on only those nodules responsible for symptoms so as to best preserve the organ's function and reduce postoperative morbidity.
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Affiliation(s)
- Muhterem Melis Canturk
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo) (Drs. Canturk, D'Ancona, and Roman), Clinique Tivoli-Ducos, Bordeaux, France.
| | - Gianmarco D'Ancona
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo) (Drs. Canturk, D'Ancona, and Roman), Clinique Tivoli-Ducos, Bordeaux, France
| | - Marc Olivier François
- Bordeaux Colorectal Institute (Dr. François), Clinique Tivoli-Ducos, Bordeaux, France
| | - Horace Roman
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo) (Drs. Canturk, D'Ancona, and Roman), Clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Institut of Endometriosis-Middle East Clinic (Dr. Roman), Burjeel Medical City, Abu Dhabi, UAE; Department of Gynecology and Obstetrics (Dr. Roman), Medical University Aarhus, Aarhus, Denmark
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9
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Piozzi GN, Burea V, Duhoky R, Stefan S, So C, Wilby D, Tsepov D, Khan JS. Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity. Tech Coloproctol 2024; 28:31. [PMID: 38329622 PMCID: PMC10853297 DOI: 10.1007/s10151-023-02904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Bowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery. METHODS Consecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021-December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires. RESULTS Sixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2-42.0) years. Median body mass index was 24.0 (21.0-26.7) kg/m2. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120-180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5-40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2-4) days. Median follow-up was 12 (7-17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0-8.0) to 1.0 (0.0-5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0-5.7) to 0.0 (0.0-2.0). Median quality of life score improved from 52.5 (35.0-70.0) to 74.5 (60.0-80.0). CONCLUSIONS Robotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.
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Affiliation(s)
- G N Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - V Burea
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - R Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - S Stefan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - C So
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - D Wilby
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
- Department of Urology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - D Tsepov
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - J S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK.
- University of Portsmouth, Portsmouth, UK.
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Kurup M, Bidarahalli S, Jayaram S. Robotic Surgery in Gynaecology: A Retrospective Evaluation of an Experience at a Single Centre. J Obstet Gynaecol India 2024; 74:53-59. [PMID: 38434133 PMCID: PMC10902232 DOI: 10.1007/s13224-023-01852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/01/2023] [Indexed: 03/05/2024] Open
Abstract
Objective The aim of this research was to assess the role of robotics and its outcome in gynaecology both in benign and malignant cases in a single centre and provide a critical evaluation of possible advantages of robot assisted surgeries from surgeons' point of view. Design A single centre, retrospective observational study. Population All women who underwent robotic gynaecological surgeries between 2015 and 2022. Methods The Da Vinci Si™ robotic system was used for these surgeries performed by all surgeons at our quaternary care centre, and data were acquired retrospectively through electronic medical records. Descriptive statistical analysis of data was done. Main outcome measures included operative time, estimated blood loss, hospital stay, complications and conversion rates in all cases. Age was analysed as a demographic data. Outcome A total of 211 robotic cases were performed including 172 hysterectomies, 20 myomectomies and 19 cases for other gynaecological indications. The mean operating time or hysterectomy and myomectomy was 113 and 129 min, respectively, and haemoglobin drop was 1.34 and 1.2 g/dl, respectively. No conversions to laparotomy were observed in either of the groups. The surgeries for 19 benign gynaecological conditions included ovarian cystectomy, cesarean scar repair and chronic cornual ectopic. Conclusion Robotic surgical system helps accomplish several procedures with exceptional laparoscopic skills. Robotic surgery is safe in all types of gynaecological procedures and is a promising alternative for comprehensive gynaecologic surgical care.
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Affiliation(s)
- Mayadevi Kurup
- Department of Obstetrics and Gynaecology, Aster Medcity, Kochi, Kerala India
| | - Suguna Bidarahalli
- Department of Obstetrics and Gynaecology, Aster Medcity, Kochi, Kerala India
- Bangalore, India
| | - Surya Jayaram
- Department of Obstetrics and Gynaecology, Medical Trust Hospital, Kochi, Kerala India
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Liang Y, Mei L, Ning Q, Zhang J, Fei J, Dong J. A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review. Int J Womens Health 2024; 16:163-174. [PMID: 38292299 PMCID: PMC10826710 DOI: 10.2147/ijwh.s445280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
Background Endometriosis involves the intestine, and its clinical manifestations are nonspecific and lack of etiological manifestations. The diagnosis is difficult, which often leads to misdiagnosis. We report a case of endometriosis which was misdiagnosed as intestinal malignant tumor after colonoscopy and three biopsies. Case Presentation We reported a 42-year-old woman who went to see a doctor because of anal distension. She was examined by three gastrointestinal endoscopists at different levels in different hospitals and underwent biopsy at the same time. Combined with clinical manifestations, imaging examination, endoscopic examination and pathological examination, she was misdiagnosed as intestinal malignant tumor, and partial intestinal resection was performed according to the surgical principle of malignant tumor. Conclusion Although there are advanced gastrointestinal endoscopy and imaging techniques, intestinal endometriosis is still easy to be misdiagnosed. As our case report shows, after three colonoscopy and biopsy, it is still misdiagnosed as intestinal malignant tumor. Further research is needed to improve the ability of preoperative diagnosis, which deserves the attention of gastroenterologists and obstetricians and gynecologists.
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Affiliation(s)
- Yufei Liang
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Lina Mei
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Qipeng Ning
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jiao Zhang
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jingying Fei
- Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jie Dong
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
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Dobó N, Márki G, Hudelist G, Csibi N, Brubel R, Ács N, Bokor A. Laparoscopic natural orifice specimen extraction colectomy versus conventional laparoscopic colorectal resection in patients with rectal endometriosis: a randomized, controlled trial. Int J Surg 2023; 109:4018-4026. [PMID: 37720929 PMCID: PMC10720833 DOI: 10.1097/js9.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND The conventional laparoscopic approach for the surgical management of deep endometriosis (DE) infiltrating the rectum appears to ensure improved digestive functional outcomes. The natural orifice specimen extraction (NOSE) technique for the treatment of colorectal DE can significantly accelerate postoperative recovery; however, data on gastrointestinal function following conventional laparoscopic segmental bowel resection (CLR) compared with NOSE colectomy (NC) for DE are sparse. MATERIALS AND METHODS Between 30 September 2019 and 31 December 2020, a randomized, open-label, two-arm, parallel-group controlled trial with women aged 18-45 years was conducted at University Hospital.Ninety-nine patients were randomized to CLR or NC, with DE infiltrating at least the muscular layer, at least 50% of the circumference of the bowel, up to 15 cm from the anal verge, exhibiting pain and bowel symptoms and/or infertility. The primary endpoint was bowel function, represented by low anterior resection syndrome (LARS). Secondary parameters included the Endometriosis Health Profile 30 (EHP30), Gastrointestinal Quality of Life Index (GIQLI), Visual Analog Scale (VAS) scores preoperatively and at set times (1 and 6 months, 1 year) following surgery. RESULTS No significant differences were observed in the postoperative LARS scores, VAS, EHP30, and GIQLI between the NC and CLR groups. LARS scores did not reveal significant differences 12 months postoperatively compared to the preoperative values in both groups (CLR group P =0.93 versus NC group, P =0.87). GIQLI scores were significantly improved 12 months after the operation compared with baseline values in the CLR group ( P =0.002) and NC group ( P =0.001). Pain symptoms and quality of life scores significantly improved 12 months postoperatively in both groups. CONCLUSIONS NC is a feasible surgical approach for treating patients with rectal DE. Our study did not show a statistically significant difference between CLR and NC techniques in mid-term digestive and pain outcomes.
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Affiliation(s)
- Noémi Dobó
- Department of Obstetrics and Gynecology, Semmelweis University
| | | | - Gernot Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Rudolfinerhaus Private Clinic and Campus, Vienna, Austria
| | - Noémi Csibi
- Department of Obstetrics and Gynecology, Semmelweis University
| | - Réka Brubel
- Department of Obstetrics and Gynecology, Semmelweis University
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Semmelweis University
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Semmelweis University
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Ceccaroni M, Ceccarello M, Roviglione G. Authors' Reply. J Minim Invasive Gynecol 2023; 30:1010-1011. [PMID: 37778633 DOI: 10.1016/j.jmig.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
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Yin W, Li X, Liu P, Li Y, Liu J, Yu S, Tai S. Digestive system deep infiltrating endometriosis: What do we know. J Cell Mol Med 2023; 27:3649-3661. [PMID: 37632165 PMCID: PMC10718155 DOI: 10.1111/jcmm.17921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/06/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Digestive system infiltrating endometriosis (DSIE) is an uncommon form of endometriosis in the digestive system. DSIE often occurs in the intestines (especially the sigmoid rectum), liver, gallbladder and pancreas. Clinically, DSIE presents with the same symptoms as endometriosis, including cyclic pain, bleeding and infertility, in addition to specific biliary/intestinal obstruction and gastrointestinal bleeding. Compared to general endometriosis, DSIE has unique biological behaviour and pathophysiological mechanisms. Most DSIEs are deep invasive endometrioses, characterized by metastasis to the lymph nodes and lymphatic vessels, angiogenesis, peripheral nerve recruitment, fibrosis and invasion of surrounding tissues. DSIE-related peripheral angiogenesis is divided into three patterns: angiogenesis, vasculogenesis and inosculation. These patterns are regulated by interactions between multiple hypoxia-hormone cytokines. The nerve growth factors regulate the extensive neurofibril recruitment in DSIE lesions, which accounts for severe symptoms of deep pain. They are also associated with fibrosis and the aggressiveness of DSIE. Cyclic changes in DSIE lesions, recurrent inflammation and oxidative stress promote repeated tissue injury and repair (ReTIAR) mechanisms in the lesions, accelerating fibril formation and cancer-related mutations. Similar to malignant tumours, DSIE can also exhibit aggressiveness derived from collective cell migration mediated by E-cadherin and N-cadherin. This often makes DSIE misdiagnosed as a malignant tumour of the digestive system in clinical practice. In addition to surgery, novel treatments are urgently required to effectively eradicate this lesion.
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Affiliation(s)
- Wenze Yin
- Department of Hepatic SurgerySecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Xiaoqing Li
- Department of PathologySecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Peng Liu
- Laboratory of Medical GeneticsHarbin Medical UniversityHarbinChina
| | - Yingjie Li
- Department of PathologySix Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Jin Liu
- Department of PathologySecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Shan Yu
- Department of PathologySecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Sheng Tai
- Department of Hepatic SurgerySecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
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15
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Mușat F, Păduraru DN, Bolocan A, Constantinescu A, Ion D, Andronic O. Endometriosis as an Uncommon Cause of Intestinal Obstruction-A Comprehensive Literature Review. J Clin Med 2023; 12:6376. [PMID: 37835020 PMCID: PMC10573381 DOI: 10.3390/jcm12196376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1-0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception.
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Affiliation(s)
- Florentina Mușat
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Dan Nicolae Păduraru
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandra Bolocan
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Alexandru Constantinescu
- Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania;
| | - Daniel Ion
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
| | - Octavian Andronic
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, The University Emergency Hospital of Bucharest, 050098 Bucharest, Romania; (F.M.); (A.B.); (D.I.); (O.A.)
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16
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Chaggar P, Tellum T, Cohen A, Jurkovic D. Intra- and interobserver reproducibility of transvaginal ultrasound for the detection and measurement of endometriotic lesions of the bowel. Acta Obstet Gynecol Scand 2023; 102:1306-1315. [PMID: 37641421 PMCID: PMC10541154 DOI: 10.1111/aogs.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The number and invasion depth of endometriotic bowel lesions, total length of bowel affected by endometriosis, lesion-to-anal verge distance, and extent of pouch of Douglas obliteration are important factors in preoperatively determining risk and complexity of endometriosis surgery. The intra- and interobserver reproducibility of transvaginal ultrasound in the evaluation of many of these parameters has not yet been investigated. Our study aimed to assess the intra- and interobserver reproducibility of transvaginal ultrasound between an experienced and less experienced examiner for all of these parameters. MATERIAL AND METHODS This prospective observational cross-sectional study was conducted between July 2019 and November 2020. Fifty consecutive premenopausal women who underwent transvaginal ultrasound examination in our clinic for the first time, were examined by the same two operators during the same attendance. Outcomes of interest were the inter-rater reproducibility of transvaginal ultrasound for detecting the presence, number, depth and size of bowel endometriotic nodules, lesion-to-anal-verge distance, total length of bowel affected, and pouch of Douglas obliteration. The intraobserver reproducibility was assessed for the continuous parameters. Cohen's kappa (κ) statistic, Cohen's weighted kappa (κ), proportions of agreement, intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement were used to assess the reproducibility of the parameters. RESULTS The inter-rater agreement and reliability were very good for identifying bowel endometriosis, the number and invasion depth of bowel nodules, determining whether the maximum nodule length was <3 cm, and lesion-to-anal-verge distance <8 cm (proportion of agreement 0.92, 0.94, 0.97, 0.94, 0.96; κ 0.92, 0.91, 0.92, 0.82, 0.89). The inter-rater agreement and reliability were good for assessing pouch of Douglas obliteration (proportion of agreement 0.86, κ 0.80). The intra-rater reliability for the mean nodule diameter (ICC 0.93 and 0.97) and total length of bowel affected (ICC 0.94 and 0.91) were excellent for operators A and B, respectively. The inter-rater reliability for the mean nodule diameter was good (ICC 0.80), and moderate for the total length of bowel affected (ICC 0.70). The Bland-Altman limits of agreement demonstrated clinically acceptable ranges for these two parameters. CONCLUSIONS This study demonstrated a high intra- and inter-rater reproducibility of transvaginal ultrasound in the diagnosis of bowel endometriosis and measurement of its various components.
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Affiliation(s)
- Prubpreet Chaggar
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Tina Tellum
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Department of GynecologyOslo University HospitalOsloNorway
| | - Abigail Cohen
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Davor Jurkovic
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
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17
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Christiansen A, Connelly TM, Lincango EP, Falcone T, King C, Kho R, Russo ML, Jia X, Valente M, Kessler H. Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients. Langenbecks Arch Surg 2023; 408:385. [PMID: 37773225 DOI: 10.1007/s00423-023-03095-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence. METHODS This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors. RESULTS Of 2681 endometriosis cases, 142 [5.3% of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%, segmental = 27.5%, full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls, p = 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5), p = 0.01], stoma formation [52.6% vs. 8.9%, HR 10.9 (3.65; 34.1), p < 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4), p < 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24), p < 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls, p = 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9), p = 0.001], stoma formation [42% vs. 3.3%, HR 20.3 (5.41; 90.0), p < 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876), p < 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9), p < 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05), p = 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59), p = 0.027] were associated. Segmental resection was associated with decreased recurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91), p = 0.024]. CONCLUSION Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.
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Affiliation(s)
| | - Tara M Connelly
- Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Eddy P Lincango
- Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Cara King
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Rosanne Kho
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Miguel Luna Russo
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Xue Jia
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Valente
- Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Maignien C, Hachem RE, Bourdon M, Marcellin L, Chalas C, Patrat C, Gonzàlez-Foruria I, Chapron C, Santulli P. Oocyte donation outcomes in endometriosis patients with multiple IVF failures. Reprod Biomed Online 2023; 47:103236. [PMID: 37390602 DOI: 10.1016/j.rbmo.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 07/02/2023]
Abstract
RESEARCH QUESTION What are the reproductive outcomes and the prognostic factors of live birth rates in patients with endometriosis referred to oocyte donation after multiple IVF failures? DESIGN Observational cohort study including all women with endometriosis-related infertility and two or more failed IVF/intracytoplasmic sperm injection (ICSI) cycles referred to oocyte donation between January 2013 and June 2022. Endometriosis was diagnosed based on published imaging criteria, and was confirmed histologically in women who had a history of surgery for endometriosis. The main outcome measured was the cumulative live birth rate (CLBR). The characteristics of women who had a live birth were compared with those who did not using univariate and multivariate analysis to identify determinant factors of fertility outcome. RESULTS Fifty-seven patients underwent 90 oocyte donation cycles after 244 failed autologous IVF cycles. The mean ± SD age of the population was 36.8 ± 3.3 years, with a mean duration of infertility of 3.6 ± 2.2 years, and a mean number of autologous IVF/ICSI cycles of 4.4 ± 2.3 cycles per patient. Three patients (5.3%) had superficial peritoneal endometriosis, two patients (3.5%) had ovarian endometriomas, and 52 patients (91.2%) had deep infiltrating endometriosis, among which 30 patients (57.7%) had bowel lesions. Thirty patients (52.6%) had associated adenomyosis. Overall, CLBR per patient was 36/57 (63.2%). After multivariate analysis, only being nulligravida (P=0.002) remained an independent negative predictive factor of the live birth rate. Previous surgery did not impact reproductive outcomes. CONCLUSION This study suggests that oocyte donation appears to be a viable option to optimize the live birth rate in women with endometriosis-related infertility and recurrent IVF failures.
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Affiliation(s)
- Chloé Maignien
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Rami El Hachem
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Mathilde Bourdon
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - Louis Marcellin
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - Céline Chalas
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Histology and Reproductive Biology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Catherine Patrat
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Histology and Reproductive Biology, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France
| | - Iñaki Gonzàlez-Foruria
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus Mujer - Dexeus University Hospital, 08028 Barcelona, Spain; NatuVitro, Travessera de les Corts, 322, 08029 Barcelona, Spain
| | - Charles Chapron
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - Pietro Santulli
- Université Paris Cité, Faculté de Santé, 12 Rue de l'Ecole de Médecine, 75006 Paris, France; Department of Gynaecology Obstetrics II and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, 123 Boulevard de Port Royal, 75014 Paris, France; Department of Development, Reproduction and Cancer, Cochin Institute, INSERM U1016, Paris, France.
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Ceccaroni M, Ceccarello M, Raimondo I, Roviglione G, Clarizia R, Bruni F, Mautone D, Manzone M, Facci E, Rettore L, Rossini R, Bertocchi E, Barugola G, Ruffo G, Barra F. "A Space Odyssey" on Laparoscopic Segmental Rectosigmoid Resection for Deep Endometriosis: A Seventeen-year Retrospective Analysis of Outcomes and Postoperative Complications among 3050 Patients Treated in a Referral Center. J Minim Invasive Gynecol 2023; 30:652-664. [PMID: 37116746 DOI: 10.1016/j.jmig.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023]
Abstract
STUDY OBJECTIVE To evaluate the feasibility of laparoscopic rectosigmoid resection for bowel endometriosis (RSE), reporting surgical and short-term postoperative outcomes in a consecutive large series of patients. DESIGN A retrospective cohort study. SETTING Third-level national referral center for deep endometriosis (DE). PATIENTS 3050 patients with symptomatic RSE requiring surgical treatment. INTERVENTIONS Nerve-sparing laparoscopic resection for RSE perfomed by a multidisciplinary team. After collecting intraoperative surgical characteristics, postoperative complications were collected by evaluating the risk factors associated with their onset. MEASUREMENTS AND MAIN RESULTS Clavien-Dindo IIIb postoperative complications were noted in 13.1% of patients, with anastomotic leakage and rectovaginal fistula accounting for 3.0% and 1.9%, respectively. Postoperative bladder impairment was observed in 13.9% of patients during hospital discharge but spontaneously decreased to 4.5% at the first evaluation after 30 days, alongside a statistically significant change towards global symptom improvement. Multivariate analyses were done to identify the risk factors for segmental bowel resection in terms of occurrence of postoperative major complications. Ultralow (≤5 cm from the anal verge), low rectal anastomosis (<8 cm, >5 cm), parametrectomy, vaginal resection, and previous surgeries seemed more related to anastomotic leakage, rectovaginal fistula, and bladder retention. CONCLUSIONS Laparoscopic rectosigmoid resection for RSE seems an effective and feasible procedure. The surgical complication rate is not negligible but could be reduced by implementing a multidisciplinary approach, an endless improvement in nerve-sparing techniques and surgical anatomy, as well as technological enhancements. Real future challenges will be to reduce the time for the first diagnosis of DE and the likelihood of surgical indications.
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Affiliation(s)
- Marcello Ceccaroni
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Matteo Ceccarello
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ivano Raimondo
- Gynecology and Breast Care Center (Dr. Raimondo), Mater Olbia Hospital, Olbia, Italy; School in Biomedical Sciences (Dr. Raimondo), University of Sassari, Sassari, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Francesco Bruni
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Daniele Mautone
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Maria Manzone
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Enrico Facci
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Lorenzo Rettore
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Roberto Rossini
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elisa Bertocchi
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giuliano Barugola
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giacomo Ruffo
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Fabio Barra
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy; Department of Health Sciences (DISSAL) (Dr. Barra), University of Genoa, Genoa, Italy
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20
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Galaviz VD, Nguyen AD, Sticco PL, Downing KT. Appendectomy in endometriosis: an update on surgical indications and management of uncommon diseases. Curr Opin Obstet Gynecol 2023; 35:377-382. [PMID: 37144569 DOI: 10.1097/gco.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Abnormal appendiceal disease is commonly encountered following an appendectomy when performed in patients with endometriosis. Appendiceal endometriosis is the most notable finding and can affect up to 39% of patients with endometriosis. Despite this knowledge, guidelines for performing an appendectomy have not been formally established. In this article, we review the surgical indications for an appendectomy at the time of endometriosis surgery and discuss the management of other diseases that may be encountered following the histopathologic evaluation of an excised appendix. RECENT FINDINGS Removal of the appendix in patients with endometriosis contributes to optimal surgical management. Relying on abnormal appendiceal appearance for removal may leave endometriosis-affected appendices. For this reason, utilizing risk factors to guide surgical management is essential. Common appendiceal diseases are sufficiently managed with appendectomy. Uncommon diseases may require further surveillance. SUMMARY Emerging data in our field support the performance of an appendectomy at the time of endometriosis surgery. Guidelines for performing a concurrent appendectomy should be formalized to encourage preoperative counselling and management for patients with risk factors for appendiceal endometriosis. Abnormal diseases is frequently encountered after appendectomy in the setting of endometriosis surgery and further management is based on the histopathology of the specimen.
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21
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Carey-Love A, Dassel M, Kessler H, Luna Russo M. Anatomical and Surgical Considerations for Ileocolic Endometriosis. J Minim Invasive Gynecol 2023; 30:445. [PMID: 36934878 DOI: 10.1016/j.jmig.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE We aim to review the incidence, location, and management of bowel endometriosis and demonstrate relevant surgical principles while emphasizing anatomic considerations for minimally invasive resection of ileocolic lesions. DESIGN This video briefly reviews the background of bowel endometriosis and indications for surgical excision. We present a case of a patient diagnosed with symptomatic terminal ileum endometriosis and review the preoperative imaging. We demonstrate the steps of a medial-to-lateral surgical approach for ileocolic resection and highlight the relevant surgical anatomy. Institutional review board approval was not required. SETTING This procedure was performed at a large academic institution with a multidisciplinary team of minimally invasive gynecologic and colorectal surgeons. PATIENTS OR PARTICIPANTS The case presented is a 44-year-old female with a known history of stage IV endometriosis. She presented with acute abdominal pain and was found to have a small bowel obstruction from a 3-centimeter lesion thought to be an endometrioma. She failed conservative management and was thoroughly counseled about the need for surgical intervention. Pelvic magnetic resonance imaging was performed for preoperative planning. INTERVENTION Laparoscopic ileocolic resection is performed using a medial-to-lateral approach for excision of a symptomatic 3-centimeter ileocecal endometrioma. The following techniques are highlighted: (1) Evaluation of the entire small bowel starting at the ligament of Treitz (2) Entry into the retroperitoneum below the ileum with cranial and caudal dissection (3) Mobilization of the ascending colon to the level of the falciform ligament (4) Extension of the umbilical incision to perform an extracorporeal ileocecal resection and anastomosis CONCLUSION: The bowel is the most common extragenital site for endometriosis to occur, with the highest rate of lesions located in the rectosigmoid colon [1]. Lesions can be either superficial or deeply infiltrative and can lead to a range of symptoms. A serious sequela of bowel endometriosis includes bowel obstruction requiring surgical intervention.
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Affiliation(s)
- Angelina Carey-Love
- Women's Health Institute, Division of Minimally Invasive Gynecologic Surgery (Drs. Carey-Love, Dassel, Russo).
| | - Mark Dassel
- Women's Health Institute, Division of Minimally Invasive Gynecologic Surgery (Drs. Carey-Love, Dassel, Russo)
| | - Hermann Kessler
- Digestive Disease and Surgery Institute Department of Colorectal Surgery (Dr. Kessler), Cleveland Clinic, Cleveland, Ohio
| | - Miguel Luna Russo
- Women's Health Institute, Division of Minimally Invasive Gynecologic Surgery (Drs. Carey-Love, Dassel, Russo)
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22
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Healey KD, Herson AB, Phrathep DD, Schwarz C, Ramos CE, Rifai AO. Renal Endometriosis in a Postmenopausal Female Mimics Renal Cell Carcinoma. Cureus 2023; 15:e41133. [PMID: 37519551 PMCID: PMC10386758 DOI: 10.7759/cureus.41133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
A 61-year-old postmenopausal female with a past medical history of type 2 diabetes, nephrolithiasis, and recurrent urinary tract infections presented to an outpatient urology clinic with a chief complaint of urinary frequency, urgency, and burning after micturition. Associated symptoms included nausea, a low-grade fever with chills, and right flank pain. After treatment with antibiotics did not relieve all of her symptoms, imaging was obtained, showing a cystic mass with calcifications in the right kidney. Following laparoscopic partial right nephrectomy and total hysterectomy with bilateral salpingo-oophorectomy, pathological examination of the right kidney mass highlighted endometrial stromal cells consistent with endometriosis of the right kidney. The left ovary also contained endometrial stromal cells, confirming another diagnosis of endometriosis of the left ovary. This case highlights the importance of considering renal endometriosis in the differential diagnosis of renal masses in women, even if they are postmenopausal.
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Affiliation(s)
- Kevin D Healey
- Urology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Andrew B Herson
- Urology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Davong D Phrathep
- Urology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Conli Schwarz
- Urology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | | | - Ahmad O Rifai
- Department of Research and Publications, The Virtual Nephrologist, Lynn Haven, USA
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23
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D'Ancona G, Merlot B, Denost Q, Roman H. Robotic assisted rectal disk excision: the 3-cm diameter cut off may be abandoned. Fertil Steril 2023; 119:886-888. [PMID: 36758889 DOI: 10.1016/j.fertnstert.2023.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To describe the robotic full-thickness rectal excision using a transanal circular stapler in rectovaginal endometriosis nodule infiltrating the rectum >3 cm. DESIGN Surgical video article. The local institutional review board was consulted, and the requirement for institutional review board approval was waived because the video describes a technique and the patient cannot be identified whatsoever. Written informed consent was obtained from the patient for the use of personal data. SETTING A tertiary referral center. PATIENTS Patients undergoing excision of rectal endometriosis. INTERVENTION(S) Standardized technique of full-thickness disk excision of large rectovaginal endometriosis nodules employing a combined robotic and trans anal approach. MAIN OUTCOME MEASURE(S) Feasibility of the technique. RESULT(S) The technique is designed for deep rectovaginal nodules infiltrating middle and low-rectum up to 3 to 5 cm in length. The procedure was performed with robotic assistance. The 7-degree freedom mobility of the robotic scissors allows for a deep rectal shaving, with the goal of progressive reduction of the thickness of rectal wall. The scissors follow the rectal wall tangentially and leave behind a thin rectal wall which can be bent and pushed into the trans anal stapler's jaws. We employed end-to-end, 33 mm-diameter, circular trans anal staplers to increase the area of rectal wall to be caught into the stapler. A stitch was placed on the superior and the inferior limits of the shaved area, then the shaved area was bent and pushed into the stapler by tying a suture. The general surgeon closed and fired the stapler, then the stapler was removed together with a rectal patch of 4- to 6-cm diameter. The procedure ended in the bubble test which checked the integrity of the stapled line. Supplementary stitches may be placed to reinforce the suture, if required. CONCLUSION(S) The preliminary rectal shaving represents the real keystone of this procedure, and our experience suggests that the robotic assistance improves its feasibility in large nodule responsible for intrarectal protrusion.
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Affiliation(s)
| | | | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
| | - Horace Roman
- IFEMEndo, Clinique Tivoli-Ducos, Bordeaux, France.
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24
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Aas‐Eng MK, Young VS, Dormagen JB, Pripp AH, Hudelist G, Lieng M. Lesion-to-anal-verge distance in rectosigmoid endometriosis on transvaginal sonography vs magnetic resonance imaging: prospective study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:243-250. [PMID: 36178730 PMCID: PMC10107681 DOI: 10.1002/uog.26083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To compare transvaginal sonography (TVS) and magnetic resonance imaging (MRI) with intraoperative measurement (IOM) using a rectal probe in the estimation of the location of rectosigmoid endometriotic lesions, i.e. lesion-to-anal-verge distance (LAVD), and to compare two different MRI techniques for measuring LAVD. METHODS This was a prospective single-center observational study that included women undergoing surgery for symptomatic rectosigmoid endometriosis by discoid (DR) or segmental (SR) resection from December 2018 to December 2019. TVS and MRI were performed presurgically for each participant to evaluate LAVD, and the measurements on imaging were compared with IOM using a rectal probe. Clinically acceptable difference and limits of agreement (LoA) between TVS and MRI compared with IOM were set at ± 20 mm. Two different measuring methods for MRI, MRICenter and MRIDirect , were proposed and evaluated, as there is currently no guideline to describe deep endometriosis on MRI. Bland-Altman plots and LoA were used to assess agreement of TVS and both MRI methods with IOM. Systematic and proportional biases were assessed using paired t-test and Bland-Altman plots. RESULTS Seventy-five women were eligible for inclusion. Twenty-eight women were excluded, leaving 47 women for the analysis. Twenty-three DR and 26 SR procedures were performed, with both procedures performed in two women. The Bland-Altman plots showed that there were no systematic differences between TVS or MRICenter when compared with IOM for all included participants. MRIDirect systematically underestimated LAVD for lesions located further from the anal verge. TVS, MRICenter and MRIDirect had LoA outside the preset clinically acceptable difference when compared with IOM. LAVD was within the clinically acceptable difference from IOM of ± 20 mm in 70% (33/47) of women on TVS, 72% (34/47) of women on MRICenter and 47% (22/47) of women on MRIDirect . CONCLUSIONS TVS should be the preferred method to estimate the location of a rectosigmoid endometriotic lesion, i.e. LAVD, as it is more available, less expensive and has a similar accuracy to that of MRI. Estimating LAVD can be relevant for planning colorectal surgery for rectosigmoid endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. K. Aas‐Eng
- Department of GynecologyOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - V. S. Young
- Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
| | - J. B. Dormagen
- Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
| | - A. H. Pripp
- Oslo Center for Biostatistics and EpidemiologyOslo University HospitalOsloNorway
| | - G. Hudelist
- Department of Gynecology, Certified Center for Endometriosis and Pelvic PainHospital St John of GodViennaAustria
- Rudolfinerhaus Private ClinicViennaAustria
- Stiftung Endometrioseforschung/Endometriosis Research Group DACH Region, Central Europe
| | - M. Lieng
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Division of Obstetrics and GynecologyOslo University HospitalOsloNorway
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LONGO M, GAIA G, AFONINA M, ALBONI C, LA MARCA A. Robotic-assisted laparoscopy in reproductive surgery: what is new? GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2023. [DOI: 10.23736/s0393-3660.22.04959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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26
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Yu V, McHenry N, Proctor S, Wolf J, Nee J. Gastroenterologist Primer: Endometriosis for Gastroenterologists. Dig Dis Sci 2023; 68:2482-2492. [PMID: 36653576 DOI: 10.1007/s10620-022-07674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIM A comprehensive understanding of endometriosis and its common gastrointestinal presentations are critical for gastroenterologists to ensure appropriate and timely screening and diagnosis. Endometriosis is a common inflammatory disease that frequently presents with gastrointestinal symptoms overlapping with irritable bowel syndrome (IBS) and other gastrointestinal disorders. Many endometriosis patients first present to a gastroenterologist or generalist, which may prolong the time to diagnosis and appropriate care. METHOD AND RESULTS This review describes the current literature on endometriosis presentation, overlap with gastrointestinal conditions, and standard diagnostic and treatment options for gastroenterologists to consider. For appropriate and swift treatment, gastroenterologists must consider an endometriosis diagnosis in females of menstruating age presenting with pain, bloating, altered stools, and non-gastrointestinal symptoms and refer patients for further evaluation.
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Affiliation(s)
- Vanessa Yu
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Nicole McHenry
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Samantha Proctor
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jacqueline Wolf
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Judy Nee
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA
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Buffeteau A, Weyl A, Vavasseur A, Meilleroux J, Pointreau A, Griffier R, Chantalat E, Vidal F. MRI and rectal endoscopy sonography performance to diagnose the digestive depth infiltration of pelvic endometriosis. Arch Gynecol Obstet 2023; 307:51-58. [PMID: 35435484 DOI: 10.1007/s00404-022-06532-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main objective of this study was to evaluate the performances of MRI and rectal endoscopy sonography (RES) in predicting the depth of bowel wall infiltration by deep infiltrating endometriosis (DIE). MATERIAL AND METHOD We conducted a single center retrospective study from April 2014 to March 2020 including all patients who had undergone digestive tract resection (discoid or segmental) for DIE removal and who had benefited from full preoperative imaging workup based on both pelvic MRI and RES. RESULTS Fifty two patients were enrolled in the study. Median age was 35.8 years (26.1-44.5 years). Indications for surgery mainly comprised chronic pelvic pain (94.2%) and infertility (36.5%). Overall, pathological examination showed digestive involvement in 92.3% of patients, while transmural infiltration was found in 38.4% of cases. In contrast, both MRI and RES suspected transmural involvement in 42 patients (80.8%). Corresponding sensitivity and specificity were 0.95 [95% CI (0.751-0.999)] and 0.28 [95% CI (0.137-0.467)], respectively. Our results revealed agreement between MRI and RES in 85% of cases with a kappa at 0.5 [95% CI (0.207-0.803), moderate agreement]. Subgroup analysis in patients with transmural MRI lesions showed a sensitivity of 0.95 [95% CI (0.740-0.999)] and a specificity of 0.13 [95% CI (0.028-0.336)]. CONCLUSION Our study suggests that performing a second-line examination is not useful if there is no transmural impairment in MRI or RES. Nevertheless, the combination of these two preoperative examinations seems to be essential for the evaluation of the depth of digestive involvement of endometriosis to guide surgical management as effectively as possible. The constitution and training of multidisciplinary expert groups must be developed to be able to offer optimal patient management.
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Affiliation(s)
- Aurélie Buffeteau
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059, Toulouse, France. .,CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059, Toulouse, France.
| | - Ariane Weyl
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059, Toulouse, France
| | - Adrien Vavasseur
- Toulouse University Hospital, Imaging Unit, Rangueil Hospital, 31059, Toulouse, France
| | - Julie Meilleroux
- Toulouse University Hospital, Anatomopathology Unit, Purpan Hospital, 31059, Toulouse, France
| | - Adeline Pointreau
- Gastroenterology Department, Clinique de La Croix du Sud, 31130, Quint-Fonsegrives, France
| | - Romain Griffier
- Bordeaux University Hospital, Public Health Unit, Pellegrin Hospital, 33000, Bordeaux, France
| | - Elodie Chantalat
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Rangueil, 31059, Toulouse, France.,University of Toulouse III, IRIT, CNRS, UMR 5505, Toulouse, France
| | - Fabien Vidal
- CHU de Toulouse, Pôle Femme Mère Couple, Hôpital Paule de Viguier, 31059, Toulouse, France.,University of Toulouse III, IRIT, CNRS, UMR 5505, Toulouse, France
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Muacevic A, Adler JR, Ward I, Healey KD, Anthony S, Herman M. Cecal Endometriosis Presenting as Hematochezia in a Postmenopausal Female. Cureus 2023; 15:e33886. [PMID: 36819337 PMCID: PMC9934007 DOI: 10.7759/cureus.33886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
Our report highlights the diagnosis of cecal endometriosis as a unique cause of hematochezia in a postmenopausal female. Cecal endometriosis manifesting as intermittent hematochezia and abdominal pain is uncommon but requires prompt clinical diagnosis and management. We report a case of cecal endometriosis causing hematochezia and subsequent syncope, which prompted the patient's admission to the emergency department. In our patient, a diagnosis of cecal endometriosis was made after a colonoscopy, with multiple biopsies confirming the presence of endometrial tissue embedded in the cecum. We aim to bring awareness of cecal endometriosis presenting as hematochezia in a postmenopausal woman with a history of abdominal pain. This case highlights intestinal endometriosis as a differential diagnosis to be considered in women, regardless of age, with intermittent hematochezia and abdominal pain.
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Pontrelli G, Huscher C, Scioscia M, Brusca F, Tedeschi U, Greco P, Mancarella M, Biglia N, Novara L. End-to-end versus side-to-end anastomosis after bowel resection for deep infiltrating endometriosis: A retrospective study. J Gynecol Obstet Hum Reprod 2022; 51:102472. [DOI: 10.1016/j.jogoh.2022.102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
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Xu Y, Xu Y, Miao L, Cao M, Xu W, Shi L. Comprehensive surgical treatment for obstructive rectal endometriosis: a case report and review of the literature. BMC Womens Health 2022; 22:280. [PMID: 35799150 PMCID: PMC9260976 DOI: 10.1186/s12905-022-01858-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intestinal obstruction caused by endometriosis maybe easily misdiagnosed as a tumor or other occupying disease in emergency condition. How to deal with it depending on the clarity of the preoperative diagnosis and the experience of the surgeon.
Case presentation
A 47-year-old woman, admitted to our emergency service with abdominal pain and distension for 5 days, anal stop exhausting and defecating for 3 days. Based on imaging and laboratory examination, we made a preoperative diagnosis of rectal endometriosis probably. After 7 days of colon decompression with a intestinal obstruction catheter, an operation of laparoscopic partial rectal and sigmoid resection without protective stoma and total hysterectomy was performed successfully. The patient obtained a smooth postoperative course and doing well after 12-weeks follow up.
Conclusions
Obstruction caused by rectal endometriosis is very rare and easily overlooked by surgeon and gynecologist. Appropriate preoperative diagnosis and preoperative management can reduce the trauma and incidence of complications.
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Alborzi S, Roman H, Askary E, Poordast T, Shahraki MH, Alborzi S, Hesam Abadi AK, Najar Kolaii EH. Colorectal endometriosis: Diagnosis, surgical strategies and post-operative complications. Front Surg 2022; 9:978326. [PMID: 36268216 PMCID: PMC9577108 DOI: 10.3389/fsurg.2022.978326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The present work aimed to investigate the feasibility, complications, recurrence rate, and infertility outcomes of the radical and conservative surgical methods for colorectal endometriosis in short- and long-term follow-ups. Methods In this prospective study, the patients with confirmed diagnosis of colorectal DIE were included from March 2015 to March 2021, who were referred to an Endometriosis Surgery Center affiliated with Shiraz University of Medical Sciences (SUMS). Information on demographics, surgical approaches, intra-operative, and post-operative findings as well as complications were collected and compared. Six- and 12-month interviews were conducted to evaluate the functional outcomes of all the procedures. Results Out of 3,111 patients who underwent endometriosis surgery, 837 (28.19%) with the average age of 34.2 ± 5.9 years and average ASRM score of 102.1 ± 36.8 had rectosigmoid endometriosis. Laparoscopic rectal shaving was performed in 263(30.0%) patients while 326 (37.2%) underwent segmental bowel resection, and 248 (28.30%) were treated with disc excision. Prophylactic ileostomy was performed in six (0.68%) patients and peritonitis was reported in four (0.45%). Five (0.58%) subjects developed rectovaginal fistula and one (0.11%) was diagnosed with bladder atonia. The recurrence rate was 3.8%, 1.2%, and 0.3% in rectal shaving, disc, and segmental bowel resection techniques, respectively. Dysmenorrhea, dyspareunia, and dyschezia were improved after surgery by 7.3, 9.4, and 12.5 times, respectively. We observed 25.2% of total pregnancy following the operation, the majority of which occurred in the first year after the surgery. Conclusion There were very few short-term or long-term complications in the three different techniques when the choice was correct.
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Affiliation(s)
- Saeed Alborzi
- Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Horace Roman
- Department of Gynecology and Obstetrics, Clinique Gynécologique et Obstétrical, Rouen University Hospital, Rouen, France
| | - Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Elham Askary
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Soroush Alborzi
- Cardiologist, Student Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alimohammad Keshtvarz Hesam Abadi
- Master of Biostatistics in Clinical Research Development Center of Nemazee Hospital, Department of Statistics, Shiraz University of Medical Sciences, Shiraz, Iran
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Shen L, Zhang W, Yuan Y, Zhu W, Shang A. Vaginal microecological characteristics of women in different physiological and pathological period. Front Cell Infect Microbiol 2022; 12:959793. [PMID: 35937699 PMCID: PMC9354832 DOI: 10.3389/fcimb.2022.959793] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
The vaginal microbiota, the host endocrine system, the vaginal anatomy, and the local mucosal immunity comprise the vaginal microbiota, which interacts with each other to maintain the balance of the vaginal microbiota, which maintains female reproductive health. Puberty, menstruation, pregnancy, and menopause are four phases women go through during their reproductive and post-reproductive years. Vaginal microbiota composition and abundance are heavily influenced by estrogen and progesterone, which start at puberty and continue during the reproductive years in a dynamic balance with some fluctuations. Estrogen promotes proliferation of vaginal epithelial cells and increases glycogen storage, while progesterone lyses vaginal epithelial cells, facilitating the release of glycogen to maintain normal pH. This review summarizes the latest national and international evidence on the composition and distribution of vaginal microecology in women during different physiological and pathological periods and proposes a hormone-driven microbial diversity hypothesis to explain the temporal patterns of vaginal microbial diversity during the female reproductive cycle and menopause. A relatively balanced vaginal microecological system has a positive effect on the maintenance of female health. An imbalance in the ratio of flora can lead to susceptibility to infections or reproductive complications. The study of human microecology and its role in the development and progression of human disease is essential for the prevention, diagnosis, and treatment of related obstetric and gynecologic conditions.
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Affiliation(s)
- Liping Shen
- Department of Obstetrics and Gynecology, Changning Maternity & Infant Health Hospital, Shanghai, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Zhang
- Department of Laboratory Medicine, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Laboratory Medicine, Jiaozuo Fifth People’s Hospital, Jiaozuo, China
| | - Yi Yuan
- Department of Laboratory Medicine, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weipei Zhu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Anquan Shang, ; Weipei Zhu,
| | - Anquan Shang
- Department of Laboratory Medicine, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Anquan Shang, ; Weipei Zhu,
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Hudelist G, Korell M, Burkhardt M, Chvatal R, Darici E, Dimitrova D, Drahonovsky J, Haj Hamoud B, Hornung D, Krämer B, Noe G, Oppelt P, Schäfer S, Seeber B, Ulrich UA, Wenzl R, De Wilde RL, Wimberger P, Senft B, Keckstein J, Montanari E, Vaineau C, Sillem M. Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis-a retrospective multicenter observational study. Acta Obstet Gynecol Scand 2022; 101:1057-1064. [PMID: 35818905 PMCID: PMC9812092 DOI: 10.1111/aogs.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries. MATERIAL AND METHODS This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared. RESULTS The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups. CONCLUSIONS A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.
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Affiliation(s)
- Gernot Hudelist
- Department of Gynecology, Center for EndometriosisHospital St. John of God; Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Matthias Korell
- Department of Obstetrics and GynecologyJohanna‐Etienne‐HospitalNeussGermany
| | - Michael Burkhardt
- Department of Obstetrics and GynecologyMedius Klinik OstfildernOstfildernGermany
| | - Radek Chvatal
- Department of Obstetrics and GynecologyZnojmo District HospitalZnojmoCzech Republic
| | - Ezgi Darici
- Brussels IVF, Center for Reproductive Medicine Universitair Ziekenhuis BrusselVrije Universiteit BrusselBrusselsBelgium
| | - Desislava Dimitrova
- Department of Obstetrics and Gynecology with Center for Oncological SurgeryCharité – Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Jan Drahonovsky
- Department of Obstetrics and Department of GynecologyUniversity of PraguePragueCzech Republic
| | - Bashar Haj Hamoud
- Department of Obstetrics and GynecologyUniversity SaarlandHomburgGermany
| | - Daniela Hornung
- Department of Obstetrics and GynecologyVidiakliniken, Diakonissen Hospital KarlsruheKarlsruheGermany
| | - Bernhard Krämer
- Department of Obstetrics and Department of GynecologyUniversity of TübingenTübingenGermany
| | - Guenter Noe
- Department of Obstetrics and Department of GynecologyRhineland ClinicDormagenGermany
| | - Peter Oppelt
- Department of Gynecology and ObstetricsKepler Medical University of LinzLinzAustria
| | | | - Beata Seeber
- Department of Gynecologic Endocrinology and Reproductive MedicineMedical University of InnsbruckInnsbruckAustria
| | - Uwe Andreas Ulrich
- Department of Obstetrics and GynecologyMartin Luther Hospital BerlinBerlinGermany
| | - Rene Wenzl
- Department of Gynecology and ObstericsMedical University of ViennaViennaAustria
| | - Rudy Leon De Wilde
- Department of Gynecology and ObstetricsPius Hospital, Universitätsmedizin Oldenburg, Carl von Ossietzky University of OldenburgOldenburgGermany
| | - Pauline Wimberger
- Department of Obstetrics and GynecologyTechnical University DresdenDresdenGermany
| | | | | | - Eliana Montanari
- Department of Gynecology, Center for EndometriosisHospital St. John of God; Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Cloe Vaineau
- Department of Gynecology and ObstericsMedical University of Bern, InselspitalBernSwitzerland
| | - Martin Sillem
- Department of Obstetrics and GynecologyUniversity SaarlandHomburgGermany,Praxisklinik am RosengartenMannheimGermany
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Kristine Aas-Eng M, Keckstein J, Condous G, Abrão MS, Hudelist G. Deep endometriosis: can surgical complexity and associated risk factors be evaluated with transvaginal sonography and classification systems? Eur J Obstet Gynecol Reprod Biol 2022; 276:204-206. [DOI: 10.1016/j.ejogrb.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
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Darici E, Salama M, Bokor A, Oral E, Dauser B, Hudelist G. Different segmental resection techniques and postoperative complications in patients with colorectal endometriosis: A systematic review. Acta Obstet Gynecol Scand 2022; 101:705-718. [PMID: 35661342 DOI: 10.1111/aogs.14379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the available literature by conducting a systematic review to assess the possible effects of nerve-sparing segmental resection and conventional bowel resection on postoperative complications for the treatment of colorectal endometriosis. MATERIAL AND METHODS Pubmed, Clinical Trials.gov, Cochrane Library, and Web of Science were comprehensively searched from 1997 to 2021 in order to perform a systematic review. Studies including patients undergoing segmental resection for colorectal endometriosis including adequate follow-up, data on postoperative complications and postoperative sequelae were enrolled in this review. Selected articles were evaluated and divided in two groups: Nerve-sparing resection (NSR), and conventional segmental resection not otherwise specified (SRNOS). Within the NSRs, studies mentioning preservation of the rectal artery supply (artery and nerve-sparing SR - ANSR) and not reporting preservation of the artery supply (NSR not otherwise specified - NSRNOS) were further analyzed. PROSPERO ID CRD42021250974. RESULTS A total of 7549 patients from 63 studies were included in the data analysis. Forty-three of these publications did not mention the preservation or the removal of the hypogastric nerve plexus, or main rectal artery supply and were summarized as SRNOS. The remaining 22 studies were listed under the NSR group. The mean size of the resected deep endometriosis lesions and patients' body mass index were comparable between SRNOS and NSR. A mean of 3.6% (0-16.6) and 2.3% (0-10.5%) of rectovaginal fistula development was reported in patients who underwent SRNOS and NSR, respectively. Anastomotic leakage rates varied from 0% to 8.6% (mean 1.7 ± 2%) in SRNOS compared with 0% to 8% (mean 1.7 ± 2%) in patients undergoing NSR. Urinary retention (4.5% and 4.9%) and long-term bladder catheterization (4.9% and 5.6%) were frequently reported in SRNOS and NSR. There was insufficient information about pain or the recurrence rates for women undergoing SRNOS and NSR. CONCLUSIONS Current data describe the outcomes of different segmental resection techniques. However, the data are inhomogeneous and not sufficient to reach a conclusion regarding a possible advantage of one technique over the other.
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Affiliation(s)
- Ezgi Darici
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Zeynep Kâmil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.,European Endometriosis League, Bordeaux, France
| | - Mohamed Salama
- Department of Thoracic Surgery, Nord Hospital, Vienna, Austria
| | - Attila Bokor
- European Endometriosis League, Bordeaux, France.,Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Engin Oral
- European Endometriosis League, Bordeaux, France.,Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bernhard Dauser
- Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
| | - Gernot Hudelist
- European Endometriosis League, Bordeaux, France.,Center for Endometriosis, Department of Gynecology, Hospital St. John of God, Vienna, Austria
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Xu P, Wang J, Zhang Y, Zhu L, Zhang X. Factors Affecting the Postoperative Bowel Function and Recurrence of Surgery for Intestinal Deep Endometriosis. Front Surg 2022; 9:914661. [PMID: 35774384 PMCID: PMC9239406 DOI: 10.3389/fsurg.2022.914661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to evaluate the factors associated with complications and long-term results in the surgical treatment of intestinal deep endometriosis and to figure out the optimized treatment measures for bowel endometriosis.MethodsA retrospective study was performed in a single center in China. Medical charts were reviewed from 61 women undergoing surgical treatment for bowel endometriosis between January 2013 and August 2019 in the Department of General Gynecology, Women’s Hospital School of Medicine Zhejiang University. Multivariate regression analysis was utilized to investigate the impact of the stages of endometriosis and surgical steps (independent risk factors) on complications (and postoperative bowel dysfunction). The clinical characters, surgical procedures, postoperative treatment, complications, and recurrence rate were summarized and analyzed by using Lasso regression.ResultsSurgery type was the most important independent risk factor related to postoperative abnormal defecation in intestinal deep endometriosis patients (P < 0.05, OR = 34.133). Infection is the most important independent risk factor related to both postoperative complications (OR = 96.931) and recurrences after conservative surgery (OR = 4.667). Surgery type and age were significantly related to recurrences after conservative surgery.ConclusionsWe recommended conservative operation especially full-thickness disc excision to improve the quality of life of intestinal deep endometriosis patients. In addition, prevention of infection is very important to reduce the postoperative complications rate and the recurrence rate.
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Gupta S, Allegretti JR. Mimics of Crohn's Disease. Gastroenterol Clin North Am 2022; 51:241-269. [PMID: 35595413 DOI: 10.1016/j.gtc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.
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Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, 850 Boyslton Street, Suite 201, Chestnut Hill, MA 02467, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Nezhat C, Agarwal S, Lee DA, Tavallaee M. Can we accurately diagnose endometriosis without a diagnostic laparoscopy? J Turk Ger Gynecol Assoc 2022; 23:117-119. [PMID: 35642436 PMCID: PMC9161000 DOI: 10.4274/jtgga.galenos.2022.2022-2-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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The analysis of the prevalence of extragenital pathology in infertile women with external genital endometriosis. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background. External genital endometriosis (EGE) is often the cause of infertility, while coagulation of its foci leads to the restoration of fertility. Often, non-invasivepreoperative diagnosis of EGE is difficult. Today, the issue of laparoscopy in infertility and whether there is a need for additional indications for its implementation remains controversial. Identification of the relationship between certain extragenital diseases with EGE is promising in terms of both understanding the pathogenesis of EGE and predicting its development.The aim. Identification of the relationship of extragenital diseases with the presence of EGE in infertile women of reproductive age.Materials and methods. In preparation for assisted reproductive technology programs at the Vitromed Clinic, 1 132 women of reproductive age were examined from 2019 to 2021. Collection and processing of clinical and anamnestic data were carried out. The diagnosis of EGE was verified by laparoscopy with histological examination. The results were analyzed using exact test and binary logistic regression to build a model of the relationship between EGE and somatic pathology.Results. EGE was detected in 222 patients. A number of somatic diseases were found that are most common in EGE: bowel diseases; minor cardiac maldevelopments; chronic anemia; pathology of the pancreas; chronic tonsillitis; allergy. A logistic regression model was constructed to predict the presence of EGE in patients with the indicated somatic pathology with a sensitivity of 81.53 % and a specificity of 97.25 %.Conclusion. Identification of comorbid extragenital diseases associated with EGE in women with infertility can serve as a basis for expanding the scope of therapeutic and diagnostic measures, in particular for laparoscopy.
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Lukac S, Schmid M, Pfister K, Janni W, Schäffler H, Dayan D. Extragenital Endometriosis in the Differential Diagnosis of Non- Gynecological Diseases. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:361-367. [PMID: 35477509 PMCID: PMC9472266 DOI: 10.3238/arztebl.m2022.0176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/02/2021] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Endometriosis is a chronic, benign disease that affects approximately 10% of women of childbearing age. Its characteristic clinical features are dysmenorrhea, dyschezia, dysuria, dyspareunia, and infertility. The manifestations of extragenital endometriosis (EE) are a diagnostic challenge, as this disease can mimic other diseases due to its unusual location with infiltration of various organs and corresponding symptoms. METHODS This review is based on publications retrieved by a selective search of the literature on the commonest extragenital sites of endometriosis, including the relevant current guideline. RESULTS Current evidence on the treatment of extragenital endometriosis consists largely of cohort studies and cross-sectional studies. The treatment is either surgical and/or conservative (e.g., hormonal therapy). Gastrointestinal endometriosis is the most common form of EE, affecting the rectum and sigmoid colon in nearly 90% of cases and typically presenting with dyschezia. Urogenital endometriosis is the second most common form of EE. It affects the bladder in more than 85% of cases and may present with dysuria, hematuria, or irritable bladder syndrome. The diaphragm is the most common site of thoracic endometri - osis, potentially presenting with period-associated shoulder pain or catamenial pneumothorax. Endometriosis affecting a nerve often presents with sciatica. In abdominal wall endometriosis, painful nodules arise in scars from prior abdominal surgery. CONCLUSION There is, as yet, no causally directed treatment for chronic endometriosis. The treatment is decided upon individually in discussion with the patient, in consideration of risk factors and after assessment of the benefits and risks. Timely diagnosis is essential.
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Affiliation(s)
- Stefan Lukac
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Marinus Schmid
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Kerstin Pfister
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Henning Schäffler
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Davut Dayan
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
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Fadadu PP, Cope A, Weng CS, Mara K, Khan Z, VanBuren W, Burnett T. Gastrointestinal symptoms as a predictor of deep endometriosis of the pelvic posterior compartment on magnetic resonance imaging. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221093262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine if gastrointestinal (GI) symptoms can predict deep endometriosis (DE) of the posterior pelvic compartment on magnetic resonance imaging (MRI). Methods: Patients with suspected endometriosis undergoing endometriosis protocol MRI at an academic center between 9/1/2015 and 7/31/2018 were identified. Presenting GI symptoms were collected via a standardized survey instrument prospectively at initial presentation. MRI and interdisciplinary conference notes were reviewed to identify posterior compartment DE (rectosigmoid, uterosacral ligaments, posterior cul de sac, and pelvic side walls). Associations between symptoms and DE were evaluated. Results: A total of 104 patients met inclusion criteria, and 89 (85.6%) presented with at least one GI symptom. Posterior compartment DE was identified on MRI in 47 patients (45.2%). The GI symptom that most strongly predicted DE was a bowel movement resulting in pain relief (OR 3.36, 95% CI 1.31–8.61, p = 0.012), with sensitivity, specificity, positive and negative predictive values 0.42, 0.82, 0.67, and 0.63, respectively. Other GI symptoms such as nausea, vomiting, rectal bleeding, change in frequency of bowel movements, and pain exacerbation by bowel movements did not significantly correlate to having DE. Of the 15 patients with no GI symptoms, 5 were found to have posterior compartment DE. Conclusion: In patients with suspected endometriosis, those who noted that bowel movements relieved their pain had more than three times the odds of having DE of the posterior compartment on MRI. Preoperative evaluation with MRI may be of value in these patients; however, lack of gastrointestinal symptoms does not exclude the possibility of posterior compartment DE.
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Affiliation(s)
| | - Adela Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Chia-Sui Weng
- Department of Obstetrics and Gyencology, Mackay Memorial Hospital, Taipei
| | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Zaraq Khan
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Tatnai Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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42
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Scioscia M, Huscher CGS, Brusca F, Marchegiani F, Cannone R, Brasile O, Greco P, Scutiero G, Anania G, Pontrelli G. Preservation of the inferior mesenteric artery in laparoscopic nerve-sparing colorectal surgery for endometriosis. Sci Rep 2022; 12:3146. [PMID: 35210558 PMCID: PMC8873484 DOI: 10.1038/s41598-022-07237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Cristiano G S Huscher
- Department of Surgical Oncology, Robotics and New Technologies, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Federica Brusca
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Francesco Marchegiani
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Rossella Cannone
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Orsola Brasile
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Pantaleo Greco
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy.
| | - Gennaro Scutiero
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Gabriele Anania
- Department of Medical Science, Section of General Surgery, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
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43
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Piachas A, Smyrnis P, Tooulias A. Rectosigmoid endometriosis: Diagnostic pitfalls and management - A case report. Clin Case Rep 2022; 10:e05222. [PMID: 35369388 PMCID: PMC8859406 DOI: 10.1002/ccr3.5222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
Endometriosis constitutes a benign condition, occurring in 10%-12% of menstruating women. Bowel involvement is estimated to occur in 5%-12% with the rectosigmoid region involved in up to 90% of these cases. We present the case of a 45-year-old Caucasian female patient with rectosigmoid endometriosis.
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Affiliation(s)
- Athanasios Piachas
- Department of SurgeryPapageorgiou General HospitalAristotle University of ThessalonikiThessalonikiGreece
| | - Panagiotis Smyrnis
- Department of SurgeryPapageorgiou General HospitalAristotle University of ThessalonikiThessalonikiGreece
| | - Andreas Tooulias
- Department of SurgeryPapageorgiou General HospitalAristotle University of ThessalonikiThessalonikiGreece
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44
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Nezhat C, Agarwal S. Genitourinary tract endometriosis. Fertil Steril 2021; 117:228-229. [PMID: 34872724 DOI: 10.1016/j.fertnstert.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Camran Nezhat
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California; University of California San Francisco, San Francisco, California; Stanford University Medical Center, Palo Alto, California
| | - Shruti Agarwal
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Palo Alto, California
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45
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Nezhat C, Agarwal S. Bowel endometriosis. Fertil Steril 2021; 117:384-386. [DOI: 10.1016/j.fertnstert.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022]
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46
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Baharuddin DMP, Hayati F, Azizan N, Dzulkarmaen Zakaria A. Letter to: Endometriosis of the rectosigmoid colon mimicking gastrointestinal stromal tumor. Turk J Surg 2021; 37:420-421. [DOI: 10.47717/turkjsurg.2021.5297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022]
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47
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Alvarado LER, Bahmad H, Mejia O, Hollembeak H, Poppiti R, Howard L, Muddasani K. Rectal endometriosis presenting as toxic megacolon. AUTOPSY AND CASE REPORTS 2021; 11:e2021319. [PMID: 34540725 PMCID: PMC8432386 DOI: 10.4322/acr.2021.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Case presentation We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain self-medicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis. Conclusions Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications.
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Affiliation(s)
| | - Hisham Bahmad
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Odille Mejia
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Heather Hollembeak
- Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA
| | - Robert Poppiti
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Lydia Howard
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Kiranmayi Muddasani
- Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA
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48
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Vascular Involvement: An Uncommon Histologic Finding of Rectal Endometriosis. Int J Gynecol Pathol 2021; 40:518-521. [PMID: 33252402 DOI: 10.1097/pgp.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Deep infiltrating endometriosis frequently affects the rectosigmoid region. It clinically presents as a chronic painful condition affecting women in their reproductive time. Here, we present a case of a 28-yr-old female patient who had a history of dysmenorrhea, dyspareunia, chronic abdominal and pelvic pain, and constipation secondary to rectal wall endometriosis. Microscopic examination of the resected rectal segment showed endometriosis with vascular and lymph node involvement. Vascular involvement is an uncommon histologic finding that may raise concern for potential malignancy. The aim of this report is to alert pathologists and physicians about this infrequent pitfall that can be mistaken for a neoplastic process and to discuss the underlying pathophysiology of vascular involvement by endometrial tissue in otherwise benign conditions.
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49
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Hiltunen J, Eloranta ML, Lindgren A, Keski-Nisula L, Anttila M, Sallinen H. Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area. J Int Med Res 2021; 49:3000605211032788. [PMID: 34407685 PMCID: PMC8381426 DOI: 10.1177/03000605211032788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. METHODS One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. RESULTS The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. CONCLUSIONS This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.
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Affiliation(s)
- Janika Hiltunen
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.,Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja-Liisa Eloranta
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Auni Lindgren
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.,Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Sallinen
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
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50
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Marcello C, Roberto C, Adele ME, Katarzyna SA, Paola DM, Matteo C, Giacomo R, Francesco B, Lorenzo R, Daniela S. "The Sword in the Stone": radical excision of deep infiltrating endometriosis with bowel shaving-a single-centre experience on 703 consecutive patients. Surg Endosc 2021; 36:3418-3431. [PMID: 34312725 DOI: 10.1007/s00464-021-08663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscopic segmental bowel resection, disc excision and rectal shaving are described as surgical options for the treatment of bowel endometriosis, but the gold standard has not yet established. The aim of the study is to investigate the efficacy of the laparoscopic bowel shaving technique in terms of pain symptomatology and to analyse early and late postoperative complications. METHODS Retrospective cohort study of a series of 703 consecutive patients treated between January 2014 and December 2019 in a tertiary care referral centre. All patients underwent laparoscopic bowel shaving with concomitant radical excision of DIE. RESULTS Bilateral posterolateral parametrectomy and ureterolysis were performed, respectively, in 314 (44.7%) and 318 cases (45.2%). A radical hysterectomy was performed in 107 cases (82.9%). Postoperative complications were infrequent: 17 patients required a reoperation (2.4%) and in this subgroup we registered 2 rectovaginal fistulas (0.3%), 4 patients received blood transfusion (0.6%), 12 patients (1.7%) experienced postoperative fever, 6 patients experienced impaired bladder voiding (0.9%) after 6 months. Median follow-up was 14 months. The study reported good clinical and surgical results, with a regression of symptoms (p < 0.0001) and an overall rate of recurrence of 6.5%. Clinical and instrumental criteria of bowel endometriosis relapse were exclusively detected in 5 patients (0.8%). Eleven patients (1.7%) with relapsed endometriosis were reoperated. CONCLUSIONS Bowel shaving is a feasible and valuable surgical procedure. It is only the last step of a complex surgery which is aimed to minimize the residual quote of infiltrating nodule and requires a multidisciplinary team to achieve optimal treatment preoperatively, intraoperatively and postoperatively.
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Affiliation(s)
- Ceccaroni Marcello
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy-IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Clarizia Roberto
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy-IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Mussi Erica Adele
- Department of Obstetrics and Gynecology, "Maggiore della Carità" Hospital, "Università del Piemonte Orientale", Corso Mazzini 18, 28100, Novara, Italy
| | - Stepniewska Anna Katarzyna
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy-IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - De Mitri Paola
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy-IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Ceccarello Matteo
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy-IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Ruffo Giacomo
- Department of General Surgery, IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Bruni Francesco
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy-IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Rettore Lorenzo
- Department of General Surgery, IRCCS "Sacro Cuore-Don Calabria" Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy
| | - Surico Daniela
- Department of Obstetrics and Gynecology, "Maggiore della Carità" Hospital, "Università del Piemonte Orientale", Corso Mazzini 18, 28100, Novara, Italy
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