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Turco LC, Raimondo D, Raffone A, Raimondo I, Vargiu V, Raspollini A, Travaglino A, Tinelli R, Zanetti E, Ferrandina G, Seracchioli R, Casadio P, Scambia G, Cosentino F. Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study. Int J Gynaecol Obstet 2024; 164:550-556. [PMID: 37715533 DOI: 10.1002/ijgo.15109] [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: 01/22/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To compare safety and effectiveness of two-different directions of suturing the posterior vaginal breach (horizontal [Ho] vs vertical [Ve]) in women undergoing recto-vaginal endometriosis (RVE) nodule resection. METHODS A multicenter, retrospective, observational, cohort study was performed including all women of reproductive age undergoing RVE nodule resection between March 2013 and December 2018 at our tertiary centers. Patients included in the present study were divided into two groups based on the direction in suturing the posterior vaginal fornix defect, for comparisons in terms of rate of postoperative complications, pain relief, pain and anatomical recurrence, and length of hospital stay. Univariate comparisons were performed adopting the t test or the Mann-Whitney test for continuous data and the chi-square test or the Fisher exact test for categorical data, with a significant P value set to <0.05. RESULTS A total of 101 women were included: 67 in the Ho-group and 34 in the Ve-group. The two groups did not significantly differ in length of hospital stay (6.7 ± 6.9 vs 6.6 ± 3.3 days; P = 0.95), overall postoperative complications (32.8% vs 14.7%; P = 0.05), pain recurrence (35.8% vs 26.5%; P = 0.34) and anatomical recurrence rate (19.4% vs 23.5%; P = 0.62). Conversely, grade III complications were significantly more common in the Ho-group than in the Ve-group (22.7% vs 20%, P = 0.009), while pain relief in terms of deep dyspareunia, dyschezia, dysuria and chronic pelvic pain was more consistent in the Ve-group patients (P = 0.04, 0.04, 0.05, 0.004, respectively). CONCLUSION In symptomatic women undergoing RVE nodule resection, Ho suturing of the vaginal breach appears more commonly associated with severe postoperative complications and a worse pain control.
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Affiliation(s)
- Luigi Carlo Turco
- Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Ivano Raimondo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy
| | - Virginia Vargiu
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, Antonio Perrino Hospital, Brindisi, Italy
| | - Enrico Zanetti
- Gynecology and Obstetrics Unit, University of Brescia, Italy
| | - Gabriella Ferrandina
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
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Ball E, Karavadra B, Kremer-Yeatman BJ, Mustard C, Lee KM, Bhogal S, Dodds J, Horne AW, Allotey J, Rivas C. Systematic review of patient-specific pre-operative predictors of pain improvement to endometriosis surgery. REPRODUCTION AND FERTILITY 2022; 2:69-80. [PMID: 35128434 PMCID: PMC8812445 DOI: 10.1530/raf-20-0057] [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: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Up to 28% of endometriosis patients do not get pain relief from therapeutic laparoscopy but this subgroup is not defined. Objectives To identify any prognostic patient-specific factors (such as but not limited to patients’ type or location of endometriosis, sociodemographics and lifestyle) associated with a clinically meaningful reduction in post-surgical pain response to operative laparoscopic surgery for endometriosis. Search strategy PubMed, Cochrane and Embase databases were searched from inception to 19 May 2020 without language restrictions. Backward and forward citation tracking was used. Selection criteria, data collection and analysis: Cohort studies reporting prognostic factors, along with scores for domains of pain associated with endometriosis before and after surgery, were included. Studies that compared surgeries, or laboratory tests, or outcomes without stratification were excluded. Results were synthesised but variation in study designs and inconsistency of outcome reporting precluded us from doing a meta-analysis. Main results Five studies were included. Quality assessment using the Newcastle–Ottawa scale graded three studies as high, one as moderate and one as having a low risk of bias. Four of five included studies separately reported that a relationship exists between more severe endometriosis and stronger pain relief from laparoscopic surgery. Conclusion Currently, there are few studies of appropriate quality to answer the research question. We recommend future studies report core outcome sets to enable meta-analysis. Lay summary Endometriosis is a painful condition caused by displaced cells from the lining of the womb, causing inflammation and scarring inside the body. It affects 6–10% of women and there is no permanent cure. Medical and laparoscopic surgical treatments are available, but about 28% of patients do not get the hoped-for pain relief after surgery. Currently, there is no way of predicting who gets better and who does not. We systematically searched the world literature to establish who may get better, in order to improve counselling when women choose treatment options. We identified five studies of variable quality showing: More complex disease (in specialist hands) responds better to surgery than less, but more studies needed.
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Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Babu Karavadra
- Department of Gynecology, Norfolk & Norwich University Hospital, Norwich, UK
| | | | - Connor Mustard
- Barts and the London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Kim May Lee
- Barts and the London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sharandeep Bhogal
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, UK
| | - John Allotey
- Institute of Metabolism and Systems Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carol Rivas
- UCL Social Research Institute, University College London, London, UK
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Raimondo D, Turco LC, Cosentino F, Mabrouk M, Mastronardi M, Borghese G, Giaquinto I, Vargiu V, Fagotti A, Meriggiola MC, Chiantera V, Scambia G, Seracchioli R. Feasibility and safety of two different surgical routes for the eradication of recto‐vaginal endometriosis with vaginal mucosa infiltration (Endo‐Vag‐r study). Acta Obstet Gynecol Scand 2020; 99:1050-1056. [DOI: 10.1111/aogs.13824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Diego Raimondo
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Luigi C. Turco
- Division of Gynecologic Oncology Fondazione di Ricerca e Cura Giovanni Paolo II Università Cattolica del Sacro Cuore Campobasso Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology Fondazione di Ricerca e Cura Giovanni Paolo II Università Cattolica del Sacro Cuore Campobasso Italy
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
- Department of Obstetrics and Gynecology Faculty of Medicine University of Cambridge Cambridge UK
- Department of Obstetrics and Gynecology Faculty of Medicine University of Alexandria Alexandria Egypt
| | - Manuela Mastronardi
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Ilaria Giaquinto
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Virginia Vargiu
- Department of Women's and Children's Health Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Anna Fagotti
- Gynecologic Oncology Università Cattolica del Sacro Cuore Rome Italy
| | - Maria C. Meriggiola
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology University of Palermo Palermo Italy
| | - Giovanni Scambia
- Gynecologic Oncology Università Cattolica del Sacro Cuore Rome Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
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Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol 2019; 239:21-29. [PMID: 31163353 DOI: 10.1016/j.ejogrb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/20/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
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Affiliation(s)
- Johannes Lermann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
| | - Nalan Topal
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany; Department of Obstetrics and Gynecology, Klinikverbund Südwest, Klinikum Sindelfingen-Böblingen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefanie Burghaus
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Felix Heindl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
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Major and minor complications after resection without bowel resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 2018; 298:991-999. [PMID: 30191419 DOI: 10.1007/s00404-018-4875-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To analyze major and minor complications following surgery for deeply infiltrating endometriosis including long-term impairment of intestinal, bladder, and sexual function. METHODS Patients who had undergone resection for deeply infiltrating endometriosis without anterior rectal resection between 2001 and 2011 were included (n = 134). Clinical and surgical data, as well as minor and major complications, were recorded. A questionnaire was sent to the patients and to a healthy control group (n = 100). RESULTS Major complications occurred in 3.7% and minor complications in 12.7% of the patients. Surgical revision was necessary in five cases. The questionnaire response rate was 66.4%, with a mean follow-up period of 75.6 months. Weak urinary flow was reported by 26.4% of the patients; a feeling of residual urine by 16.1%; constipation by 13.5%; more than one bowel movement/day by 16.9%; insufficient lubrication during intercourse by 30.3%. The findings for weak urinary flow, feeling of residual urine, and insufficient lubrication differed significantly from the control group. Subgroup analysis did not identify any statistical associations between questionnaire responses and dyspareunia or dysmenorrhea as reasons for surgery, or previous endometriosis surgery in the patient's history. CONCLUSIONS The major and minor complication rates were consistent with or lower than the literature data. Few studies have investigated complication rates associated with treatment for endometriosis in the sacrouterine ligaments and/or the rectovaginal septum. The high rates of impaired bladder function and sexual function after endometriosis surgery, as well as inadequate data, make further prospective studies on this topic necessary.
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Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
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Barbara G, Facchin F, Buggio L, Somigliana E, Berlanda N, Kustermann A, Vercellini P. What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature. Reprod Sci 2017; 24:1566-1576. [PMID: 28558521 DOI: 10.1177/1933719117707054] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future research and treatment strategies. An electronic database research was performed to identify all the studies on the relation between endometriosis and sexual functioning published in the period 2000 to 2016. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After the screening process, a total of 9 studies investigating the relation between endometriosis and female sexual functioning were considered. Overall, these studies indicated that around two thirds of women with endometriosis have some form of sexual dysfunction not limited to deep dyspareunia. These findings suggest that the global sexual impact of endometriosis requires further investigation, focusing not only on pain during intercourse but also on psychological and relational dimensions, including partner's sexual functioning. Because sexual functioning is a complex, multidimensional phenomenon, the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team composed of gynecologists, sexologists, and psychologists/psychotherapists.
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Affiliation(s)
- Giussy Barbara
- 1 Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- 2 Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Laura Buggio
- 3 Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- 4 Infertility Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nicola Berlanda
- 3 Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- 1 Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- 5 Unità Operativa Dipartimentale di Ginecologia Chirurgica ed Endometriosi, Università degli Studi di Milano, Milan, Italy.,6 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Barbara G, Facchin F, Meschia M, Berlanda N, Frattaruolo MP, VercellinI P. When love hurts. A systematic review on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning. Acta Obstet Gynecol Scand 2016; 96:668-687. [DOI: 10.1111/aogs.13031] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/24/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Giussy Barbara
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Federica Facchin
- Faculty of Psychology; Catholic University of Milan; Milan Italy
| | - Michele Meschia
- Department of Obstetrics and Gynecology; “G. Fornaroli” Hospital; Milan Italy
| | - Nicola Berlanda
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Maria P. Frattaruolo
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Paolo VercellinI
- Department of Clinical Science and Community Health, Università degli Studi di Milano; and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
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