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Ekine AA, Fülöp I, Tekse I, Rúcz Á, Jeges S, Koppán Á, Koppán M. The Surgical Benefit of Hysterolaparoscopy in Endometriosis-Related Infertility: A Single Centre Retrospective Study with a Minimum 2-Year Follow-Up. J Clin Med 2020; 9:E507. [PMID: 32069800 PMCID: PMC7073634 DOI: 10.3390/jcm9020507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 11/25/2022] Open
Abstract
AIM This study examined the fertility performance of women after combined hysterolaparoscopic surgical management of endometriosis. Design: This study is a hospital-based retrospective review. MATERIALS AND METHODS Data collected from the records of all patients presented with endometriosis-related infertility using a checklist designed for the purpose. Result: A total of 81.3% (370/455) of women who have had the desire to have children became pregnant during the study period after the surgery. Of those who became pregnant, all three-hundred-forty-seven patients were followed to the end of their pregnancies. A successful live birth occurred in 94.2% (327/347) of individuals, and pregnancy loss occurred in 5.8% (20/347). The mean patient age was 34.1 ± 4.1 years, and the average duration of infertility was 3.4 ± 3.3 years. Pregnancy occurred spontaneously in 39.5% (146/370) of patients, after artificial insemination (AIH) in 3.8% (14/370) of women, and after in vitro fertilization-embryo transfer (IVF-ET) in 56.8% (210/370) of cases. Patients aged ≤ 35 years had a higher chance of conception post-surgery-84% versus 77%, respectively (p = 0.039). Based on the modes of pregnancy, the timely introduction of an assisted reproductive technique (ART) demonstrated a significant effect on fertility performance postsurgery. Comparatively, this effect was 91.3% vs. 74.1% among the ≤35- and >35-year-old age groups, respectively. There was no significant difference in reproductive performance based on stages of endometriosis, nor in the other parameters evaluated. Conclusion: Our data are consistent with previous clinical studies regarding the management options of endometriosis-related infertility. Overall, the combined hysterolaparoscopy treatment is a very effective and reliable procedure, and is even more effective when combined with ART. It enhances women's wellbeing and quality of life, and significantly improves reproductive performance.
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Affiliation(s)
- Atombosoba Adokiye Ekine
- Department of Obstetrics & Gynaecology, Robert Károly Private Hospital, 1135 Budapest, Hungary; (I.F.); (I.T.); (Á.R.)
| | - István Fülöp
- Department of Obstetrics & Gynaecology, Robert Károly Private Hospital, 1135 Budapest, Hungary; (I.F.); (I.T.); (Á.R.)
| | - István Tekse
- Department of Obstetrics & Gynaecology, Robert Károly Private Hospital, 1135 Budapest, Hungary; (I.F.); (I.T.); (Á.R.)
| | - Árpád Rúcz
- Department of Obstetrics & Gynaecology, Robert Károly Private Hospital, 1135 Budapest, Hungary; (I.F.); (I.T.); (Á.R.)
| | - Sara Jeges
- Faculty of Health Sciences, University of Pécs, 48-as tér 1, 7622 Pécs, Hungary; (S.J.); (Á.K.)
| | - Ágnes Koppán
- Faculty of Health Sciences, University of Pécs, 48-as tér 1, 7622 Pécs, Hungary; (S.J.); (Á.K.)
| | - Miklós Koppán
- Department of Obstetrics & Gynaecology, University of Pécs, 48-as tér 1, 7622 Pécs, Hungary;
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Singh SS, Gude K, Perdeaux E, Gattrell WT, Becker CM. Surgical Outcomes in Patients With Endometriosis: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:881-888.e11. [PMID: 31718952 DOI: 10.1016/j.jogc.2019.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Among women treated surgically for endometriosis-associated pain, comprehensive data are lacking on the proportions of patients who experience little or no symptom relief, develop recurrent symptoms, or require further surgical treatment for endometriosis. The aim of this study was to assess the efficacy of surgical procedures used to treat endometriosis-associated pain. METHODS Medline and Embase were searched on October 13, 2016. Articles referring to women undergoing surgery for the treatment of endometriosis-associated pain were screened by two independent investigators. For each included treatment arm, data were extracted for the proportion of patients reporting partial or no improvement after surgery for endometriosis-associated pain, pain recurrence, or requirement for further surgery. RESULTS A total of 38 studies were included. Most studies did not report relevant outcomes to evaluate pain (71.1%) and recurrent surgery (68.4%). Of the women who underwent lesion excision, 11.8% reported no improvement in pain, and 22.6% underwent further surgery. Postoperative pain, recurrent pain, and adverse events were reported by 34.3%, 28.7%, and 14.8%, respectively, of patients who underwent excision or ablation of endometriosis combined with pelvic denervation and in 25.0%, 15.8%, and 8.1% of women who underwent lesion excision alone. Of the patients who were treated surgically for deep endometriosis affecting the bowel and/or bladder, 7.0% experienced recurrent symptoms, and 4.1% underwent further surgery. CONCLUSION This review supports the findings of previous studies and highlights the need for standardized reporting and more detailed follow-up after surgery for endometriosis-associated pain.
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Affiliation(s)
- Sukhbir S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital & University of Ottawa, Ottawa, ON.
| | - Kerstin Gude
- Global Pharmacovigilance, Bayer AG, Berlin, Germany
| | | | - William T Gattrell
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, United Kingdom; Department of Mechanical Engineering and Mathematical Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Christian M Becker
- Endometriosis Care and Research (CaRe) Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
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Leroy A, Azaïs H, Garabedian C, Bregegere S, Rubod C, Collier F. Psychologie et sexologie : une approche essentielle, du diagnostic à la prise en charge globale de l’endométriose. ACTA ACUST UNITED AC 2016; 44:363-7. [DOI: 10.1016/j.gyobfe.2016.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/29/2016] [Indexed: 12/24/2022]
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Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
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Al-Jefout M. Brief update on endometriosis treatment. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2011. [DOI: 10.1016/j.mefs.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bignardi T, Khong SY, Lam A. Excisional versus ablative surgery for peritoneal endometriosis. Hippokratia 2011. [DOI: 10.1002/14651858.cd008979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tommaso Bignardi
- University of Sydney; Obstetrics and Gynaecology; Sydney Australia
| | - Su-Yen Khong
- Centre for Advanced Reproductive Endosurgery; Sydney Australia
| | - Alan Lam
- University of Sydney; Obstetrics, Gynaecology and Neonatology; Sydney Australia
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Ai-Inizi S, Bamigboye V. Laparoscopic Helica Thermal Coagulation for the Treatment of Early Endometriosis. J Gynecol Surg 2007. [DOI: 10.1089/gyn.2007.b-02269-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shamma Ai-Inizi
- Department of Obstetrics and Gynecology, Furness General Hospital, Barrow in Furness, Cumbria, United Kingdom
| | - Vincent Bamigboye
- Department of Obstetrics and Gynecology, Furness General Hospital, Barrow in Furness, Cumbria, United Kingdom
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Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod 2006; 22:1142-8. [PMID: 17182665 DOI: 10.1093/humrep/del465] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Among subjects with endometriosis and deep dyspareunia (DD), those with endometriosis of the uterosacral ligament (USLE) have the most severe impairment of sexual function. This study examines the effect of laparoscopic excision of endometriosis on DD and quality of sex life. METHODS This observational cohort prospective study included 68 women with endometriosis suffering DD (intensity of pain >or= 6 on a 10-cm visual analogue scale). Patients underwent laparoscopic full excision of endometriosis. Following surgery, they were asked to use nonhormonal contraception devices. Before surgery, at 6- and at 12-month follow-up, patients answered a self-administered questionnaire based on the Sexual Satisfaction Subscale of the Derogatis Sexual Functioning Inventory. RESULTS At 6- and 12-month follow-up, women with and without USLE had significant improvement in DD. Subjects with USLE reported increased variety in sex life, increased frequency of intercourse, more satisfying orgasms with sex, relaxing more easily during sex and being more relaxed and fulfilled after sex. Similar improvements were observed among women without USLE; however, for some variables statistical significance was not reached. CONCLUSIONS Surgical excision of endometriosis improves not only DD but also the quality of sex life.
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Affiliation(s)
- S Ferrero
- Department of Obstetrics and Gynaecology, San Martino Hospital, University of Genoa, Genoa, Italy.
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Bibliography. Current world literature. Minimally invasive gynecologic procedures. Curr Opin Obstet Gynecol 2006; 18:464-7. [PMID: 16794430 DOI: 10.1097/01.gco.0000233944.74672.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hill N, McQueen J, Morey R, Hanna L, Chandakas S, El-Toukhy T, Erian J. Over one thousand patients with early stage endometriosis treated with the Helica Thermal Coagulator (HELICA): safety aspects. Arch Gynecol Obstet 2006; 274:203-5. [PMID: 16691384 DOI: 10.1007/s00404-006-0154-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 03/08/2006] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess the safety of the Helica Thermal Coagulator in the laparoscopic treatment of early stage endometriosis. DESIGN Retrospective, observational. SETTINGS The Princess Royal University Hospital, The Sloane and Chelsfield Park Hospitals, Kent, UK. PATIENTS One thousand and sixty patients with early stage endometriosis. RESULTS All patients were treated laparoscopically with the Helica Thermal Coagulator; a new laparoscopic device that combines electrical energy with helium for the treatment of endometriosis. No major bladder, ureteric or bowel injuries occurred. The only complication was a perforated vagina from the cutting probe during dissection of the cul-de-sac in a patient with a vaginal endometriotic nodule. CONCLUSION The Helica Thermal Coagulator is a safe device for the laparoscopic treatment of endometriosis.
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Affiliation(s)
- Nicholas Hill
- Department of Obstetrics and Gynaecology, Princess Royal University Hospital, Farnborough Common, Kent, BR6 8ND, UK.
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Nardo LG, Moustafa M, Beynon DWG. Reproductive outcome after laparoscopic treatment of minimal and mild endometriosis using Helica Thermal Coagulator. Eur J Obstet Gynecol Reprod Biol 2005; 126:264-7. [PMID: 16377064 DOI: 10.1016/j.ejogrb.2005.10.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 08/31/2005] [Accepted: 10/30/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the reproductive outcome following Helica Thermal Coagulator (Helica TC) in an infertile population with early-stage endometriosis. DESIGN A clinical observational trial conducted in a NHS tertiary referral centre for treatment of endometriosis. Forty-four healthy infertile women (mean age 21 years, range 18-34 years) with laparoscopically confirmed diagnosis of minimal (stage I) or mild (stage II) endometriosis were included. All visible endometriotic lesions and adhesions were treated using Helica TC at the same time of diagnostic laparoscopy. Following laparoscopy, women attempted to conceive spontaneously and were followed for 12 months or until delivery. No hormonal therapy for endometriosis was given whatsoever. RESULTS One woman was lost to follow-up and the remaining 43 women were considered in the final analysis. The cumulative pregnancy rate was 23.2% (10/43). All pregnancies occurred spontaneously and neither miscarriages nor ectopic pregnancies were observed. Pregnancy rate did not differ between women with stage I and those with stage II endometriosis. The time-to-pregnancy was similar in women with different stage endometriosis. No surgical complications were encountered. CONCLUSIONS These findings suggest that Helica TC is a simple and safe conservative laparoscopic surgery for early-stage endometriosis. Helica TC appears to improve reproductive outcome in women with otherwise unexplained infertility. Large RCTs are needed to define these preliminary data.
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Affiliation(s)
- Luciano G Nardo
- Department of Obstetrics and Gynaecology, Frimley Park Hospital, Surrey, United Kingdom.
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