Variations in tubal configuration in endometriosis?

Potential anatomical determinants of retrograde menstruation: a comprehensive narrative review

A century ago, Sampson identified three uterine anatomical structures that may determine the amount of retrograde menstruation and the likelihood of the development of endometriosis: the cervix, the intramural portion of the fallopian tubes, and the myometrium. Critical appraisal was undertaken of data published over the last 40 years on the potential effect of the characteristics of these three anatomical variables on the risk of endometriosis. There is some evidence to support the pathogenic role of the diameter of the cervical canal, stenosis of internal or external orifices, and stiffness of cervical tissue. One study showed a significant association between the morphology of the intramural tubal tract and the frequency of endometriosis. A large body of evidence points to abnormalities of the myometrial structure as the anatomical aberration most consistently associated with endometriosis. These abnormalities have largely been interpreted as signs of early-onset adenomyosis, which may precede endometriosis and even lead to its development by increasing the amount of retrograde menstruation. Future research should aim to verify whether a positive relationship exists between the substantially increased number of ovulatory menses occurring in the decade following menarche, the development of anatomical myometrial abnormalities, changes in the amount of retrograde menstruation over time, and the risk of endometriosis.

Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis

Anterior discoid resection is associated with a shorter operative time, lower blood loss, shorter hospital stay, and lower rate of anastomotic strictures than laparoscopic anterior resection is in the treatment of rectal endometriosis.

Objective:

To compare laparoscopic anterior discoid resection (ADR) with low anterior resection (LAR).

Methods:

This is a retrospective review of a cohort (Canadian Task Force classification II-2) of patients undergoing laparoscopic ADR or LAR at a university hospital. Chart review and telephone questionnaires were conducted to examine long-term outcomes. Preoperative and operative findings, short- and long-term outcomes were compared. SF-12 quality of life scores, need for further interventions, and overall satisfaction were also compared.

Results:

Twenty-two patients underwent laparoscopic ADR (n=8) or LAR (n=14) for rectosigmoid endometriosis between January 2001 and December 2009. Mean follow-up time was 41.26 months (range, 14 to 70). Patients undergoing laparoscopic ADR had significantly less blood loss and shorter operative time and hospital stay. Patients who required LAR had a significantly higher rate of mucosal involvement (61.5% v. 0%). No statistically significant difference was found in the size, depth of invasion, location of lesions, or operative complications. Fifty percent of the LAR group had several lesions as opposed to 12.5% of the ADR group. Median age was significantly higher in patients who required LAR (39) than in patients who required ADR (32). Three patients in the LAR group (21.4%) had anastomotic strictures; 2 required dilation. The ADR group had consistently higher increments of improvement in bowel symptoms and dyspareunia. Overall satisfaction rate with the procedures was 93.3%. SF-12 scores were comparable between the 2 groups.

Conclusion:

ADR compared with LAR is associated with decreased operative time, blood loss, and hospital stay and a lower rate of anastomotic strictures. Other outcomes and satisfaction rates are comparable between the 2 procedures.