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Osada M, Faller E, Lecointre L, Boisrame T, Martel C, Gabriele V, Akladios C, Host A. [Interest of multidisciplinary consultation meetings dedicated to endometriosis: From a series of 682 patients]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:336-342. [PMID: 38237734 DOI: 10.1016/j.gofs.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE We decided to conduct a study based on these multidisciplinary team (MDT) in order to investigate their impact at the University Hospitals of Strasbourg and look for ways to improve this MDT. METHODS This is a retrospective study of the 682 patients presented to endometriosis MDT from its inception in March 2017 to December 2020. RESULTS The MDT decision was different from that initially proposed by the patient's referent for 406 patients (60%). Surgery was chosen for 417 patients (61%) and assisted reproduction for 261 patients (38%). A review of the MRI by a referring radiologist was carried out for 348 cases (51%), with a modification of the results for 255 patients (73%). Initial underestimation of lesions was noted in 198 cases. CONCLUSION Our study has shown the importance of MDT in endometriosis since the therapeutic proposal was modified in 60% of cases. In addition, we supported the importance of radiologists specializing in this field since they made a modification in two-thirds of the MRIs reread. These results show the importance of collegial discussions, which can modify the decisions of medical teams. This underlines the importance of setting up endometriosis networks.
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Affiliation(s)
- Marine Osada
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France.
| | - Emilie Faller
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Lise Lecointre
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Thomas Boisrame
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Camille Martel
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Victor Gabriele
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Cherif Akladios
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - Aline Host
- Hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France; Centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Rubod C, de Prémare C, Kerbage Y, Kyheng M, Plouvier P, Chossegros C, Robin G. Does surgery for colorectal endometriosis prior to IVF±ICSI have an impact on cumulative live birth rates? Reprod Biomed Online 2024; 48:103649. [PMID: 38335899 DOI: 10.1016/j.rbmo.2023.103649] [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: 07/02/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 02/12/2024]
Abstract
RESEARCH QUESTION Does colorectal endometriosis surgery prior to IVF ± intracytoplasmic sperm injection (ICSI) impact cumulative live birth rates? DESIGN This retrospective, monocentric study (Lille University Hospital) was conducted between 1 January 2007 and 31 December 2018. Two groups of patients from the JFIV database were included: a group undergoing IVF±ICSI alone (120 patients, 215 oocyte retrievals), and a group undergoing surgery and then IVF±ICSI (69 patients, 109 oocyte retrievals). The mode of management was decided after a multidisciplinary team meeting. Different criteria such as age (cut-off 35 years), anti-Müllerian hormone concentration (cut off 2 ng/ml), imaging results and the patient's symptomatology were considered: the most symptomatic patients underwent surgery prior to IVF±ICSI. The cumulative clinical pregnancy and live birth rates obtained after four IVF attempts were estimated and compared between the two groups using competing risk survival methods. RESULTS The cumulative live birth rates after four IVF attempts in the two groups were not statistically significantly different (50.8% in the IVF±ICSI group versus 52.2% in the surgery followed by IVF±ICSI group, P = 0.43). The results for the cumulative clinical pregnancy rates were the same (56.7% in the IVF±ICSI group versus 58% in the surgery followed by IVF±ICSI group, P = 0.47). CONCLUSION The study shows that cumulative live birth and pregnancy rates were similar in infertile patients with colorectal endometriosis who underwent IVF±ICSI either with or without prior colorectal endometriosis surgery.
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Affiliation(s)
- Chrystèle Rubod
- Service de chirurgie gynécologique, CHU Lille, Lille, France.; Univ. Lille, CHU Lille, Lille, France
| | | | - Yohan Kerbage
- Service de chirurgie gynécologique, CHU Lille, Lille, France
| | - Maeva Kyheng
- Service de Biostatistiques, CHU Lille, Lille, France
| | - Pauline Plouvier
- Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité, CHU Lille, Lille, France
| | | | - Geoffroy Robin
- Univ. Lille, CHU Lille, Lille, France.; Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité, CHU Lille, Lille, France
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Rubod C, Fouquet A, Bartolo S, Lepage J, Capelle A, Lefebvre C, Kamus E, Dewailly D, Collinet P. Factors associated with pregnancy after in vitro fertilization in infertile patients with posterior deep pelvic endometriosis: A retrospective study. J Gynecol Obstet Hum Reprod 2019; 48:235-239. [DOI: 10.1016/j.jogoh.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/28/2022]
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Alborzi S, Hosseini-Nohadani A, Poordast T, Shomali Z. Surgical outcomes of laparoscopic endometriosis surgery: a 6 year experience. Curr Med Res Opin 2017; 33:2229-2234. [PMID: 28760003 DOI: 10.1080/03007995.2017.1362377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of the present study was to review 6 year experience on the surgical outcomes of laparoscopic endometriosis surgery. METHODS A cohort study was performed in Shiraz University of Medical Sciences using data from medical records of 1315 cases of patients with endometriosis undergoing laparoscopic surgery with follow-up of 6 to 72 months. RESULTS This study concerned a cohort of 1315 patients diagnosed with endometriosis operated between April 2010 and April 2016, 1086 (82.5%) of whom were in stage III and IV; 968 (73.61%) had endometrioma (regardless of having deep infiltrative endometriosis [DIE] or peritoneal involvement) and 347 (26.39%) of patients had either DIE or peritoneal involvement without endometrioma. Regarding the patients, unilateral endometrioma was statistically significant in the left ovary (p = .002). One hundred and thirty-three (10.7%) rectal wall, 7 (0.32%) sigmoid colon, 4 (0.18%) vagina, 125 (5.6%) ureter and 33 (1.52) bladder involvements were detected. Prior to operation, the pain VAS score was 8.23 ± 2.03, which decreased to 4.46 ± 2.47 in 93.07% of patients. Fifty-three patients (6.56%) needed reoperation. Sixty-six (33.1%) infertile women had spontaneous pregnancy and 15 (25%) became pregnant using intrauterine insemination (IUI) or assisted reproductive technique (ART) post-operatively. CONCLUSION Surgical treatment of endometriosis seems to be an effective treatment. DIE can be present in the absence of endometrioma. The rate of left endometrioma is higher due to the pressure effect of the sigmoid colon. Nonetheless, if an expert surgeon performs this procedure, not only the rate of post-operative complications, but also the possibility of recurrence would decrease.
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Affiliation(s)
- S Alborzi
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - A Hosseini-Nohadani
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - T Poordast
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Z Shomali
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
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Rebibo L, Maréchal V, De Lameth I, Dhahri A, Escoffier I, Lalau JD, Regimbeau JM. Compliance with a multidisciplinary team meeting's decision prior to bariatric surgery protects against major postoperative complications. Surg Obes Relat Dis 2017; 13:1537-1543. [PMID: 28705572 DOI: 10.1016/j.soard.2017.05.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/10/2017] [Accepted: 05/28/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Good surgical practice guidelines in France state that patients eligible for bariatric surgery must always be discussed at a multidisciplinary team (MDT) meeting. OBJECTIVE Describe MDT meetings and assess their possible impact on the postoperative course. SETTING University Hospital, France, public practice. METHODS From April 2009 to March 2013, we included all patients reviewed in a MDT meeting before bariatric surgery. The primary endpoint was the case validation rate. The secondary endpoints were the number of MDT meetings, the number of submissions discussed or refused, outcomes in patients who underwent surgery in another center after refusal, or deferral in our MDT meeting. RESULTS Forty-nine MDT meetings were held representing 1099 case files (816 patients) that were discussed. Of the case files, 84.5% concerned first-line surgery, 14% concerned second-line surgery, and 1.4% concerned third-line surgery. Overall, 776 (70.6%) of these submissions were approved, accounting for 95% of the patients. Further investigation before a decision was required in 13.3%. Surgery was definitively refused in 1% (n = 11). For the 776 patients having undergone surgery, the complication rate was 10.1%, the major complication rate was 6%, and the reoperation rate was 3.2%. For the 11 patients for whom bariatric surgery was refused, 7 patients underwent surgery in another center (without MDT meetings). There were 4 postoperative complications (57.1%; 3 major and 1 minor). CONCLUSION The MDT meeting's decision is important for standardizing the management of obese patients before bariatric surgery. MDT meetings might help to reduce complication by optimizing patient selection and preoperative care.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Virginie Maréchal
- Department of Psychiatry, Amiens University Hospital, Amiens, France
| | - Ileana De Lameth
- Department of Endocrinology and Nutrition, Amiens University Hospital, Amiens, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Isabelle Escoffier
- Department of Prevention and Patient Education, Amiens University Hospital, Amiens, France
| | - Jean-Daniel Lalau
- Department of Endocrinology and Nutrition, Amiens University Hospital, Amiens, France; Department of Prevention and Patient Education, Amiens University Hospital, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France.
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Quicray M, Darwish B, Bridoux V, Roman H. Bowel occlusion in an infertile woman with documented deep endometriosis of the sigmoid colon: Why was it not unexpected? ACTA ACUST UNITED AC 2016; 44:727-729. [PMID: 27773612 DOI: 10.1016/j.gyobfe.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M Quicray
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France
| | - B Darwish
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen, France
| | - H Roman
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France; Research Group EA 4308 'Spermatogenesis and Male Gamete Quality', Rouen University Hospital, 76031 Rouen, France.
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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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le Carpentier M, Merlot B, Bot Robin V, Rubod C, Collinet P. [Partial cystectomy for bladder endometriosis: Robotic assisted laparoscopy versus standard laparoscopy]. ACTA ACUST UNITED AC 2016; 44:315-21. [PMID: 27032760 DOI: 10.1016/j.gyobfe.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. METHODS A retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. RESULTS We included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. CONCLUSIONS Robot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications.
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Affiliation(s)
- M le Carpentier
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France.
| | - B Merlot
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - V Bot Robin
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - C Rubod
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
| | - P Collinet
- Chirurgie gynécologique, clinique de gynécologie, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France
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Leroy A, Garabedian C, Fourquet T, Azaïs H, Merlot B, Collinet P, Rubod C. [Pictures balance for optimal surgical management of pelvic endometriosis. Imaging and surgery of endometriosis]. ACTA ACUST UNITED AC 2016; 45:214-25. [PMID: 26874665 DOI: 10.1016/j.jgyn.2016.01.003] [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: 10/08/2015] [Revised: 12/24/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
Abstract
Endometriosis is a frequent benign pathology that is found in 10-15% of women and in 20% of infertile women. It has an impact on fertility, but also in everyday life. If medical treatment fails, surgical treatment can be offered to the patient. To provide adequate treatment and give clearer information to patients, it seems essential to achieve an optimal preoperative imaging assessment. Thus, the aim of this work is to define the information expected by the surgeon and the indications of each imaging test for each compartment of the pelvis, allowing an ideal surgical management of pelvic endometriosis. We will not discuss imaging techniques' principles and we will not develop the indications and surgical techniques.
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Affiliation(s)
- A Leroy
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France.
| | - C Garabedian
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France.
| | - T Fourquet
- Centre d'imagerie de la femme, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59037 Lille cedex, France
| | - H Azaïs
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| | - B Merlot
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
| | - C Rubod
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, avenue Eugène-Avinée, 59037 Lille, France; Faculté de médecine Henri-Warembourg, université Lille nord de France, avenue Eugène-Avinée, 59045 Lille, France
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Chirurgie pour endométriose pelvienne profonde avant fécondation in vitro : pas de bénéfice pour la fertilité ? ACTA ACUST UNITED AC 2015; 43:109-16. [DOI: 10.1016/j.gyobfe.2014.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 12/16/2014] [Indexed: 11/20/2022]
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