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Comptour A, Chauvet P, Canis M, Grémeau AS, Pouly JL, Rabischong B, Pereira B, Bourdel N. Patient Quality of Life and Symptoms after Surgical Treatment for Endometriosis. J Minim Invasive Gynecol 2019; 26:717-726. [DOI: 10.1016/j.jmig.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022]
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Rosefort A, Huchon C, Estrade S, Paternostre A, Bernard JP, Fauconnier A. Is training sufficient for ultrasound operators to diagnose deep infiltrating endometriosis and bowel involvement by transvaginal ultrasound? J Gynecol Obstet Hum Reprod 2018; 48:109-114. [PMID: 29654939 DOI: 10.1016/j.jogoh.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess and compare the diagnostic accuracy of transvaginal ultrasonography (TVUS) by trained or untrained ultrasound operators in deep infiltrating endometriosis (DIE) imaging, for diagnosing DIE and bowel involvement. METHODS This was an observational study of patients with clinically suspected DIE operated in a reference center. TVUS was performed pre-operatively by a trained or/and untrained ultrasound operator to search for DIE and rectal involvement. During surgery, DIE was diagnosed according to macroscopic and histological criteria. Sensitivity (Se), specificity (Sp) and c-index were calculated with 95% confidence intervals for trained and untrained operators, if TVUS results were significantly predictive of DIE and rectal involvement at p<0.05. RESULTS 115 patients were included: 100 (87%) had DIE and 34 (29.6%) had bowel involvement. TVUS was performed by a trained ultrasound operator for 70 patients and by an untrained one for 56 patients. When performed by a trained operator, TVUS significantly predicted DIE with a Se of 58% (95% CI, 46-70), a Sp of 87.5% (95% CI, 63-100) and a c-index of 0.73 (95% CI, 0.59-0.87). TVUS performed by an untrained operator was not significantly predictive of DIE (p=0.58). Rectal involvement was significantly predicted by TVUS performed by a trained operator with a Se of 40% (95% CI, 23-59), a Sp of 93% (95% CI, 86-100) and a c-index of 0.67 (95% CI, 0.56-0.77). None of the untrained ultrasound operators diagnosed a bowel involvement. CONCLUSION TVUS is not sufficient to diagnose DIE and bowel involvement, in particular when performed by untrained ultrasound operators.
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Affiliation(s)
- A Rosefort
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France
| | - C Huchon
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", University Versailles Saint-Quentin en Yvelines, 78000 Versailles, France
| | - S Estrade
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France
| | - A Paternostre
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; European Center of Diagnosis and Exploration of the Woman, 78150 Le Chesnay, France
| | - J-P Bernard
- European Center of Diagnosis and Exploration of the Woman, 78150 Le Chesnay, France
| | - A Fauconnier
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", University Versailles Saint-Quentin en Yvelines, 78000 Versailles, France.
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[Surgical management of endometrioma: Different alternatives in term of pain, fertility and recurrence. CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:278-289. [PMID: 29510964 DOI: 10.1016/j.gofs.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 11/22/2022]
Abstract
Surgical management of ovarian endometrioma is most often part of a global approach of endometriosis pathology. Isolated endometrioma are rare. Laparoscopic cystectomy is the gold standard for surgical management of endometrioma. Nevertheless, this technique impacts the ovarian function. The hemostasis of the ovarian cyst bed should be performed to conserve the ovarian stroma. Ultrasonography-guided cyst aspiration, laparoscopic drainage and simple bipolar coagulation are not recommended as first line of treatment. Based on the actual literature, we cannot state the place of laser-vaporization and plasma-energy ablation in surgical management. Ethanol sclerotherapy could be an alternative to treat recurrent endometrioma. Uncompleted surgical removal of endometriosis lesions increases the recurrence rate. Endometriosis management should take into account the research and treatment of all the pelvic lesion, especially before surgical management of endometrioma. In this context, the evaluation of ovarian reserve could be useful before surgery.
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Abstract
Preoperative evaluation: clinical examination, and research for associated lesions. Laparoscopic approach. Cystectomy: gold standard, conformed to the endometrioma pathophysiology (3 zones). Laser CO2 Plasmajet® vaporisation: important data lead to legitimate utilisation. Haemostasis: be patient! Use of bipolar energy sparingly. Look for other endometriotic lesions, and systematic treatment. Preoperative medical treatment not always useful. Postoperative treatment: decrease recurrence. Especially for patients with no immediate pregnancy desire.
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Darwish B, Leleup G, Martin C, Roman H. Our experience with long-term triptorelin therapy in a large endometriosis nodule arising in an episiotomy scar. ACTA ACUST UNITED AC 2015; 43:757-8. [DOI: 10.1016/j.gyobfe.2015.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/11/2015] [Indexed: 02/07/2023]
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Roman H, Saint Ghislain M, Milles M, Marty N, Hennetier C, Moatassim S, Desnyder E, Abo C. Improvement of digestive complaints in women with severe colorectal endometriosis benefiting from continuous amenorrhoea triggered by triptorelin. A prospective pilot study. ACTA ACUST UNITED AC 2015; 43:575-81. [DOI: 10.1016/j.gyobfe.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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Diguisto C, Hébert T, Paternotte J, Kellal I, Marret H, Ouldamer L, Body G. Laparoscopie robot-assistée pour endométriose colorectale : morbidité de la résection digestive et du shaving. ACTA ACUST UNITED AC 2015; 43:266-70. [DOI: 10.1016/j.gyobfe.2015.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
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Place de la robotique dans l’endométriose pelvienne profonde : à propos du registre de la SERGS. ACTA ACUST UNITED AC 2014; 42:744-8. [DOI: 10.1016/j.gyobfe.2014.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/09/2014] [Indexed: 11/17/2022]
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Collinet P, Leguevaque P, Neme RM, Cela V, Barton-Smith P, Hébert T, Hanssens S, Nishi H, Nisolle M. Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc 2014; 28:2474-9. [DOI: 10.1007/s00464-014-3480-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/03/2014] [Indexed: 12/21/2022]
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Évolution des symptômes et de la qualité de vie des patientes après chirurgie de l’endométriose digestive. ACTA ACUST UNITED AC 2013; 41:627-34. [DOI: 10.1016/j.gyobfe.2013.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Indexed: 11/22/2022]
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Quibel A, Puscasiu L, Marpeau L, Roman H. Les médecins traitants devant le défi du dépistage et de la prise en charge de l’endométriose : résultats d’une enquête. ACTA ACUST UNITED AC 2013; 41:372-80. [DOI: 10.1016/j.gyobfe.2012.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
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Roman H, Sanguin S, Puscasiu L. [Medical treatment of endometriosis: an obligation rather than a mere option!]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2012; 40:320-325. [PMID: 22521988 DOI: 10.1016/j.gyobfe.2012.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 01/16/2012] [Indexed: 05/31/2023]
Abstract
The aim of this article is to argue the usefulness of the systematic administration of medical treatment in women managed for endometriosis, either alone or associated with the surgery. The authors dispute seven frequent objections against the medical treatment: the lack of curative effect, the lack of primary prevention and the risk of delaying the diagnostic, the contraceptive effect in women wishing to conceive, the adverse effects, the risk of occurrence of new lesions following the arrest of the treatment, the lack of proof favourable to the efficient prevention of recurrences and the cost of the treatment. The authors conclude that to date the therapeutic amenorrhea represents an indispensable tool in the management of the endometriosis, in women both benefiting or not from surgical procedures.
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Affiliation(s)
- H Roman
- Clinique gynécologique et obstétricale, CHU de Rouen, 1 rue de Germont, Rouen, France.
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Lasmar RB, Lasmar BP, Pillar C. Diagram to map the locations of endometriosis. Int J Gynaecol Obstet 2012; 118:42-6. [PMID: 22507261 DOI: 10.1016/j.ijgo.2012.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/09/2012] [Accepted: 03/20/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop and test a visual map that corresponds practically and objectively to the anatomical areas affected by endometriosis. METHOD The study comprised 150 questionnaires concerning 10 clinical cases of endometriosis presented as a visual diagram that were distributed at 3 different scientific events, among 3 groups of 50 gynecologists. Data were analyzed to evaluate the diagram's ability to graphically represent the endometriosis sites. RESULTS After presentation at the first event, the rate of correct answers on the site of endometriosis was 84.7%; at the second event, after modifications implemented after feedback from the first event, the rate of correct answers was 97.4%; and at the third event, when all suggestions and modifications had been made, the rate was 99.7%. CONCLUSION The diagram proposed to map the location of endometriosis lesions appears to be an adequate and effective instrument to represent the site of the disease, with correlation at almost 100%.
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Affiliation(s)
- Ricardo Bassil Lasmar
- Department of Gynecology of Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.
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Bourdel N, Roman H, Mage G, Canis M. Chirurgie des endométriomes ovariens : de la physiopathologie à la prise en charge pratique pré-, per- et postopératoire. ACTA ACUST UNITED AC 2011; 39:709-21. [DOI: 10.1016/j.gyobfe.2011.07.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
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Jensen AM, Bewketu B, Sanford D. Intermittent low back pain referred from a uterine adenomyosis: a case report. J Chiropr Med 2011; 10:64-9. [DOI: 10.1016/j.jcm.2010.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 08/09/2010] [Accepted: 08/10/2010] [Indexed: 11/25/2022] Open
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Roman H, Rozsnayi F, Puscasiu L, Resch B, Belhiba H, Lefebure B, Scotte M, Michot F, Marpeau L, Tuech JJ. Complications associated with two laparoscopic procedures used in the management of rectal endometriosis. JSLS 2010; 14:169-77. [PMID: 20932363 PMCID: PMC3043562 DOI: 10.4293/108680810x12785289143800] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND To evaluate intra- and postoperative complications associated with laparoscopic management of rectal endometriosis by either colorectal segmental resection or nodule excision. METHODS During 39 consecutive months, 46 women underwent laparoscopic management of rectal endometriosis and were included in a retrospective comparative study. The distinguishing feature of the study is that the choice of the surgical procedure is not related to the characteristics of the nodule. RESULTS Colorectal segmental resection with colorectal anastomosis was carried out in 15 patients (37%), while macroscopically complete rectal nodule excision was performed in 31 women (63%). No intraoperative complications were recorded. In the colorectal resection group, 3 women (18%) had a bladder atony (spontaneously regressive in 2 women), 4 women (24%) experienced chronic constipation, one had an anastomosis leakage (6%), while 2 women (13%) had acute compartment syndrome with peripheral sensory disturbance. In the nodule excision group, 1 woman (4%) developed transitory right obturator nerve motor palsy. Based on both postoperative pain and improvement in quality of life, all 29 women in the excision group (100%) and 14 women in the colorectal resection group (82%) would recommend the surgical procedure to a friend suffering from the same disease. CONCLUSION Our study suggests that carrying out colorectal segmental resection in rectal endometriosis is associated with unfavourable postoperative outcomes, such as bladder and rectal dysfunction. These outcomes are less likely to occur when rectal nodules are managed by excision. Information about complications related to both surgical procedures should be provided to patients managed for rectal endometriosis and should be taken into account when a decision is being made about the most appropriate treatment of rectal endometriosis in each case.
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Affiliation(s)
- Horace Roman
- Department of Gynecology and Obstetrics, University Hospital Charles Nicolle, Rouen, France.
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Endométriose et douleurs pelvipérinéales chroniques. Prog Urol 2010; 20:1010-8. [DOI: 10.1016/j.purol.2010.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/16/2010] [Indexed: 11/21/2022]
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Roman H. [Postoperative long-term amenorrhea avoids recurrence of endometriosis: finally the proof!]. ACTA ACUST UNITED AC 2009; 37:771-2. [PMID: 19766041 DOI: 10.1016/j.gyobfe.2009.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Évaluation anatomique et histologique du ligament utérosacré : conséquences pratiques en chirurgie. ACTA ACUST UNITED AC 2009; 38:304-11. [DOI: 10.1016/j.jgyn.2009.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/12/2009] [Accepted: 03/02/2009] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Endometriosis is characterized by the presence of ectopic endometrial tissue that might lead to many distressing and debilitating symptoms. Despite available studies supporting standard hormone therapy for women with endometriosis and post-surgical menopause, there is still a concern that estrogens may induce a recurrence of the disease and its symptoms. OBJECTIVES This review aimed to look at pain and disease recurrence in women with endometriosis who used hormone therapy for post-surgical menopause. SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Specialized Register (March 2008), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 3), MEDLINE (1966 to March 2008), EMBASE (1980 to March 2008), and references lists of articles. Relevant journals and conference proceedings were handsearched. SELECTION CRITERIA Randomized controlled trials studying hormone therapy for women with endometriosis in post-surgical menopause. DATA COLLECTION AND ANALYSIS Review authors assessed the eligibility of trials and their quality. MAIN RESULTS Two studies fulfilled our inclusion criteria. One trial compared the nonstop transdermal application of 17beta-estradiol (0.05 mg/day) combined with cyclic medroxy progesterone acetate (10 mg per day) for 12 days per month in women with a conserved uterus with nonstop tibolone (2.5 mg/day). The second trial used sequential administration of estrogens and progesterone with two 22 cm(2) patches applied weekly to produce a controlled release of 0.05 mg/day. Micronized progesterone was administered orally (200 mg/day) for 14 days with a 16-day interval free of treatment. Pain and dyspareunia The first trial reported recurrence of pain in the estrogen and progesterone arm in 4/10 of women compared with 1/11 in the tibilone arm. In the latter, 4/115 women reported recurrence of pain in the treatment group compared with 0/57 patients in the no-treatment arm. Neither finding was statistically different.Confirmed recurrence or exacerbation of endometriosis This outcome was not reported in the first trial. The second found that 2/115 of the treatment group developed recurrence of endometriosis with no recurrence reported in the no-treatment group. This was not statistically significant. No woman was re-operated on in the no-treatment group compared with 2/115 in the treatment group. AUTHORS' CONCLUSIONS Hormone replacement therapy for women with endometriosis in post-surgical menopause could result in pain and disease recurrence. However, the evidence in the literature is not strong enough to suggest depriving severely symptomatic patients from this treatment. There is a need for more randomised controlled studies.
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Affiliation(s)
- Hanan Al Kadri
- Obstetrics & Gynaecology, KFNGH, PO Box 57374, Riyadh, Saudi Arabia, 11574.
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Fauconnier A, Fritel X, Chapron C. [Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications]. ACTA ACUST UNITED AC 2009; 37:57-69. [PMID: 19128998 DOI: 10.1016/j.gyobfe.2008.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 08/27/2008] [Indexed: 01/04/2023]
Abstract
The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic microbleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the subperitoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as "location indicating pain". A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic.
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Affiliation(s)
- A Fauconnier
- Unité 149 recherches épidémiologiques en santé périnatale et santé des femmes, Inserm, Paris, France.
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Roman H, Kouteich K, Gromez A, Hochain P, Resch B, Marpeau L. Endorectal ultrasound accuracy in the diagnosis of rectal endometriosis infiltration depth. Fertil Steril 2008; 90:1008-13. [DOI: 10.1016/j.fertnstert.2007.07.1361] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 07/23/2007] [Accepted: 07/23/2007] [Indexed: 12/18/2022]
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Oui, il faut opérer les patientes qui ont des lésions d’endométriose infiltrante ! « Préférez l’optimisme de la volonté au pessimisme de l’intelligence ! ». ACTA ACUST UNITED AC 2008; 36:218-221. [DOI: 10.1016/j.gyobfe.2007.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Fernandez H, Deffieux X, Faivre E, Gervaise A. Faut-il réellement opérer les lésions infiltrantes d’endométriose ? – Non « Choisir le réalisme et non l’idéalisme ». ACTA ACUST UNITED AC 2008; 36:214-217. [DOI: 10.1016/j.gyobfe.2007.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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