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Dolci C, Kerbage Y, Ruffolo AF, Candiani M, Gandon A, Rubod C. Protective defunctioning stoma in bowel segmental resection at the time of total hysterectomy for endometriosis: when less is more. Arch Gynecol Obstet 2024:10.1007/s00404-024-07629-5. [PMID: 38995389 DOI: 10.1007/s00404-024-07629-5] [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: 04/12/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE To compare postoperative complications in women undergoing total hysterectomy with segmental resection (TH-SR) for intestinal endometriosis with or without protective defunctioning stoma (PDS) confection. METHODS Retrospective cohort study conducted at the Gynecologic department of University Hospital of Lille (France) from January 2008 to January 2022 in patients undergone TH-SR for bowel endometriosis. RESULTS 100 women were considered for the analysis. PDS were performed in 56 women. The rate of rectal resections was significantly higher in the PDS group (p = 0.03). The mean operative time, AAGL scores and length of hospital stay were significantly higher in the PDS group (p = 0.002). The rate of grade III complication according to Clavien-Dindo classification was higher in the PDS group (p = 0.03). Among digestive complications, one case of anastomosis leakage (1.8%) and one case of recto-vaginal fistula (2.3%) was recorded in the non-PDS group, 4 cases of anastomosis stenosis were recorded in the PDS group (7.1%). Persisting bladder atony requiring self-catheterization over one month was the most common disturb (4.6% in the non-PDS group and 7.1% in the PDS group, p = 0.58). The distance of digestive lesion from anal margin was the only risk factor for digestive complications, persistent bladder atony, Clavien-Dindo IIIA and IIIB complications at the multivariate analysis (p = 0.04 and p = 0.06 respectively). CONCLUSION No statistically significant differences were found in the rate of digestive complications in case of total hysterectomy and concomitant segmental resection when performing or not preventing stoma.
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Affiliation(s)
- Carolina Dolci
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France.
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Yohan Kerbage
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59000, Lille, France
| | | | - Massimo Candiani
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Anne Gandon
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
| | - Chrystèle Rubod
- Centre Hospitalier Universitaire de Lille, Service de Chirurgie Gynécologique, 59000, Lille, France
- Faculté de Médecine, Université de Lille, 59000, Lille, France
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2
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Piozzi GN, Burea V, Duhoky R, Stefan S, So C, Wilby D, Tsepov D, Khan JS. Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity. Tech Coloproctol 2024; 28:31. [PMID: 38329622 PMCID: PMC10853297 DOI: 10.1007/s10151-023-02904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Bowel endometriosis impacts quality of life. Treatment requires complex surgical procedures with associated morbidity. Precision approach with robotic surgery leads to organ preservation. Bowel endometriosis requires a multidisciplinary management to improve patient outcomes. This study evaluates perioperative outcomes of bowel endometriosis undergoing multidisciplinary planning and robotic surgery. METHODS Consecutive cases of multidisciplinary robotic bowel endometriosis procedures (January 2021-December 2022) were evaluated from a prospectively maintained database in a national endometriosis accredited centre. Patients were managed through a multidisciplinary setting including gynaecologists, colorectal robotic surgeons, and other specialists. Dyschezia (menstrual and non-cyclical) and quality of life were assessed pre- and postoperatively (6 months) through validated questionnaires. RESULTS Sixty-eight consecutive cases of robotic bowel endometriosis were included. Median age was 35.0 (30.2-42.0) years. Median body mass index was 24.0 (21.0-26.7) kg/m2. Procedures performed were 48 (70.6%) shavings, 11 (16.2%) deep shavings, 3 (4.4%) disc excisions, and 6 (8.8%) segmental resections. One (1.5%) patient required temporary stoma. Median operating time was 150 (120-180) min. There were no conversions/return to theatre postoperatively. Median endometriotic nodule size was 25.0 (15.5-40.0) mm. Two (2.9%) patients developed postoperative complications. Median length of postoperative stay was 2 (2-4) days. Median follow-up was 12 (7-17) months. One (1.5%) patient recurred. Median menstrual dyschezia score improved from 5.0 (2.0-8.0) to 1.0 (0.0-5.7). Median non-cyclical dyschezia significantly improved (p < 0.001) from 1.0 (0.0-5.7) to 0.0 (0.0-2.0). Median quality of life score improved from 52.5 (35.0-70.0) to 74.5 (60.0-80.0). CONCLUSIONS Robotic multidisciplinary approach to bowel endometriosis provides good perioperative outcomes with improvement of dyschezia and quality of life.
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Affiliation(s)
- G N Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - V Burea
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - R Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - S Stefan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK
| | - C So
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - D Wilby
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
- Department of Urology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - D Tsepov
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK
| | - J S Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
- The Princess Grace Hospital Robotic Endometriosis Centre, The Harley Street Clinic, HCA Healthcare UK, London, UK.
- University of Portsmouth, Portsmouth, UK.
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Intestinal Endometriosis Leading to Recurrent Hematochezia. ACG Case Rep J 2022; 9:e00872. [PMID: 36237283 PMCID: PMC9553394 DOI: 10.14309/crj.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Endometriosis occurs when endometrial tissue existing outside of the endometrial cavity has an inflammatory response, which can lead to swelling and scarring, generally in the abdominopelvic cavity. It commonly presents in reproductive-age women and very infrequently presents in postmenopausal women. We report a case of a 51-year-old woman who underwent a hysterectomy a decade before presentation with new-onset intermittent proctalgia and hematochezia. Her colonoscopy showed a sigmoid polyp, which was confirmed to be endometriosis on histopathology. This case highlights intestinal endometriosis as a rare differential to be considered in women, regardless of age, with abnormal rectal bleeding.
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Mège D, Bernard C, Pivano A, Nho RLH, Aubert M, Duclos J, Agostini A, Pirro N. Morbidity of diverting stoma during colorectal surgery for deep infiltrating endometriosis – an observational study. J Gynecol Obstet Hum Reprod 2022; 51:102347. [DOI: 10.1016/j.jogoh.2022.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/28/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
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Vermel M, Lecointre L, Jochum F, Schwaab T, Futcher F, Faller É, Boisramé T, Baldauf JJ, Akladios C. Bowel resection performed by gynecologists - Outcomes and learning curves. Activity profile in a Gynecology Department: 7-year observational cohort. Eur J Obstet Gynecol Reprod Biol 2021; 267:142-149. [PMID: 34773876 DOI: 10.1016/j.ejogrb.2021.09.024] [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: 06/04/2021] [Revised: 08/31/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bowel resection is frequently used when performing oncological surgery to obtain complete cytoreduction or to remove endometriosis in case of intestinal invasion. Acquiring the surgical skills to perform this kind of procedure is crucial to offer to our patients an optimal management. The aim of this study is to describe a 7-years surgical experience in bowel resections of a gynecologic surgeon and to determine his learning curves. STUDY DESIGN This is a monocentric retrospective cohort study reporting digestive resection performed between January 2013 and April 2020 in the Gynecology Department of Strasbourg University Hospital. Ninety-one consecutive patients were assigned in two groups: gynecological cancer (n = 44) and deep infiltrating endometriosis (DIE) (n = 47). The main outcome measure was the postoperative complications rate at 30 days, based on the modified Clavien-Dindo severity system. Learning curves were evaluated using cumulative sum (CUSUM) analysis of operative time and risk-adjusted cumulative sum (RA-CUSUM) analysis of severe perioperative complications. Identification of predictive factors for operation duration and severe perioperative complication occurrence was conducted using multivariate analysis. RESULTS Minor complications were found in 25% of cases. Major complication rate (Clavien-Dindo ≥ IIIa) was 14% in total and only involved patients operated for cancer. The CUSUM curve for operative time peaked at the 35th case and showed a downward slope after the 45th case. Significant predictive factors of operating time were cytoreductive tumoral surgery, size of the bowel resection and laparoscopic surgery, while learning phase 3 significantly decreased it. The RA-CUSUM curve for severe perioperative complications (Clavien-Dindo ≥ IIIa) showed a progressive decrease in the complication rate as the number of interventions increases without showing clear inflection points. Only cardiopulmonary pathologies were found as significant predictive factor of severe complications. CONCLUSION Proficiency in performing highly complex surgery was achieved after approximately 45 cases, cancer and DIE all together. Acceptable rates of severe perioperative complications were observed even during the initial learning period and are comparable with those found in the literature concerning bowel resection performed by gynecologic oncologists but also by general and digestive surgeons.
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Affiliation(s)
- Muriel Vermel
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Lise Lecointre
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France; I-Cube UMR 7357, laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie, Strasbourg University, Pôle API - Parc d'innovation, 300 boulevard Sébastien Brant - BP 10413, 67412 Illkirch Cedex, France
| | - Floriane Jochum
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Thomas Schwaab
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Françoise Futcher
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Émilie Faller
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Thomas Boisramé
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Jean-Jacques Baldauf
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Chérif Akladios
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France.
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Pellerin M, Faller E, Minella C, Garbin O, Host A, Lecointre L, Akladios C. Surgical management of deep pelvic endometriosis in France: Do we need to be a pelvic surgeon to deal with DPE? J Gynecol Obstet Hum Reprod 2021; 50:102158. [PMID: 33945889 DOI: 10.1016/j.jogoh.2021.102158] [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: 07/02/2020] [Revised: 02/11/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Endometriosis is a common disease in women, which requires a medical and surgical approach. Surgical societies recommend a multidisciplinary management in tertiary referral centers. The objective of our study is to assess the surgical management of endometriosis in France by studying the surgeons' attitude for bowel and urinary endometriosis. METHODS We sent a survey to french endometriosis surgeons. We did a descriptive analysis and a comparative analysis between surgeons who believe endometriosis surgeons should be considered as "pelvic surgeons", able to treat bowel and urinary involvement. RESULTS We included 90 answers, from gynaecologic surgeons from all over France. Gynaecologic surgeons perform minor bowel and urinary tract surgery, and more complex procedures are performed with digestive or urological surgeon (bowel resection 85% of cases, ureteric resection-anastomosis 84% of cases, ureteric reimplantation 91% of cases). Surgeons considering that gynaecologists should be able to deal with urinary and bowel endometriosis carry out more bowel and urinary procedures. They have an additional training in surgery and perform more endometriosis surgery every year. However, bowel and urinary endometriosis management by gynaecologic surgeons is contested amongst gynaecologists. CONCLUSION To this day, there is no dedicated training in France to coach gynaecologist to perform such procedures. Multidisciplinary approach is essential for quality care, in expert centers. The basic education of gynaecologic surgeons does not allow them to perform complex pelvic surgeries, but qualifications can be gained for these interventions with a special training, and perform a greater number of surgeries.
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Affiliation(s)
- Madeleine Pellerin
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
| | - Emilie Faller
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France.
| | - Chris Minella
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
| | - Olivier Garbin
- Gynaecology Unit, Centre medico chirurgical et obstetrical (CMCO), University Hospitals of Strasbourg, 19 rue Louis Pasteur, 67300 Schiltigheim France
| | - Aline Host
- Gynaecology Unit, Centre medico chirurgical et obstetrical (CMCO), University Hospitals of Strasbourg, 19 rue Louis Pasteur, 67300 Schiltigheim France
| | - Lise Lecointre
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
| | - Chérif Akladios
- Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France
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7
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Tanaka K, Sasaki A, Egashira H, Teshima S, Kimura K, Nishino T, Tazawa T, Tasaki J, Ichita C, Masuda S, Koizumi K, Kako M. A Targeted Biopsy during Menstruation for the Definitive Diagnosis of Rectovaginal Endometriosis: A Report of Two Cases. Intern Med 2021; 60:999-1004. [PMID: 33116009 PMCID: PMC8079915 DOI: 10.2169/internalmedicine.5430-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/27/2020] [Indexed: 11/06/2022] Open
Abstract
We herein report the definitive diagnosis of rectovaginal endometriosis in two cases. Case 1 involved a 46-year-old woman with abdominal pain and hematochezia. The diagnosis after the first and second examinations using lower gastrointestinal (GI) endoscopy was unclear. Differential diagnoses included mucosa-associated lymphoid tissue and colorectal cancer. The third lower GI endoscopy with a targeted biopsy, performed during menstruation, confirmed rectovaginal endometriosis. Case 2 involved a 38-year-old woman with hematochezia. Lower GI endoscopy during menstruation revealed rectovaginal endometriosis. When rectovaginal or bowel endometriosis is suspected, lower GI endoscopy and a targeted biopsy during menstruation can prevent unnecessary surgery.
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Affiliation(s)
- Kosuke Tanaka
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Hideto Egashira
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | | | - Karen Kimura
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Takashi Nishino
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Tomohiko Tazawa
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Junichi Tasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
| | - Makoto Kako
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Japan
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Heinz-Partington S, Costa W, Martins WP, Condous G. Conservative vs radical bowel surgery for endometriosis: A systematic analysis of complications. Aust N Z J Obstet Gynaecol 2021; 61:169-176. [PMID: 33527359 DOI: 10.1111/ajo.13311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endometriosis of the bowel can be associated with significant morbidity. Surgery to remove it carries risks. Options include conservative shaving or discoid resection and more radical segmental bowel resection. AIMS To determine if more conservative shaving or discoid bowel resection is associated with fewer risks than more radical segmental resection. MATERIAL AND METHODS This study is a systematic review. We considered eligible any cohort, observational or randomised controlled trial (RCT) study of at least ten women per arm comparing conservative vs radical bowel surgery for endometriosis. We divided complications into two groups, major and minor. One additional article was added due to its significance in answering our study question as well as the high quality of the study design as an RCT. RESULTS There were 3041 studies screened. Eleven studies were included (n = 1648). For major complications, the risk ratio for shaving and disc excision vs segmental resection is 0.31 (95% CI 0.21-0.46), while the risk difference is -0.25 (95% CI -0.41 to 0.10). For minor complications, the risk ratio is 0.63 (95% CI 0.36-1.09), while the risk difference is -0.03 (95% CI -0.12 to 0.05). CONCLUSIONS Conservative shaving or discoid excision surgery is associated with reduced complications. Previous studies demonstrated a trend toward this finding, but suffered from relatively low participant numbers, increasing the risk of type one statistical error. Our results allow surgeons to make informed choices about potential complications when deciding how to approach bowel endometriosis. The results also allow patients to have more information about the risks. However, outcomes in the studies analysed are heterogenous and are from low-quality evidence.
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Affiliation(s)
- Sean Heinz-Partington
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Walter Costa
- Reproductive Medicine, Ginecologia, Goiânia, Brazil
| | | | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, University of Sydney, Sydney, New South Wales, Australia
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Roman H, Marabha J, Polexa A, Prosszer M, Huet E, Hennetier C, Tuech JJ, Marpeau L. Crude complication rate is not an accurate marker of a surgeon's skill: A single surgeon retrospective series of 1060 procedures for colorectal endometriosis. J Visc Surg 2021; 158:289-298. [PMID: 33451966 DOI: 10.1016/j.jviscsurg.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the relationship between the rate of postoperative bowel fistula and surgeon experience. DESIGN Retrospective study. SETTING Two referral centers. PATIENTS 1060 women managed for colorectal deep endometriosis by one gynecologist surgeon from January 2005 to March 2020. INTERVENTIONS Shaving, disc excision and segmental colorectal resection. MAIN OUTCOME MEASURES Rate of bowel fistula stratified according to 4 time periods: P1 from 2005 to 2009, P2 from 2010 to 2014, P3 from 2015 to June 2018 and P4 from September 2018 to March 2020. RESULTS 68 patients (6.4%) were managed during P1, 299 patients (28.2%) during P2, 422 patients (39.8%) during P3 and 271 patients (25.6%) during P4. Both diameter of rectal infiltration and rate of complex surgical procedures progressively increased from P1 to P4. Bowel fistula rate was comparable between all 4 time periods, respectively 2.9, 3.3, 4 and 4.4%. Logistic regression model revealed that risk of fistula decreased when shaving was performed when compared to segmental resection (adj OR 0.1, 95% CI 0-0.5) and increased when deep endometriosis nodules also involved sacral roots (adjOR 4.9, 95%CI 1.8-13.3) and infiltration of the vagina (adj OR 3, 95%CI 1.3-7). No statistically significant relationship was found between surgery time period and risk of fistula. CONCLUSION Crude rates of bowel fistula following surgical management of deep endometriosis infiltrating the colon and the rectum are not an accurate marker of surgeon expertise and should be considered in conjunction with expected higher risks related to challenging procedures performed by experienced surgeons.
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Affiliation(s)
- H Roman
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France; Department of gynaecology and obstetrics, university hospital Aarhus, Aarhus, Denmark.
| | - J Marabha
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France
| | - A Polexa
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France
| | - M Prosszer
- Endometriosis centre, clinique Tivoli-Ducos, Bordeaux, France
| | - E Huet
- Department of surgery, Rouen university hospital, Rouen, France
| | - C Hennetier
- Expert center in the diagnosis and multidisciplinary management of endometriosis, Rouen university hospital, Rouen, France
| | - J-J Tuech
- Department of surgery, Rouen university hospital, Rouen, France
| | - L Marpeau
- Expert center in the diagnosis and multidisciplinary management of endometriosis, Rouen university hospital, Rouen, France
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10
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Chamié LP, Ribeiro DMFR, Ribeiro GMPAR, Serafini PC. Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis. Abdom Radiol (NY) 2020; 45:1847-1865. [PMID: 32030450 DOI: 10.1007/s00261-020-02434-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Deeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residual disease, complications, and recurrence.
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Affiliation(s)
- Luciana P Chamié
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, São Paulo, 04546-004, Brazil.
- Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, São Paulo, Brazil.
| | - Duarte M F R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Gladis M P A R Ribeiro
- Department of Female Reconstructive Surgery, Clínica Doutor Duarte Miguel Ferreira Ribeiro, São Paulo, São Paulo, Brazil
| | - Paulo C Serafini
- Clínica Huntington de Medicina Reprodutiva, São Paulo, São Paulo, Brazil
- Department of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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11
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Burnett TL, Feldman MK, Huang JQ. The role of imaging as a guide to the surgical treatment of endometriosis. Abdom Radiol (NY) 2020; 45:1840-1846. [PMID: 31925491 DOI: 10.1007/s00261-019-02399-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.
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Affiliation(s)
- Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Myra K Feldman
- Imaging Institute, Section of Abdominal Imaging, Cleveland Clinic, 9500 Euclid Ave A-21, Cleveland, OH, USA
| | - Jian Qun Huang
- Department of Obstetrics and Gynecology, New York University, 550 First Avenue, New York, NY, 10016, USA
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12
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The Complementary Role of Ultrasound and Magnetic Resonance Imaging in the Evaluation of Endometriosis: A Review. Ultrasound Q 2020; 36:123-132. [DOI: 10.1097/ruq.0000000000000458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Roman H, Chanavaz-Lacheray I, Forestier D, Magne E, Celhay O, Pasticier G, Susperregui J, Merlot B. [Early postoperative complications in a multidisciplinary surgical center exclusively dedicated to endometriosis: A 491-patients series]. ACTA ACUST UNITED AC 2020; 48:484-490. [PMID: 32173597 DOI: 10.1016/j.gofs.2020.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of our study is to present the activity volume and postoperative complications in a center exclusively destined to endometriosis surgery. METHODS Retrospective mono-centric study analyzing data collected prospectively in patients surgically managed for endometriosis from September 2018 to August 2019. RESULTS Four hundred and ninety-one patients underwent surgery for endometriosis during 12 consecutive months: 268 for colorectal localizations (54.6%), 51 for endometriosis of the urinary tract (10.4%), 17 for nodules of ileum and right colon (3.5%), 43 for nodules of parametriums (8.8%), 12 for nodules of sacral roots and sciatic nerves (2.4%), 7 for diaphragmatic localizations (1.4%). Among 268 patients with colorectal endometrioses, of which 48.1% concerned the low and mid rectum, shaving was performed in 102 cases, disc excision in 96 cases and colorectal resection in 100 cases. Stoma was performed in 13.1% of the cases. Patients could have 2 different procedures for multiple colorectal nodules. One hundred and ninety-nine ovarian endometriomas were managed by plasma energy ablation in 64.8%, sclerotherapy in 11.1%, cystectomy in 13.1%, oophorectomy in 11.1%. Major postoperative complications included 12 rectovaginal fistulas, while 18 other surgical procedures were carried out for various complications. In all, 38.1% of procedures involved a general surgeon and 5.3% an urologist. CONCLUSION The creation of centers exclusively destined to endometriosis surgery allows the multidisciplinary management of a high number of patients, with an over-representation of severe forms and rare locations of the disease, followed by satisfactory complication rates.
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Affiliation(s)
- H Roman
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France; Département de chirurgie gynécologique et neuropelvéologie, Hôpital Universitaire d'Aarhu, Aarhus, Danemark.
| | - I Chanavaz-Lacheray
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
| | - D Forestier
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
| | - E Magne
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
| | - O Celhay
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
| | - G Pasticier
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
| | - J Susperregui
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
| | - B Merlot
- Centre d'endométriose, clinique Tivoli-Ducos, 220, rue Mandron, 33000 Bordeaux, France
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14
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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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15
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Graham A, Chen S, Skancke M, Moawad G, Obias V. A review of deep infiltrative colorectal endometriosis treated robotically at a single institution. Int J Med Robot 2019; 15:e2001. [DOI: 10.1002/rcs.2001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ada Graham
- Department of General Surgery and Colorectal SurgeryGeorge Washington University Hospital Washington District of Columbia
| | - Sheena Chen
- Department of General Surgery and Colorectal SurgeryGeorge Washington University Hospital Washington District of Columbia
| | - Matthew Skancke
- Department of General Surgery and Colorectal SurgeryGeorge Washington University Hospital Washington District of Columbia
| | - Gaby Moawad
- Department of Obstetrics and GynecologyGeorge Washington University Hospital Washington District of Columbia
| | - Vincent Obias
- Department of General Surgery and Colorectal SurgeryGeorge Washington University Hospital Washington District of Columbia
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16
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Adam A, Narayanan M, Hachem C. Endoscopic Appearance and Management of Recto-Sigmoid Endometriosis: Case Report. Gastroenterology Res 2018; 11:326-328. [PMID: 30116434 PMCID: PMC6089590 DOI: 10.14740/gr1049w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023] Open
Abstract
Endometriosis is the presence of endometrial glands outside the uterine cavity. Endometriosis can involve any part of the bowel but most commonly affects the recto-sigmoid part of the bowel. This case shows the endoscopic views of bowel endometriosis and also elaborates on how to approach and manage similar cases of bowel endometriosis. Patients with bowel endometriosis are better managed and treated with a multidisciplinary team including gastroenterologist, gynecologist and colorectal surgeon.
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Affiliation(s)
- Abubakr Adam
- Department of Internal Medicine, SSM Health St. Mary's Hospital, St. Louis, MO, USA
| | - Mechu Narayanan
- Department of Gastroenterology, St. Louis University, St. Louis, MO, USA
| | - Christine Hachem
- Department of Medicine, Division of Gastroenterology, St. Louis University, St. Louis, MO, USA
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17
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[The Rouen Expert center in the diagnosis and multidisciplinary management of endometriosis: A French pilot experiment]. ACTA ACUST UNITED AC 2018; 46:563-569. [PMID: 29937108 DOI: 10.1016/j.gofs.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To retrospectively describe the activity of the Diagnosis and Multidisciplinary Management of Endometriosis Expert Center of Rouen-Normandy, before and after official identification by French Health Authorities. METHODS Retrospective study of the main activities of an Expert Center, from January 2013 to March 2018. RESULTS The Endometriosis Expert Center of Rouen-Normandy is a regional network, organised as a pyramid with a Referral Center at the top (the Rouen University Hospital) leading a network of public and private Expertise Centers below in Normandy. Ten to 11 Multidisciplinary Team meetings per year were organised, allowing the study of 15 to 20 cases by physicians coming from up to 17different places (hospital, clinic or private practice). 2066patients diagnosed with endometriosis were hospitalised in the Referral Center, among them 615were operated for colorectal endometriosis, among which 607by laparoscopy (97%). The surgical team was multidisciplinary in 444surgeries (72.2%). 50cycles of fertility preservation (oocyte freezing) were led. Research activity allowed the publication of 76scientific articles, among which 41 (53.9 %) in a journal of rank SIGAPS A or B. Medical training was organised for active health professionals as well as students, including school nurses. CONCLUSION The Endometriosis Expert Center of Rouen-Normandy pilot project has helped improving the diagnosis and better management of the disease in Normandy. This experiment could be exported to all the other regions of France, in order to unit health professionals with the aim of a national fight program against endometriosis.
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18
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Endometriosis, an unusual case of rectal mass with bloody stool and bowel habit changes. Kaohsiung J Med Sci 2018; 34:65-66. [PMID: 29310818 DOI: 10.1016/j.kjms.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/17/2017] [Accepted: 08/18/2017] [Indexed: 11/23/2022] Open
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19
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Tomiguchi J, Miyamoto H, Ozono K, Gushima R, Shono T, Naoe H, Tanaka M, Baba H, Katabuchi H, Sasaki Y. Preoperative Diagnosis of Intestinal Endometriosis by Magnifying Colonoscopy and Target Biopsy. Case Rep Gastroenterol 2017; 11:494-499. [PMID: 29033768 PMCID: PMC5624264 DOI: 10.1159/000475751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
Endometriosis can affect any portion of the gastrointestinal tract. A preoperative definitive diagnosis of intestinal endometriosis is difficult, because there is no characteristic endoscopic finding and the endoscopic biopsies usually sample insufficient endometrial tissue for pathologic diagnosis. To our knowledge, the magnifying endoscopic features of intestinal mucosal endometriosis have not been well documented. In this study, we report a case of intestinal endometriosis diagnosed preoperatively by magnifying image-enhanced colonoscopy and target biopsy. A 45-year-old woman was referred to our hospital with abdominal pain in the left lower quadrant. Colonoscopy showed a submucosal tumor-like lesion of approximately 30 mm in diameter exhibiting surface reddening and granular changes in the sigmoid colon. Magnifying endoscopy revealed sparsely distributed round pits in the granules. The mucosal biopsy specimen from the granule provided the diagnosis of intestinal endometriosis. Segmental sigmoidectomy was performed, and pathological examination revealed that the surface colonic mucosa was partially replaced by endometrial tissue, which accounted for the granular change detected in the colonoscopy. It can be speculated that the round pit might reflect the endometrial glands surrounded by endometrial stroma. This case illustrated the characteristic finding and utility of magnifying endoscopy for mucosal intestinal endometriosis.
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Affiliation(s)
- Jun Tomiguchi
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Gastroenterology and Hepatology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hideaki Miyamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazutaka Ozono
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashi Shono
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideaki Naoe
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Motohiko Tanaka
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetaka Katabuchi
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yutaka Sasaki
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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20
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Soto E, Catenacci M, Bedient C, Jelovsek JE, Falcone T. Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study. J Minim Invasive Gynecol 2016; 23:753-9. [DOI: 10.1016/j.jmig.2016.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/27/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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21
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Capsule Endoscopy for Ileitis with Potential Involvement of Other Sections of the Small Bowel. Gastroenterol Res Pract 2016; 2016:9804783. [PMID: 26880904 PMCID: PMC4737449 DOI: 10.1155/2016/9804783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/11/2015] [Accepted: 08/23/2015] [Indexed: 02/08/2023] Open
Abstract
Ileitis is defined as inflammation of the ileum. This condition includes ulcers, aphthous ulcers, erosions, and nodular or erythematous mucosa. Various etiologies are associated with ileitis. Crohn's disease, ulcerative colitis, medications such as nonsteroidal anti-inflammatory drugs, infectious conditions, neoplasms, infiltrative disorders, vasculitides, spondyloarthritis, endometriosis, and radiation therapy-related conditions involve the ileum. However, the differential diagnosis of terminal ileitis can be difficult in many cases. Video capsule endoscopy (VCE) has become a useful tool for the diagnosis of a variety of small bowel lesions. This review describes each of the various conditions associated with ileitis and the diagnostic value of VCE for ileitis, which may help identify and evaluate these conditions in clinical practice. Based on the information provided by VCE, a definitive diagnosis could be made using the patients' medical history, clinical course, laboratory and ileocolonoscopic findings, radiologic imaging findings, and histologic findings.
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22
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Martínez-Serrano MJ, Martínez-Román S, Pahisa J, Balasch J, Carmona F. Intestinal surgery performed by gynecologists. Acta Obstet Gynecol Scand 2015; 94:954-9. [DOI: 10.1111/aogs.12698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 06/08/2015] [Indexed: 01/15/2023]
Affiliation(s)
- María José Martínez-Serrano
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Sergio Martínez-Román
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Jaume Pahisa
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Joan Balasch
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Francisco Carmona
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
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23
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Wadhwa V, Slattery E, Garud S, Sethi S, Wang H, Poylin VY, Berzin TM. Endometriosis mimicking colonic stromal tumor. Gastroenterol Rep (Oxf) 2015; 4:257-9. [PMID: 25725039 PMCID: PMC4976676 DOI: 10.1093/gastro/gov008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/05/2015] [Indexed: 11/14/2022] Open
Abstract
Endometriosis is defined as the presence of endometrial glands and stroma at extra-uterine sites; it is a common disease affecting women of reproductive age. Endometrial tissue can implant itself to various organs, including the gastrointestinal tract, and can cause significant gastrointestinal symptoms. These ectopic endometrial tissue implants are usually located in the pelvis but can be present almost anywhere in the body. Endometriosis seems to be the most frequent cause of chronic pelvic pain in women of reproductive age and may cause prolonged suffering and disability that negatively affect health-related quality of life. We report a case in a generally healthy young female patient who presented for evaluation of diarrhea.
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Affiliation(s)
- Vaibhav Wadhwa
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA
| | - Eoin Slattery
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sagar Garud
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Saurabh Sethi
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Helen Wang
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Vitaliy Y Poylin
- Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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24
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Abrao MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21:329-39. [DOI: 10.1093/humupd/dmv003] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/06/2015] [Indexed: 12/15/2022] Open
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25
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Posadzka E, Jach R, Pityński K, Jablonski MJ. Treatment efficacy for pain complaints in women with endometriosis of the lesser pelvis after laparoscopic electroablation vs. CO2 laser ablation. Lasers Med Sci 2015; 30:147-52. [PMID: 25053520 PMCID: PMC4289154 DOI: 10.1007/s10103-014-1630-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/03/2014] [Indexed: 01/02/2023]
Abstract
Endometriosis is a chronic disease affecting mainly women of the reproductive age. Its most common manifestations include impaired fecundity, pelvic pain, and dyschezia. Laparoscopic removal of endometriotic foci remains to be the gold standard for the treatment of endometriosis. More effective techniques of endoscopic approach-among others, laser application-are continually being developed. The aim of the study was to evaluate the efficacy of laparoscopic treatment with the use of CO2 laser ablation vs. electroablation with regard to pain complaints in the affected patients. The study included 48 women (aged 22-42) with varying degrees of endometriosis of the lesser pelvis. The Numeric Rating Scale (NRS) was used to evaluate pain intensity before the surgery in all patients, followed by either laser ablation or electroablation of the endometriotic foci. The results of the laparoscopic treatment were monitored after 3 and 6 months postoperatively. p value of 0.05 was considered to be statistically significant. Patients from both groups reported less intensive pain before/during menstruation (dysmenorrhea) 6 months postoperatively, with more distinct tendency in the electroablation group (p = 0.004) as compared to the laser ablation group (p = 0.025). Despite the initial improvement reported at the 3-month checkup (p = 0.008), 6 months postoperatively, a statistically significant increase in pain intensity was noted in both groups (p = 0.016 and p = 0.032 for CO2 laser ablation and electroablation, respectively). Both surgical methods seem to be effective only in the treatment of endometriosis-related dysmenorrhea, whereas the intensity of other pain complaints (dyspareunia, dysuria, dyschezia, pelvic pain syndrome (PPS)) has remained on the same level.
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Affiliation(s)
- Ewa Posadzka
- Departament of Gynecology and Obstetrics, Jagiellonian University Medical College, 23 Kopernika str, 31-501 Krakow, Poland
| | - Robert Jach
- Departament of Gynecology and Obstetrics, Jagiellonian University Medical College, 23 Kopernika str, 31-501 Krakow, Poland
| | - Kazimierz Pityński
- Departament of Gynecology and Obstetrics, Jagiellonian University Medical College, 23 Kopernika str, 31-501 Krakow, Poland
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26
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, De Wilde RL, Schweppe KW. National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis: Long Version - AWMF Registry No. 015-045. Geburtshilfe Frauenheilkd 2014; 74:1104-1118. [PMID: 26157194 PMCID: PMC4470398 DOI: 10.1055/s-0034-1383187] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In this guideline, recommendations and standards for optimum diagnosis and treatment of endometriosis are presented. They are based on the analysis of the available scientific evidence as published in prospective randomized and retrospective studies as well as in systematic reviews. The guideline working group consisted of experts from Austria, Germany, Switzerland, and the Czech Republic.
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Affiliation(s)
- U. Ulrich
- Department of Obstetrics and Gynecology, Martin Luther Hospital,
Berlin
| | - O. Buchweitz
- Gynecological Outpatient Surgery Altonaer Straße, Hamburg
| | - R. Greb
- Center for Reproductive Medicine, Dortmund
| | - J. Keckstein
- Department of Obstetrics and Gynecology, Provincial Hospital,
Villach
| | - I. von Leffern
- Department of Obstetrics and Gynecology, Albertinen Hospital,
Hamburg
| | - P. Oppelt
- Department of Obstetrics and Gynecology, Provincial Womenʼs and
Childrenʼs Hospital, Linz
| | - S. P. Renner
- Department of Obstetrics and Gynecology, University of Erlangen School
of Medicine
| | - M. Sillem
- Gynecological Practice and Clinic Rosengarten, Mannheim
| | - W. Stummvoll
- Departement of Gynecology, Hospital of the Sisters of Mercy,
Linz
| | - R.-L. De Wilde
- Department of Obstetrics, Gynecology, and Gynecologic Oncology, Pius
Hospital Oldenburg, University of Oldenburg School of Medicine
| | - K.-W. Schweppe
- Endometriosis Center Ammerland, Ammerland Clinic,
Westerstede
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27
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English J, Sajid MS, Lo J, Hudelist G, Baig MK, Miles WA. Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years' experience from a tertiary referral unit. Gastroenterol Rep (Oxf) 2014; 2:288-94. [PMID: 25146341 PMCID: PMC4219148 DOI: 10.1093/gastro/gou055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/18/2014] [Accepted: 07/27/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection (LSARR) depending upon the extent and severity of the disease. OBJECTIVE To report the efficacy of LSARR in terms of pain, quality of life and short- and long-term complications-in particular, those pertaining to bowel function. METHODS The case notes of all patients undergoing LSARR were reviewed. The analysed variables included surgical complications, overall symptomatic improvement rate, dysmenorrhoea, dyspareunia, and dyschezia. Chronic pain was measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre (MSKCC) questionnaire. RESULTS Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study. Sixty-nine (93.2%) women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem. Approximately 42% of women who wished to conceive had at least one baby. The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score. Post-operative complications were recorded in 14.9% of cases. CONCLUSIONS LSARR for rectal endometriosis is associated with a high degree of symptomatic relief. Pain relief achieved following LSARR does not appear to degrade with time. As anticipated, some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction.
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Affiliation(s)
- James English
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria
| | - Muhammad S Sajid
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria
| | - Jenney Lo
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria
| | - Guy Hudelist
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria
| | - Mirza K Baig
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria
| | - William A Miles
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria
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Touboul C, Ballester M, Dubernard G, Zilberman S, Thomin A, Daraï E. Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery. Surg Endosc 2014; 29:1879-87. [PMID: 25294552 DOI: 10.1007/s00464-014-3880-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/02/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate the long-term symptoms, quality of life (QOL), and fertility after colorectal resection for endometriosis. METHODS Extended analysis of a randomized controlled trial including 52 patients with colorectal endometriosis, comparing laparoscopically assisted to open colorectal resection. All included patients were invited to complete questionnaires evaluating the presence and intensity of symptoms and QOL using the SF-36 and fertility at a mean (SD) follow-up of 50.7 (13.8) months. We compared symptoms intensity and QOL before and after surgery at short- (mean follow-up of 19 months) and long-term (mean follow-up of 51 months). RESULTS Persistent improvement in QOL was noted after surgery without differences between short and long term. Self-catheterization >6 months was the sole factor decreasing the long-term QOL (P = 0.02). No difference in symptoms and QOL was noted according to the route. Among the 28 patients (53.8%) wishing to conceive, 12 (42.9%) conceived within a mean (SD) time of 17 (13) months. No difference in fertility including pregnancy after IVF was noted between the routes, but spontaneous pregnancy occurred only after laparoscopy (P = 0.016). CONCLUSIONS Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.
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Affiliation(s)
- Cyril Touboul
- Department of Obstetrics and Gynecology, GRC-UPMC 6 (Centre Expert En Endometriose (C3E)), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris VI, Paris, France,
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Akladios C, Messori P, Faller E, Puga M, Afors K, Leroy J, Wattiez A. Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? J Minim Invasive Gynecol 2014; 22:103-9. [PMID: 25109779 DOI: 10.1016/j.jmig.2014.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/31/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To verify the hypothesis that in most patients bowel segmental resection to treat endometriosis can be safely performed without creation of a stoma and to discuss the limitations of this statement. DESIGN Retrospective study (Canadian Task Force classification III). SETTING Tertiary referral center. PATIENTS Forty-one women with sigmoid and rectal endometriotic lesions who underwent segmental resection. INTERVENTION Segmental resection procedures performed between 2004 and 2011. Patient demographic, operative, and postoperative data were compared. MEASUREMENTS AND MAIN RESULTS Sigmoid resection was performed in 6 patients (15%), and rectal anterior resection in 35 patients (high in 21 patients [51%], and low, i.e., <10 cm from the anal verge, in 14 [34%]). In 4 patients a temporary ileostomy was created. There was 1 anastomotic leak (2.4%), in a patient with an unprotected anastomosis, which was treated via laparoscopic surgery and creation of a temporary ileostomy. Other postoperative complications included hemoperitoneum, pelvic abscess, pelvic collection, and a ureteral vaginal fistula, in 1 patient each (all 2.4%). CONCLUSION A protective stoma may be averted in low anastomosis if it is >5 cm from the anal verge and there are no adverse intraoperative events.
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Affiliation(s)
- Cherif Akladios
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France.
| | - Pietro Messori
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Emilie Faller
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Marco Puga
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Karolina Afors
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Joel Leroy
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
| | - Arnaud Wattiez
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France; IRCAD, Strasbourg, France
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30
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Afors K, Murtada R, Centini G, Fernandes R, Meza C, Castellano J, Wattiez A. Employing Laparoscopic Surgery for Endometriosis. WOMENS HEALTH 2014; 10:431-43. [DOI: 10.2217/whe.14.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endometriosis is a chronic, multifactorial disease, which can impact significantly on a women's quality of life. It is associated with pelvic pain, dyspareunia and intestinal disorders, and can lead to infertility. The use of laparoscopic surgery in the management of endometriosis is well documented; however, the optimal management of women with deep infiltrating disease remains controversial. This review describes the different surgical strategies for the treatment of endometriosis.
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Affiliation(s)
- Karolina Afors
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Rouba Murtada
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Gabriele Centini
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Rodrigo Fernandes
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Carolina Meza
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Jesus Castellano
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Arnaud Wattiez
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
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31
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[Urinary functional disorders bound to deep endometriosis and to its treatment: review of the literature]. ACTA ACUST UNITED AC 2014; 43:431-42. [PMID: 24831568 DOI: 10.1016/j.jgyn.2014.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022]
Abstract
Lower urinary tract disorders in case of deep endometriosis are common (up to 50% of patients), although often masked by pelvic pain. They result from damage to the pelvic autonomic nervous system by direct infiltration of these structures by endometriotic lesions or surgical trauma (especially in resection of the uterosacral ligaments, rectum or vagina). These are mainly sensory disturbances and bladder voiding dysfunction. They impact quality of life and could be responsible for long-term complications (recurrent urinary tract infections on a persistent residual urine or pelvic floor disorders due to chronic thrusting). It is therefore important to diagnose and treat early these troubles by well-conducted interviews or standardized questionnaires. Different drug treatments have been proposed, such as cholinergics or prokinetics, but their effectiveness has not been demonstrated yet. Neuromodulation of the superior hypogastric plexus for treatment of refractory atonic bladder with persistent urinary retention after surgery seems promising but should be confirmed by further studies. To date, standard treatment of urinary retention after surgery remains self-catheterization. In terms of prevention, surgical nerve sparing techniques have been developed in order to minimize intraoperative injury of pelvic nerve plexus and reduce postoperative morbidity.
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32
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Belghiti J, Ballester M, Zilberman S, Thomin A, Zacharopoulou C, Bazot M, Thomassin-Naggara I, Daraï E. Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2014; 21:472-9. [DOI: 10.1016/j.jmig.2013.12.094] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
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Moawad NS, Caplin A. Diagnosis, management, and long-term outcomes of rectovaginal endometriosis. Int J Womens Health 2013; 5:753-63. [PMID: 24232977 PMCID: PMC3825702 DOI: 10.2147/ijwh.s37846] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rectovaginal endometriosis is the most severe form of endometriosis. Clinically, it presents with a number of symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding. The gold standard for diagnosis is laparoscopy with histological confirmation; however, there are a number of options for presurgical diagnosis, including clinical examination, transvaginal/transrectal ultrasound, magnetic resonance imagining, colonoscopy, and computed tomography colonography. Treatment can be medical or surgical. Medical therapies include birth control pills, oral progestins, gonadotropin-releasing hormone agonists, danazol, and injectable progestins. Analgesics are often used as well. Surgery improves up to 70% of symptoms. Surgery is either ablative or excisional, and is conducted via transvaginal, laparoscopic, laparotomy, or combined approaches. Common surgical techniques involve shaving of the superficial rectal lesion, laparoscopic anterior discoid resection, and low anterior bowel resection and reanastomosis. Outcomes are generally favorable, but postoperative complications may include intra-abdominal bleeding, anastomotic leaks, rectovaginal fistulas, strictures, chronic constipation, and the need for reoperation. Recurrence of rectal endometriosis is a possibility as well. Other outcomes are improved pain-related symptoms and fertility. Long-term outcomes vary according to the management strategy used. This review will provide the most recent approaches and techniques for the diagnosis and treatment of rectovaginal endometriosis.
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Affiliation(s)
- Nash S Moawad
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida, FL, USA
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34
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Ulrich U, Buchweitz O, Greb R, Keckstein J, von Leffern I, Oppelt P, Renner SP, Sillem M, Stummvoll W, Schweppe KW. Interdisciplinary S2k Guidelines for the Diagnosis and Treatment of Endometriosis: Short Version - AWMF Registry No. 015-045, August 2013. Geburtshilfe Frauenheilkd 2013; 73:890-898. [PMID: 24771938 PMCID: PMC3975317 DOI: 10.1055/s-0033-1350810] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- U Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
| | | | - R Greb
- Kinderwunschzentrum Dortmund, Dortmund
| | - J Keckstein
- Abteilung für Gynäkologie und Geburtshilfe, Landeskrankenhaus, Villach
| | - I von Leffern
- Klinik für Gynäkologie und Geburtshilfe, Albertinen-Krankenhaus, Hamburg
| | - P Oppelt
- Abteilung für Gynäkologie und Geburtshilfe, Landesfrauen- und Kinderklinik, Linz
| | - S P Renner
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - M Sillem
- Praxisklinik am Rosengarten, Mannheim
| | - W Stummvoll
- vormals Abteilung für Gynäkologie, Krankenhaus der Barmherzigen Schwestern, Linz
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Colonic obstruction as an unusual presentation of endometrioma: a case report. Surg Laparosc Endosc Percutan Tech 2013; 23:e131-3. [PMID: 23752022 DOI: 10.1097/sle.0b013e318278e87a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis usually occurs in the pelvis but can be found nearly anywhere in the body. Bowel involvement in endometriosis is uncommon and it is estimated to be present in 3.7% to 35% of women with endometriosis. It can rarely result in intestinal obstruction. Here, we present a synchronous localization of endometriosis, ovarian and intestinal, resulting in chronic gastrointestinal symptoms and colonic obstruction in a 33-year-old woman.
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36
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Nezhat C, Hajhosseini B, King LP. Laparoscopic management of bowel endometriosis: predictors of severe disease and recurrence. JSLS 2012; 15:431-8. [PMID: 22643495 PMCID: PMC3340949 DOI: 10.4293/108680811x13176785203752] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study suggests that laparoscopic management of bowel endometriosis can be safe and effective. Two statistically significant predictors of higher stage disease were identified that showed the need for careful surgical planning. Background and Objectives: The identification of high-stage and recurrent cases of bowel endometriosis is critical, because these cases require careful surgical planning. We aim to describe the clinical characteristics of women with bowel endometriosis, our principles in laparoscopic management of this pathology, and to identify predictors of severe disease and recurrence. Methods: This was a retrospective study of 193 patients with pathologically confirmed bowel endometriosis. Results: Predictors of higher-stage endometriosis include a history of previous laparoscopic surgery (P=.04) and a presenting complaint of abnormal uterine bleeding (P=.01). The higher the stage of endometriosis, the more likely there would be coexistent urinary tract endometriosis (P=.02), a need for enterolysis (P=.002), ovarian cystectomy (P<.001), and bowel resection (P=.01) performed during laparoscopy. Patients with higher body mass index (BMI) had significantly higher recurrence rates of endometriosis compared to those with lower BMI (P=.002). Within our cohort, 87% of our patients achieved amelioration of symptoms by the end of the first postoperative month. Conclusions: Our study confirms that laparoscopic management of bowel endometriosis is safe and effective. We found 2 statistically significant predictors of higher-stage disease that should prompt careful surgical planning. Obesity is associated with a higher rate of recurrence of endometriosis.
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Affiliation(s)
- Camran Nezhat
- Department of Obstetrics and Gynecology, Stanford University Medical Center, Palo Alto, CA, USA.
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Adán Merino L, Aldeguer Martínez M, Argüello de Andrés JM, Rivera García T, Plaza Santos R, Lozano Maya M, Donat Garrido M, Ortiz Johannsson C, Seoane González B. [Isolated polypoid endometriosis of the colon mimicking a sigmoid tumor]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35:727-9. [PMID: 22809519 DOI: 10.1016/j.gastrohep.2012.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
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Ceccaroni M, Clarizia R, Bruni F, D'Urso E, Gagliardi ML, Roviglione G, Minelli L, Ruffo G. Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. Surg Endosc 2012; 26:2029-45. [PMID: 22278102 DOI: 10.1007/s00464-012-2153-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 12/20/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The weight of surgical radicality, together with a lack of anatomical theoretical basis for surgery and inappropriate practical skills, can lead to serious impairments to bladder, rectal, and sexual functions after laparoscopic excision of deep infiltrating endometriosis. Although the "classical" laparoscopic technique for endometriosis excision involving segmental bowel resection has proven to relieve symptoms successfully, it is hampered by several postoperative long-term and/or definitive pelvic dysfunctions. METHODS In this prospective cohort study, we compare the laparoscopic nerve-sparing approach to the classical laparoscopic procedure in a series of 126 cases. Satisfactory data for bowel, bladder, and sexual function were considered as primary endpoints. RESULTS A total of 126 patients were considered for analysis: 61 treated with nerve-sparing radical excision of pelvic endometriosis with segmental bowel resection (group B), and 65 treated with the classical technique (group A). Intraoperative, perioperative, and postoperative complications were similar between the two groups. Mean days of self-catheterization were significantly lower in the nerve-sparing group (39.8 days) compared with the non-nerve-sparing group (121.1 days; p < 0.001). The relapse rate within 12 months after surgery was comparable between the two groups. Patients of group A suffered from urinary retention more frequently between 1 and 6 months (p = 0.035) compared with group B and did not experience any improvement between 6 months and 1 year (p = 0.018). Overall detection of severe bladder/rectal/sexual dysfunctions was significantly different between the two groups, and 56 patients of group A (86.2%) reported a significantly higher rate of severe neurologic pelvic dysfunctions vs. 1 patient (1.6%) of group B (p < 0.001). CONCLUSIONS Our technique appears to be feasible and offers good results in terms of reduced bladder morbidity and apparently higher satisfaction than the classical technique. Considering that this kind of surgery requires uncommon surgical skills and anatomical knowledge, we believe that it should be performed only in selected reference centers.
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Affiliation(s)
- Marcello Ceccaroni
- Division of Gynecologic Oncology, International School of Surgical Anatomy, Sacred Heart Hospital, Ospedale Sacro Cuore-Don Calabria, Via Don A.Sempreboni no. 5, 37024 Negrar, VR, Italy.
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Ercoli A, D'asta M, Fagotti A, Fanfani F, Romano F, Baldazzi G, Salerno MG, Scambia G. Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results. Hum Reprod 2012; 27:722-6. [PMID: 22238113 DOI: 10.1093/humrep/der444] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Deep infiltrating endometriosis (DIE) is a complex disease that impairs the quality of life and the fertility of women. Since a medical approach is often insufficient, a minimally invasive approach is considered the gold standard for complete disease excision. Robotic-assisted surgery is a revolutionary approach, with several advantages compared with traditional laparoscopic surgery. METHODS From March 2010 to May 2011, we performed 22 consecutive robotic-assisted complete laparoscopic excisions of DIE endometriosis with colorectal involvement. All clinical data were collected by our team and all patients were interviewed preoperatively and 3 and 6 months post-operatively and yearly thereafter regarding endometriosis-related symptoms. Dysmenorrhoea, dyschezia, dyspareunia and dysuria were evaluated with a 10-point analog rating scale. RESULTS There were 12 patients, with a median larger endometriotic nodule of 35 mm, who underwent segmental resection, and 10 patients, with a median larger endometriotic nodule of 30 mm, who underwent complete nodule debulking by colorectal wall-shaving technique. No laparotomic conversions were performed, nor was any blood transfusion necessary. No intra-operative complications were observed and, in particular, there were no inadvertent rectal perforations in any of the cases treated by the shaving technique. None of the patients had ileostomy or colostomy. No major post-operative complications were observed, except one small bowel occlusion 14 days post-surgery that was resolved in 3 days with medical treatment. Post-operatively, a statistically significant improvement of patient symptoms was shown for all the investigated parameters. CONCLUSIONS To our knowledge, this is the first study reporting the feasibility and short-term results and complications of laparoscopic robotic-assisted treatment of DIE with colorectal involvement. We demonstrate that this approach is feasible and safe, without conversion to laparotomy.
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Affiliation(s)
- A Ercoli
- Department of Gynecology, Policlinico Abano Terme, Piazza Cristoforo Colombo, 1- 35031 Abano Terme (PD), Italy.
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Crispi CP, de Souza CAP, Oliveira MAP, Dibi RP, Cardeman L, Sato H, Schor E. Endometriosis of the Round Ligament of the Uterus. J Minim Invasive Gynecol 2012; 19:46-51. [DOI: 10.1016/j.jmig.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/02/2011] [Accepted: 09/08/2011] [Indexed: 10/15/2022]
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Abstract
PURPOSE OF REVIEW Rectal endometriosis is a very indolent disease whose treatment has been debated by a range of competing schools. Meanwhile, not all audiences in the scientific community are entirely familiar with the full aspects of the disease. Hence, the purpose of this review is to outline the basic as well as the recent literature pertaining to the disease, thus offering a broader view to the interested reader. RECENT FINDINGS Laparoscopic shaving or disc excision for rectal endometriotic nodules may be simple, safe options of controlling the disease. On the contrary, laparoscopic rectal resections, originally reserved for more extensive disease, are now more skillfully mastered by surgeons and gynecologists. Meta-analyses, retrospective, and prospective studies are being published frequently supporting one form of therapy at a time and discrediting another at other times. SUMMARY Laparoscopic shaving or disc excisions for rectal endometriotic foci or rectal resections are feasible and efficient methods for treating rectal endometriosis. More complex surgery to the bowel means more risk for complications. With the rising learning curve of the operators, laparoscopic rectal resections have become a safe option that should be offered to patients. The patient's preference to a particular treatment option should be central to the type of surgery to be elected.
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Meuleman C, D'Hoore A, Van Cleynenbreugel B, D'Hooghe T. Incorrect presentation of our article in an opinion paper. J Minim Invasive Gynecol 2011; 18:410-1. [PMID: 21545974 DOI: 10.1016/j.jmig.2011.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 03/01/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
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Meuleman C, D'Hoore A, Van Cleynenbreugel B, Tomassetti C, D'Hooghe T. Why we need international agreement on terms and definitions to assess clinical outcome after endometriosis surgery. Hum Reprod 2011; 26:1598-9; author reply 1599-600. [PMID: 21478183 DOI: 10.1093/humrep/der098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Payá V, Hidalgo-Mora JJ, Diaz-Garcia C, Pellicer A. Surgical treatment of rectovaginal endometriosis with rectal involvement. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-011-0663-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Meuleman C, Tomassetti C, D'Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D'Hooghe T. Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 2011; 17:311-26. [DOI: 10.1093/humupd/dmq057] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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The feasibility of laparoscopic bowel resection performed by a gynaecologist to treat endometriosis. Curr Opin Obstet Gynecol 2010; 22:344-53. [PMID: 20611000 DOI: 10.1097/gco.0b013e32833beae0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Intestinal endometriosis is commonly diagnosed in the setting of deeply infiltrating endometriosis. A multidisciplinary team that includes gynaecologists and general surgeons traditionally performs laparoscopic bowel resections for symptomatic patients. Recently, Pereira et al. has published the results of a series of patients who underwent laparoscopic bowel resection for endometriosis performed by a team of gynaecologic surgeons, after a period of experimental training with animals and joining participation with general surgeons in the first cases. It is suggested that gynaecologic surgeons may be able to perform laparoscopic bowel resections for endometriosis, if properly trained, although the results may not be reproducible. RECENT FINDINGS A review of recent literature related to laparoscopic bowel resections for endometriosis showed that the learning curve and experience of the surgeon may be the most important predictive factors for the effectiveness of the procedure. Results concerning major operative complications and clinical remission were considered satisfactory in both single and multidisciplinary approaches, that is, laparoscopic bowel resections performed by gynaecologic and colorectal surgeons. Protective colostomies or ileostomies could not reduce the rate of rectovaginal fistulae in multidisciplinary experiences. SUMMARY The single-surgeon model approach in laparoscopic excision of endometriosis that includes bowel resection may provide advantages for both the patients and healthcare system. The best model should be decided on the maximum benefit of the patient.
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De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: a systematic review. BJOG 2010; 118:285-91. [PMID: 21040395 DOI: 10.1111/j.1471-0528.2010.02744.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND deep endometriosis involving the bowel often is treated by segmental bowel resection. In a recent review of over 10000 segmental bowel resections for indications other than endometriosis, low rectum resections, in particular, were associated with a high long-term complication rate for bladder, bowel and sexual function. OBJECTIVES to review systematically segmental bowel resections for endometriosis for indications, outcome and complications according to the level of resection and the volume of the nodule. SEARCH STRATEGY all published articles on segmental bowel resection for endometriosis identified through MEDLINE, EMBASE and ISI Web of Knowledge databases during 1997-2009. SELECTION CRITERIA the terms 'bowel', 'rectal', 'colorectal', 'rectovaginal', 'rectosigmoid', 'resection' and 'endometriosis' were used. Articles describing more than five bowel resections for endometriosis, and with details of at least three of the relevant endpoints. DATA COLLECTION AND ANALYSIS data did not permit a meaningful meta-analysis. MAIN RESULTS thirty-four articles were found describing 1889 bowel resections. The level of bowel resection and the size of the lesions were poorly reported. The indications to perform a bowel resection were variable and were rarely described accurately. The duration of surgery varied widely and endometriosis was not always confirmed by pathology. Although not recorded prospectively, pain relief was systematically reported as excellent for the first year after surgery. Recurrence of pain was reported in 45 of 189 women; recurrence requiring reintervention occurred in 61 of 314 women. Recurrence of endometriosis was reported in 37 of 267 women. The complication rate was comparable with that of bowel resection for indications other than endometriosis. Data on sexual function were not found. CONCLUSIONS after a systematic review, it was found that the indication to perform a segmental resection was poorly documented and the data did not permit an analysis of indication and outcome according to localisation or diameter of the endometriotic nodule. Segmental resections were rectum resections in over 90%, and the postoperative complication rate was comparable with that of resections for indications other than endometriosis. No data were found evaluating sexual dysfunction.
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Affiliation(s)
- C De Cicco
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:354-9. [PMID: 20611001 DOI: 10.1097/gco.0b013e32833d582e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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