1
|
Ottolina J, Villanacci R, D’Alessandro S, He X, Grisafi G, Ferrari SM, Candiani M. Endometriosis and Adenomyosis: Modern Concepts of Their Clinical Outcomes, Treatment, and Management. J Clin Med 2024; 13:3996. [PMID: 39064036 PMCID: PMC11277467 DOI: 10.3390/jcm13143996] [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: 04/10/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Endometriosis and adenomyosis are complex gynecological conditions characterized by diverse clinical presentations, including superficial peritoneal endometriosis (SPE), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). The hallmark features of these pathologies involve the manifestation of pain symptoms and infertility, and approximately 30% of patients are asymptomatic. Despite ongoing research, definitive treatments for these conditions remain elusive, and clinical management primarily revolves around medical or surgical interventions. Recent advancements in our understanding of the efficacy of various treatment modalities, including medical therapy and surgical interventions, have provided clinicians with valuable insights into pain relief and fertility preservation. This review aims to provide an updated overview of the latest literature on clinical outcomes, treatment options, and management strategies for different types of endometriosis. By synthesizing the newest available data, this review seeks to inform clinicians and guide decision making based on factors such as patients' symptom severity, childbearing desire, and overall health.
Collapse
Affiliation(s)
- Jessica Ottolina
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Roberta Villanacci
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Sara D’Alessandro
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Xuemin He
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of “Aldo Moro”, 70124 Bari, Italy;
| | - Giorgia Grisafi
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Stefano Maria Ferrari
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| | - Massimo Candiani
- IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; (R.V.); (S.D.); (G.G.); (S.M.F.); (M.C.)
| |
Collapse
|
2
|
Shirafkan H, Moher D, Mirabi P. The reporting quality and spin of randomized controlled trials of endometriosis pain: Methodological study based on CONSORT extension on abstracts. PLoS One 2024; 19:e0302108. [PMID: 38696383 PMCID: PMC11065215 DOI: 10.1371/journal.pone.0302108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE To assess the reporting quality of published RCT abstracts regarding patients with endometriosis pelvic pain and investigate the prevalence and characteristics of spin in these abstracts. METHODS PubMed and Scopus were searched for RCT abstracts addressing endometriosis pelvic pain published from January 1st, 2010 to December 1st, 2023.The reporting quality of RCT abstracts was assessed using the CONSORT statement for abstracts. Additionally, spin was evaluated in the results and conclusions section of the abstracts, defined as the misleading reporting of study findings to emphasize the perceived benefits of an intervention or to confound readers from statistically non-significant results. Assessing factors affecting the reporting quality and spin existence, linear and logistic regression was used, respectively. RESULTS A total of 47 RCT abstracts were included. Out of 16 checklist items, only three items including objective, intervention and conclusions were sufficiently reported in the most abstracts (more than 95%), and none of the abstracts presented precise data as required by the CONSORT-A guidelines. In the reporting quality of material and method section, trial design, type of randomization, the generation of random allocation sequences, the allocation concealment and blinding were most items identified that were suboptimal. The total score for the quality varied between 5 and 15 (mean: 9.59, SD: 3.03, median: 9, IQR: 5). Word count (beta = 0.015, p-value = 0.005) and publishing in open-accessed journals (beta = 2.023, p-value = 0.023) were the significant factors that affecting the reporting quality. Evaluating spin within each included paper, we found that 18 (51.43%) papers had statistically non-significant results. From these studies, 12 (66.66%) had spin in both results and conclusion sections. Furthermore, the spin intensity increased during 2010-2023 and 38.29% of abstracts had spin in both results and conclusion sections. CONCLUSION Overall poor adherence to CONSORT-A was observed, with spin detected in several RCTs featuring non-significant primary endpoints in obstetrics and gynecology literature.
Collapse
Affiliation(s)
- Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - David Moher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Parvaneh Mirabi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
3
|
Van Niekerk L, Pugh S, Mikocka-Walus A, Ng C, O’Hara R, Armour M, Leonardi M, Evans S. An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis. Hum Reprod 2024; 39:992-1002. [PMID: 38563055 PMCID: PMC11063542 DOI: 10.1093/humrep/deae063] [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: 10/16/2023] [Revised: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
STUDY QUESTION What is the relationship between sexual function, health-related quality of life (HRQoL), and laparoscopic surgery in individuals living with endometriosis? SUMMARY ANSWER A higher number of laparoscopic surgeries is significantly associated with poorer HRQoL and greater levels of sexual dysfunction in individuals with endometriosis. WHAT IS KNOWN ALREADY Prior research indicates that endometriosis is associated with lowered HRQoL and sexual function and that these outcomes are influenced by endometriosis-related symptom profiles, medical, and surgical management. A limited number of studies have examined changes in sexual function in individuals with endometriosis following laparoscopic surgery or following repeated surgeries. STUDY DESIGN, SIZE, DURATION A cross-sectional community-based online survey was used to examine the relationships between sexual function, HRQoL, and laparoscopic surgery (n = 210). PARTICIPANTS/MATERIALS, SETTING, METHODS Individuals with a self-reported diagnosis of endometriosis were recruited via online advertising through social media and gynaecology clinics. Endometriosis-specific data (e.g. diagnostic delay, symptom experience) was collected in addition to engagement with laparoscopic surgery, level of HRQoL (EuroQol-5 Dimension: EQ-5D-5L), and sexual function (Female Sexual Function Index: FSFI). Bivariate correlational analyses and hierarchical multiple regression were used to determine the associations between the variables of interest. MAIN RESULTS AND THE ROLE OF CHANCE Individuals with endometriosis have substantially poorer HRQoL in comparison to Australian normative samples, with greater levels of endometriosis-related symptom burden, distress, and pain significantly associated with lower levels of HRQoL. The mean FSFI score was suggestive of clinically significant female sexual dysfunction, with the lowest level of function noted in the domain of sexual pain and the highest level of function noted in the sexual satisfaction domain. A greater number of laparoscopic surgeries was significantly associated with poorer overall HRQoL and greater levels of sexual dysfunction. LIMITATIONS, REASONS FOR CAUTION The cross-sectional nature of the data precludes direct findings of causality and further longitudinal research is recommended. The information pertaining to engagement in laparoscopic surgery was self-report in nature and was not medically verified. WIDER IMPLICATIONS OF THE FINDINGS The study's findings highlight the pervasive impact of endometriosis on all domains of living, emphasizing the need to extend treatment planning beyond that of physical pain management alone. Early referral for assessment and management of sexual wellbeing is recommended prior to, and post-surgical intervention, with a focus on maintaining post-surgical changes, potentially reducing the need for multiple surgeries. STUDY FUNDING, COMPETING INTEREST(S) The study was not associated with research funding. Author CN reports grant funding from the Australian Government and Medical Research Future Fund (MRFF) and was a previous employee of CSL Vifor (formerly Vifor Pharma Pty Ltd). TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Leesa Van Niekerk
- School of Psychological Sciences, College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
| | - Shaunagh Pugh
- School of Psychological Sciences, College of Health & Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Antonina Mikocka-Walus
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Cecilia Ng
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca O’Hara
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, North Adelaide, SA, Australia
| | - Mike Armour
- National Endometriosis Clinical and Scientific Trials (NECST) Network, UNSW, Sydney, Australia
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mathew Leonardi
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, North Adelaide, SA, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Subhadra Evans
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
4
|
Oppenheimer A, Boitrelle F, Nicolas‐Boluda A, Fauconnier A. Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines. Acta Obstet Gynecol Scand 2024; 103:799-823. [PMID: 38226426 PMCID: PMC11019533 DOI: 10.1111/aogs.14768] [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: 07/16/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Sexual function of patients with endometriosis should be assessed by patient-reported outcome measures (PROMs) that present high reliability and validity. The objective was to study the PROMs used to assess sexual function for patients with endometriosis to improve their selection for research and clinical practice. MATERIAL AND METHODS We performed a systematic literature review from January 2000 to September 2023. All studies including women with confirmed endometriosis and assessing sexual quality of life or sexual function or sexual distress were retrieved. Different properties of PROMs used for sexual dysfunction were assessed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Properties evaluated were: structural validity, internal consistency, cross-cultural validity, reliability, measurement error, criterion validity, construct validity, and responsiveness. This literature review was registered on Prospero as 2018 CRD42018102278. RESULTS Seventy-four articles with evaluation of sexual function were included. Of the 25 PROMs assessing sexual function, the Female Sexual Function Index (FSFI) was the most frequently used (34/74 [45.9%] items), followed by the Female Sexual Distress Scale (9/74 [12.2%] items) and the Sexual Activity Questionnaire (SAQ) (8/74 [10.8%] items). The most commonly used measurement properties were "hypothesis testing" and "responsiveness". The PROMs with a high level of evidence for these two measurement properties were the FSFI, the SAQ, the Short Sexual Functioning Scale, the Sexual Satisfaction Scale for Women, Sexual Quality of Life-Female, the Brief Profile of Female Sexual Function, and the Sexual Health Outcomes in Women Questionnaire. The FSFI questionnaire appeared to be more relevant for evaluating medical treatment, and the SAQ for evaluating surgical treatment. Only one instrument was specific to endometriosis (the Subjective Impact of Dyspareunia Inventory [SIDI]). CONCLUSIONS In this systematic literature review of sexual function assessment questionnaires in endometriosis, the FSFI and the SAQ questionnaires emerged as having the best measurement properties according to the COSMIN criteria. The FSFI questionnaire appears to be suited for evaluating medical treatment, and the SAQ for surgical treatment. The SIDI is the only specific questionnaire, but its responsiveness remains to be defined.
Collapse
Affiliation(s)
- Anne Oppenheimer
- EA 7285 Research Unit “Risk and Safety in Clinical Medicine for Women and Perinatal Health”Versailles‐Saint‐Quentin University (UVSQ)Montigny‐le‐BretonneuxFrance
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Department of Reproductive MedicineClinique de La MuetteParisFrance
| | - Florence Boitrelle
- Department of Reproductive Biology, Fertility Preservation, Andrology and CECOSPoissy HospitalPoissyFrance
- Department BREED, UVSQ, INRAEParis Saclay UniversityJouy‐en‐JosasFrance
| | | | - Arnaud Fauconnier
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Centre Hospitalier Intercommunal de Poissy‐Saint‐Germain‐en‐LayeDepartment of Gynecology and ObstetricsPoissyFrance
| |
Collapse
|
5
|
Abbott J, Billow M, Gallant T, Hackett L, Kho RM, Knapman B, Russo MAL, Maheux-Lacroix S, Gonzalez AM, Ng C, Orlando MS, Sit A, Xu X. Patient-Reported Outcome Measures Used in Randomized Controlled Trials Following Surgical Intervention for Endometriosis: A Structured Review from the AAGL Practice Guidelines Group. J Minim Invasive Gynecol 2024; 31:71-83.e17. [PMID: 37931893 DOI: 10.1016/j.jmig.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE No consensus currently exists regarding patient-reported outcome measure (PROM) instruments. This structured review was conducted to identify the PROMs used by randomized controlled trials (RCTs) that evaluated surgical treatment in patients with endometriosis. DATA SOURCES Two parallel searches were conducted by a medical librarian using Ovid MEDLINE, Ovid Embase, and Cochrane Library for RCTs published from 2000 to July 2022. One search focused on studies reporting quality of life (QoL), and the second search focused on studies reporting pain and sexual, bowel, and bladder function. METHOD OF STUDY SELECTION During the title and abstract screening and reference check, 600 results were identified on PROMs relating to QoL and 465 studies on PROMs relating to pain and sexual, bowel, and/or bladder function and an evaluation of 17 and 12 studies conducted, respectively. The inclusion criteria involved selecting RCTs that focused on surgical intervention and assessing QoL, pain, and sexual, bowel, and/or bladder function using PROMs. TABULATION, INTEGRATION, AND RESULTS Covidence software was used to organize and identify duplicate articles through screening. We developed a data extraction form to collect key information about each included study, as well as the pertinent PROMs used in the study. Assessment of the risk of bias of each study was also performed. A total of 19 studies were identified involving 2089 participants and a total of 16 PROMs used across the studies; 9 of 19 studies (47%) were rated as having a low risk of bias. There were no high-risk studies identified in this review. CONCLUSION This study identified a large number of RCTs in surgical treatment of endometriosis that used various PROMs to assess QoL, pain, and bladder, bowel, and sexual function. The PROMs used by high-quality RCTs for QoL include Endometriosis Health Profile-30, Endometriosis Health Profile-5, Short-Form 36, Short-Form 12, and EQ-5D; for bowel-related symptoms Knowles-Eccersley-Scott-Symptom Questionnaire, Gastrointestinal Quality of Life Index, and Cleveland Clinic Fecal Incontinence Severity Scoring System/Wexner; for bladder-related function Bristol Female Lower Urinary Tract Symptoms, International Prostate Symptom Score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and Urinary Symptom Profile; and finally for sexual function Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire and Sexual Activity Questionnaire. Unlike other domains, only one tool (visual analog scale) was the dominant PROM used for the assessment of pain. In addition, the use of more than one PROM in each study to assess different aspects of patient's health and pain symptoms did not become prevalent until after 2015.
Collapse
Affiliation(s)
- Jason Abbott
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Megan Billow
- Women's Health Institute (Drs. Billow, Gallant, and Luna Russo)
| | - Thomas Gallant
- Women's Health Institute (Drs. Billow, Gallant, and Luna Russo)
| | - Loren Hackett
- Cleveland Clinic Foundation, Cleveland, OH (Dr. Hackett); AAGL Practice Guidelines Committee, in-house team (Drs. Hackett, Kho, and Xu)
| | - Rosanne M Kho
- Department of Obstetrics and Gynecology, University of Arizona Phoenix/Banner University Medical Center Phoenix, Phoenix, AZ (Dr. Kho); AAGL Practice Guidelines Committee, in-house team (Drs. Hackett, Kho, and Xu)..
| | - Blake Knapman
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | | | | | - Adriana Meneses Gonzalez
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Cecilia Ng
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Megan S Orlando
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO (Dr. Orlando)
| | - Andrea Sit
- Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Xiao Xu
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT (Dr. Xu); AAGL Practice Guidelines Committee, in-house team (Drs. Hackett, Kho, and Xu)
| |
Collapse
|
6
|
Adler H, Lewis M, Ng CHM, Brooks C, Leonardi M, Mikocka-Walus A, Bush D, Semprini A, Wilkinson-Tomey J, Condous G, Patravali N, Abbott J, Armour M. Social Media, Endometriosis, and Evidence-Based Information: An Analysis of Instagram Content. Healthcare (Basel) 2024; 12:121. [PMID: 38201027 PMCID: PMC10778603 DOI: 10.3390/healthcare12010121] [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: 11/01/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Social media platforms are used for support and as resources by people from the endometriosis community who are seeking advice about diagnosis, education, and disease management. However, little is known about the scientific accuracy of information circulated on Instagram about the disease. To fill this gap, this study analysed the evidence-based nature of content on Instagram about endometriosis. A total of 515 Instagram posts published between February 2022 and April 2022 were gathered and analysed using a content analysis method, resulting in sixteen main content categories, including "educational", which comprised eleven subcategories. Claims within educational posts were further analysed for their evidence-based accuracy, guided by a process which included fact-checking all claims against the current scientific evidence and research. Of the eleven educational subcategories, only four categories (cure, scientific article, symptoms, and fertility) comprised claims that were at least 50% or greater evidence-based. More commonly, claims comprised varying degrees of evidence-based, mixed, and non-evidence-based information, and some categories, such as surgery, were dominated by non-evidence-based information about the disease. This is concerning as social media can impact real-life decision-making and management for individuals with endometriosis. Therefore, this study suggests that health communicators, clinicians, scientists, educators, and community groups trying to engage with the endometriosis online community need to be aware of social media discourses about endometriosis, while also ensuring that accurate and translatable information is provided.
Collapse
Affiliation(s)
- Hannah Adler
- Centre for Social and Cultural Research, Griffith University, Gold Coast, QLD 4215, Australia;
| | - Monique Lewis
- Centre for Social and Cultural Research, Griffith University, Gold Coast, QLD 4215, Australia;
| | - Cecilia Hoi Man Ng
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (C.H.M.N.); (J.A.)
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, NSW 2031, Australia
- National Endometriosis Clinical and Scientific Trials (NECST) Network, University of New South Wales, Sydney, NSW 2052, Australia
| | - Cristy Brooks
- School of Health Sciences, Western Sydney University, Sydney, NSW 2751, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2751, Australia;
| | - Mathew Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8S 4LB, Canada
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5006, Australia
| | | | - Deborah Bush
- World Endometriosis Organisations (WEO), Christchurch 8013, New Zealand
| | - Alex Semprini
- Medical Research Institute of New Zealand, Wellington 6021, New Zealand
- School of Biological Sciences, Victoria University of Wellington, Wellington 6021, New Zealand
- NICM Health Research Institute, Western Sydney University, Sydney, NSW 2145, Australia
| | | | - George Condous
- Endometriosis Ultrasound and Advanced Endosurgery Unit, Sydney Medical School Nepean, Sydney, NSW 2747, Australia
- Nepean Hospital, University of Sydney, Sydney, NSW 2747, Australia
| | - Nikhil Patravali
- Nepean Hospital, University of Sydney, Sydney, NSW 2747, Australia
- School of Medicine, University of Sydney, Sydney, NSW 2747, Australia
- Monash IVF, Sydney, NSW 2747, Australia
- Mildura Private Hospital, Mildura, VIC 3500, Australia
| | - Jason Abbott
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (C.H.M.N.); (J.A.)
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, NSW 2031, Australia
- National Endometriosis Clinical and Scientific Trials (NECST) Network, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mike Armour
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2751, Australia;
- NICM Health Research Institute, Western Sydney University, Sydney, NSW 2145, Australia
| |
Collapse
|
7
|
Bortoletto P, Romanski PA, Petrozza JC, Pfeifer SM. Reproductive surgery: revisiting its origins and role in the modern management of fertility. Fertil Steril 2023; 120:539-550. [PMID: 36870592 DOI: 10.1016/j.fertnstert.2023.02.031] [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: 12/11/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
For years, reproductive surgery was the mainstay of reproductive care. With the evolution and ultimate success of in vitro fertilization (IVF), reproductive surgery became an adjuvant therapy, indicated mainly for severe symptoms or to enhance success rates with assisted reproductive technologies. As success rates for IVF have plateaued, and emerging data rekindles the enormous benefits of surgically correcting reproductive pathologies, there is renewed interest among reproductive surgeons in reviving research and surgical expertise in this area. In addition, new instrumentation and surgical techniques to preserve fertility have gained traction and will solidify the need to have skilled reproductive endocrinology and infertility surgeons in our practice.
Collapse
Affiliation(s)
- Pietro Bortoletto
- Boston IVF, Waltham, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | | | - John C Petrozza
- Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Decision of Reproductive Medicine & IVF, Massachusetts General Hospital, Boston, Massachusetts
| | - Samantha M Pfeifer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, New York
| |
Collapse
|
8
|
Hirsing N, Meyrose AK, Buchweitz O, Nestoriuc Y. Do expectations determine postoperative disability in women with endometriosis? Study protocol for a clinical mixed-methods observational cohort study. BMJ Open 2023; 13:e067497. [PMID: 36599637 PMCID: PMC9815008 DOI: 10.1136/bmjopen-2022-067497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Overall, 20%-30% of women with endometriosis report endometriosis-related disability after successful laparoscopy. This indicates a potential impact of psychological factors, such as expectations, on treatment outcomes. It is already known that expectations determine treatment outcomes in various health conditions, such as cardiologic or gynaecology. Therefore, we investigate the impact of expectations and other psychological factors on patients' course of treatment outcomes after laparoscopy. METHODS AND ANALYSIS A longitudinal mixed-methods study with N=300 women treated at a specialised centre of surgical endoscopy and endometriosis will be conducted with one preoperative and eight postoperative assessments of endometriosis-related disability and a priori specified predictors such as expectations.Additionally, two subsamples (each ~n=30) will be either interviewed about their endometriosis-related disability, expectations, and experiences of laparoscopy before and after surgery or asked once per day for 30 consecutive days using ambulatory assessments. Quantitative data will be analysed using multilevel modelling for longitudinal data. Structural content analysis will be used for qualitative data. DISCUSSION To optimise treatment for women with endometriosis, it is essential to understand how treatment expectations and other psychological and medical factors influence treatment outcomes after laparoscopy. ETHICS AND DISSEMINATION The Ethics Committee of the Psychotherapeutenkammer Hamburg, Germany, gave ethical approval (ROXWELL-2021-HH, 25 June 2021). TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05019612).
Collapse
Affiliation(s)
- Nina Hirsing
- Clinical Psychology, Helmut-Schmidt-University/University of the Armed Forces Hamburg, Hamburg, Germany
| | - Ann-Katrin Meyrose
- Clinical Psychology, Helmut-Schmidt-University/University of the Armed Forces Hamburg, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Buchweitz
- Certified Centre of Surgical Endoscopy and Endometriosis, Frauenklinik an der Elbe, Hamburg, Germany
| | - Yvonne Nestoriuc
- Clinical Psychology, Helmut-Schmidt-University/University of the Armed Forces Hamburg, Hamburg, Germany
- Institute of Sytems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
9
|
Harada T, Taniguchi F, Kitajima M, Kitawaki J, Koga K, Momoeda M, Mori T, Murakami T, Narahara H, Osuga Y, Yamaguchi K. Clinical practice guidelines for endometriosis in Japan (The 3rd edition). J Obstet Gynaecol Res 2022; 48:2993-3044. [PMID: 36164759 PMCID: PMC10087749 DOI: 10.1111/jog.15416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Tasuku Harada
- Department Obstetrics and Gynecology, Tottori University
| | | | | | - Jo Kitawaki
- Department Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
| | - Kaori Koga
- Department Obstetrics and Gynecology, The University of Tokyo
| | - Mikio Momoeda
- Department Obstetrics and Gynecology, Aiiku Hospital
| | - Taisuke Mori
- Department Obstetrics and Gynecology, Kyoto Prefectural University of Medicine
| | - Takashi Murakami
- Department Obstetrics and Gynecology, Shiga University of Medical Science
| | | | - Yutaka Osuga
- Department Obstetrics and Gynecology, The University of Tokyo
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine
| |
Collapse
|
10
|
Efficacy of excision versus ablation for improving endometriosis related pain: A systematic review and meta-analysis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221074850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Surgical treatment of superficial peritoneal endometriosis includes excision or ablation. Controversy exists about which method is better for providing pain relief. We performed a meta-analysis of randomized control trials (RCTs) comparing the efficacy of excision versus ablation for improving the most frequently encountered endometriosis pain symptoms: dysmenorrhea, dyspareunia, non-cyclic pelvic pain, and dyschezia. Methods: A search from inception to May 2020 was conducted in PubMed, MEDLINE, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials, and Web of Science. RCTs comparing excision versus ablation for peritoneal endometriosis were included if they assessed dysmenorrhea, dyspareunia, dyschezia, and pelvic pain/non-menstrual pain. Exclusion criteria included extra-peritoneal endometriosis or endometriomas, and non-English publications. Publications were assessed for risk of bias and quality of evidence using Cochrane risk of bias tool (RoB 2) and GradePro. Results: Of the 2025 records identified initially, four met inclusion criteria. The sample sizes of the included studies ranged from 24 to 133 participants. The excision and ablation groups included 204 participants each. There was no difference after excision or ablation for dysmenorrhea when comparing the mean change in pain scores from baseline to 12 months after surgery (−0.31, 95% CI −1.66, 1.04, p = 0.65), dyspareunia (−0.24, 95% CI −1.78, 1.30, p = 0.76), dyschezia (−0.72, 95% CI −1.94, 0.50, p = 0.25), or non-cyclic pain (−0.78, 95% CI −2.47, 0.91, p = 0.37). Conclusions: We found low to moderate quality evidence suggesting that neither excision nor ablation is superior in reduction of endometriosis-related pain up to 12 months after surgery.
Collapse
|
11
|
Ball E, Karavadra B, Kremer-Yeatman BJ, Mustard C, Lee KM, Bhogal S, Dodds J, Horne AW, Allotey J, Rivas C. Systematic review of patient-specific pre-operative predictors of pain improvement to endometriosis surgery. REPRODUCTION AND FERTILITY 2022; 2:69-80. [PMID: 35128434 PMCID: PMC8812445 DOI: 10.1530/raf-20-0057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Up to 28% of endometriosis patients do not get pain relief from therapeutic laparoscopy but this subgroup is not defined. Objectives To identify any prognostic patient-specific factors (such as but not limited to patients’ type or location of endometriosis, sociodemographics and lifestyle) associated with a clinically meaningful reduction in post-surgical pain response to operative laparoscopic surgery for endometriosis. Search strategy PubMed, Cochrane and Embase databases were searched from inception to 19 May 2020 without language restrictions. Backward and forward citation tracking was used. Selection criteria, data collection and analysis: Cohort studies reporting prognostic factors, along with scores for domains of pain associated with endometriosis before and after surgery, were included. Studies that compared surgeries, or laboratory tests, or outcomes without stratification were excluded. Results were synthesised but variation in study designs and inconsistency of outcome reporting precluded us from doing a meta-analysis. Main results Five studies were included. Quality assessment using the Newcastle–Ottawa scale graded three studies as high, one as moderate and one as having a low risk of bias. Four of five included studies separately reported that a relationship exists between more severe endometriosis and stronger pain relief from laparoscopic surgery. Conclusion Currently, there are few studies of appropriate quality to answer the research question. We recommend future studies report core outcome sets to enable meta-analysis. Lay summary Endometriosis is a painful condition caused by displaced cells from the lining of the womb, causing inflammation and scarring inside the body. It affects 6–10% of women and there is no permanent cure. Medical and laparoscopic surgical treatments are available, but about 28% of patients do not get the hoped-for pain relief after surgery. Currently, there is no way of predicting who gets better and who does not. We systematically searched the world literature to establish who may get better, in order to improve counselling when women choose treatment options. We identified five studies of variable quality showing: More complex disease (in specialist hands) responds better to surgery than less, but more studies needed.
Collapse
Affiliation(s)
- Elizabeth Ball
- Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, London, UK.,Women's Health Research Unit, Queen Mary University of London, London, UK
| | - Babu Karavadra
- Department of Gynecology, Norfolk & Norwich University Hospital, Norwich, UK
| | | | - Connor Mustard
- Barts and the London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Kim May Lee
- Barts and the London Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Sharandeep Bhogal
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Julie Dodds
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, UK
| | - John Allotey
- Institute of Metabolism and Systems Research and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carol Rivas
- UCL Social Research Institute, University College London, London, UK
| |
Collapse
|
12
|
Andres MP, Souza C, Villaescusa M, Vieira M, Abrao MS. The current role of robotic surgery in endometriosis management. Expert Rev Endocrinol Metab 2022; 17:63-73. [PMID: 35073819 DOI: 10.1080/17446651.2022.2031976] [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: 08/30/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Endometriosis is a chronic inflammatory disease that affects approximately 10%-15% of women of childbearing age. Laparoscopic surgery is the preferred surgical approach. Recently, robotic surgery has been used for benign gynecologic surgery, but its role in the treatment of endometriosis is still unknown. AREAS COVERED We included studies that evaluated the outcomes of robotic surgery for endometriosis. Using the keywords 'endometriosis' and 'robotics', a comprehensive literature search on PubMed, Embase, and the Cochrane Library was performed in July 2021. EXPERT OPINION Robotic surgery for endometriosis has similar outcomes as conventional laparoscopy, with no evidence of increased complication rates. Despite the non-inferiority of the surgical route, the associated costs of robotic surgery limit its availability. Rapid development of robot-assisted surgery necessitates long-term prospective randomized controlled trials. However, the limitations of robotic surgery should not be overlooked. If robotic surgery can facilitate the spread of minimally invasive surgery, it will be necessary to evaluate the cost, availability, complexity of the lesions, and most importantly, the results of patient satisfaction and values of value-based medicine.
Collapse
Affiliation(s)
- Marina Paula Andres
- Departamento de Obstetricia E Ginecologia, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Carolina Souza
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Marina Villaescusa
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Marcelo Vieira
- Gynecologic Oncology, Barretos Cancer Hospital/Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Mauricio S Abrao
- Departamento de Obstetricia E Ginecologia, Hospital Das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Division of Gynecologic, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| |
Collapse
|
13
|
Gratton SM, Choudhry AJ, Vilos GA, Vilos A, Baier K, Holubeshen S, Medor MC, Mercier S, Nguyen V, Chen I. Diagnosis of Endometriosis at Laparoscopy: A Validation Study Comparing Surgeon Visualization with Histologic Findings. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:135-141. [PMID: 34562632 DOI: 10.1016/j.jogc.2021.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to evaluate the validity of laparoscopic visualization for the diagnosis of endometriosis compared with histopathology. METHODS We conducted a retrospective chart review at a tertiary care hospital in Canada for the period of April 1, 2016 to March 31, 2017. Of 1069 women, 96 were selected for having undergone laparoscopic visualization and concurrent histopathological biopsy for suspected endometriosis. Standard measures of validity for diagnostic tests (sensitivity, specificity, positive predictive and negative predictive values, accuracy) were used. RESULTS Mean age of the 96 women included was 40 ± 7.2 years, and median gravidity and parity were 1 (IQR 0-3) and 0 (IQR 0-2), respectively. Common symptoms were abdominal and pelvic pain (41.7%), menstrual bleeding concerns (34.4%), dysmenorrhea (29.2%), and infertility (8.3%). Approximately one-third of women had endometriomas (31.3%), while more than half had deep infiltrating endometriosis (59.4%). The diagnosis of endometriosis was made by surgeons at laparoscopic visualization in 82.3% of women and by histopathology in 74.0%. Using histopathology as the gold standard, sensitivity for laparoscopic visualization was 90.1% (95% CI 81.0-95.1), while specificity was 40.0% (95% CI 23.4-59.3). Positive and negative predictive values were 81.0% (95% CI 71.0-88.1) and 58.8% (95% CI 36.0-78.4), respectively; and the accuracy was 77.1% (95% CI 67.7-84.4). CONCLUSION Although laparoscopic visualization had relatively high sensitivity and positive predictive value, its specificity and negative predictive value were relatively low. These findings support the use of laparoscopic visualization with histopathological analysis for accurate diagnosis of endometriosis.
Collapse
Affiliation(s)
- Sara-Michelle Gratton
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON.
| | | | - George A Vilos
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON; Minimally Invasive Gynecology, The Fertility Clinic, London Health Science Center-Victoria Hospital, London, ON
| | - Angelos Vilos
- Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, London, ON; The Fertility Clinic, London Health Science Center-Victoria Hospital, London, ON
| | - Kristina Baier
- Department of Family Medicine, University of Ottawa, Ottawa, ON
| | - Simonne Holubeshen
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON
| | - Maria Cassandra Medor
- Département de Chirurgie, Division de Chirurgie plastique, Université de Montréal, Montréal, QC
| | - Stéphanie Mercier
- Department of Medicine, Division of Internal Medicine, University of Ottawa, Ottawa, ON
| | - Vincent Nguyen
- Division of Obstetrics & Gynecology, University of Ottawa, Ottawa, ON
| | - Innie Chen
- Ottawa Hospital Research Institute, Ottawa, ON; Department of Obstetrics, Gynecology and Newborn Care, University of Ottawa, Ottawa, ON; Minimally Invasive Gynecology, The Ottawa Hospital, Ottawa, ON
| |
Collapse
|
14
|
D'Alterio MN, Saponara S, D'Ancona G, Russo M, Laganà AS, Sorrentino F, Nappi L, Angioni S. Role of surgical treatment in endometriosis. Minerva Obstet Gynecol 2021; 73:317-332. [PMID: 34008386 DOI: 10.23736/s2724-606x.21.04737-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endometriosis can take one of three forms depending on its clinical presentation and management: endometriotic ovarian cyst (ovarian endometrioma), superficial or peritoneal endometriosis and deep infiltrating endometriosis (DIE).1Among them, DIE is considered the most aggressive, and the patient is often affected by more than one type together. The therapeutic methodology should not be influenced by a combination of different types of endometriotic lesion. According to the clinical context and the patient's needs, the treatment of this pathology can be medical or surgical. Although medical therapy could improve endometriosis-associated symptoms, it never offers a definite treatment for symptomatic patients, who often require surgical treatment. The rationale behind endometriosis surgical treatment is to achieve the complete removal of all lesions through a one-step surgical procedure; to obtain promising long-term results for pelvic pain, recurrence rate, and fertility; and to protect the functionality of the involved organs. Achieving these results depends on the total removal of the pathology from the pelvis, in an attempt to preserve, as much as possible, the healthy tissues surrounding the site of the disease. The choice of a surgical approach rather than medical therapy is subject to the patient's expectations, such as pregnancy desire, the effectiveness of treatment compared to possible complications, the type of pain and its intensity, and the location and severity of the disease. In this context, surgical management using a multidisciplinary endometriosis team is an important factor for achieving good outcomes.
Collapse
Affiliation(s)
- Maurizio N D'Alterio
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy -
| | - Stefania Saponara
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gianmarco D'Ancona
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Margherita Russo
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Stefano Angioni
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| |
Collapse
|
15
|
Crispi CP, Crispi CP, de Oliveira BRS, de Nadai Filho N, Peixoto-Filho FM, Fonseca MDF. Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia? PLoS One 2021; 16:e0250046. [PMID: 33891600 PMCID: PMC8064592 DOI: 10.1371/journal.pone.0250046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. METHODS This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. RESULTS Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P < .001) by 3 points or more in 75.8% (95%CI: 64.7-86.2) and disappeared totally in 59.7% of cases (95%CI:47.8-71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0-10.7) and the probability of a woman with no DDyspareunia developing "de novo" moderate or severe DDyspareunia was 7.7% (95%CI: 1.8-15.8) and 5.8% (95%CI: 0.0-13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. CONCLUSION Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.
Collapse
Affiliation(s)
| | | | | | - Nilton de Nadai Filho
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Maia Peixoto-Filho
- Department of Women’s Health—Fernandes Figueira National Institute for Women, Children and Youth Health—Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marlon de Freitas Fonseca
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Women’s Health—Fernandes Figueira National Institute for Women, Children and Youth Health—Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
16
|
Burghaus S, Schäfer SD, Beckmann MW, Brandes I, Brünahl C, Chvatal R, Drahoňovský J, Dudek W, Ebert AD, Fahlbusch C, Fehm T, Fehr PM, Hack CC, Häuser W, Hancke K, Heinecke V, Horn LC, Houbois C, Klapp C, Kramer H, Krentel H, Langrehr J, Matuschewski H, Mayer I, Mechsner S, Müller A, Müller A, Müller M, Oppelt P, Papathemelis T, Renner SP, Schmidt D, Schüring A, Schweppe KW, Seeber B, Siedentopf F, Sirbu H, Soeffge D, Weidner K, Zraik I, Ulrich UA. Diagnosis and Treatment of Endometriosis. Guideline of the DGGG, SGGG and OEGGG (S2k Level, AWMF Registry Number 015/045, August 2020). Geburtshilfe Frauenheilkd 2021; 81:422-446. [PMID: 33867562 DOI: 10.1055/a-1380-3693] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 01/16/2023] Open
Abstract
Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature. Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG. Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed.
Collapse
Affiliation(s)
| | - Sebastian D Schäfer
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Münster, Germany
| | | | - Iris Brandes
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christian Brünahl
- Institut für Psychosomatische Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Wojciech Dudek
- Thoraxchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas D Ebert
- Praxis für Frauengesundheit, Gynäkologie & Geburtshilfe, Berlin, Germany
| | | | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Carolin C Hack
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Winfried Häuser
- Klinik für Innere Medizin 1 (Gastroenterologie, Hepatologie, Onkologie, Stoffwechsel- und Infektionskrankheiten, Psychosomatik), Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | | | | | | | - Christian Houbois
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Germany
| | - Christine Klapp
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. Hamburg, Charité - Universitätsmedizin Berlin Klinik für Geburtsmedizin, Berlin, Germany
| | - Heike Kramer
- Ärztliche Gesellschaft zur Gesundheitsförderung e. V. Hamburg, Spardorf, Germany
| | - Harald Krentel
- Klinik für Frauenheilkunde, Geburtshilfe, Gynäkologische Onkologie und Senologie, Ev. Krankenhaus BETHESDA, Duisburg, Germany
| | - Jan Langrehr
- Allgemein-, Gefäß- und Viszeralchirurgie, Martin Luther Krankenhaus, Berlin, Germany
| | | | - Ines Mayer
- EVA - Endometriose Vereinigung Austria e. V., Wien, Austria
| | - Sylvia Mechsner
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Müller
- Frauenklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Armelle Müller
- EVA - Endometriose Vereinigung Austria e. V., Wien, Austria
| | - Michael Müller
- Universitätsklinik für Frauenheilkunde, Universitätsspital Bern, Bern, Switzerland
| | - Peter Oppelt
- Universitätsklinik für Gynäkologie, Geburtshilfe und Gynäkologische Endokrinologie, Kepler Universitätsklinikum, Linz, Austria
| | | | - Stefan P Renner
- Klinik für Frauenheilkunde und Geburtshilfe, Kliniken Böblingen, Böblingen, Germany
| | - Dietmar Schmidt
- MVZ für Histologie, Zytologie und molekulare Diagnostik, Trier, Germany
| | | | | | - Beata Seeber
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Department Frauenheilkunde, Innsbruck, Austria
| | | | - Horia Sirbu
- Thoraxchirurgie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniela Soeffge
- Endometriose-Vereinigung Deutschland e. V., Leipzig, Germany
| | - Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Isabella Zraik
- Urologie, KEM
- Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Uwe Andreas Ulrich
- Klinik für Gynäkologie und Geburtshilfe, Martin Luther Krankenhaus, Berlin, Germany
| |
Collapse
|
17
|
Burghaus S, Beckmann MW. [Endometriosis: gynecological diagnosis and treatment : What should pain management specialists know?]. Schmerz 2021; 35:172-178. [PMID: 33730222 DOI: 10.1007/s00482-021-00541-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endometriosis is one of the most common diseases in women of reproductive age. Despite characteristic symptoms such as dysmenorrhea, chronic abdominal pain, dysuria, dyschezia and dyspareunia, the average latency until diagnosis is around 10 years. In addition to the individual limitations, the disease also has economic and health policy relevance. The complaints are followed by reductions in working hours, cyclically recurring short-term sick leave or presenteeism with reduced performance. OBJECTIVE An overview of the main recommendations of the S2k guideline on the diagnosis and treatment of endometriosis. MATERIAL AND METHODS For the S2k guideline "Diagnostics and therapy of endometriosis", a systematic literature search was conducted in PubMed and Cochrane according to a defined algorithm and over a period of more than 5 years, from 01.01.2014 to 31.12.2018. For the evaluation, 322 publications, including systematic reviews, meta-analyses and randomized controlled trials were considered and these were assessed by 41 mandate holders and representatives from 25 Association of the Scientific Medical Societies in Germany (AWMF) and non-AWMF professional societies, organizations, associations and working groups of the German Society for Gynecology and Obstetrics (DGGG), as well as two patient target groups. RESULTS In a structured consensus process, 48 recommendations and 27 statements were formulated, which are presented in extracts in this paper. DISCUSSION Interdisciplinary cooperation is essential in the treatment of patients with (suspected) endometriosis. This team should include all necessary disciplines in a cross-sectoral network. This is most likely to be achieved in a certified structure.
Collapse
Affiliation(s)
- Stefanie Burghaus
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Universitätsstr. 21-23, 91054, Erlangen, Deutschland.
| | - Matthias W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Universitäts-Endometriosezentrum Franken (UEF), Universitätsstr. 21-23, 91054, Erlangen, Deutschland
| |
Collapse
|
18
|
Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet 2021; 304:143-155. [PMID: 33537880 PMCID: PMC8164581 DOI: 10.1007/s00404-021-05971-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Purpose To analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility. Methods Using our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed. Results Laparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed. Conclusion According to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.
Collapse
Affiliation(s)
- A M Dückelmann
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Taube
- Department of Pathology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - E Abesadze
- Department of Gynecology, Vivantes Clinic Berlin Hellersdorf, Myslowitzerstr. 45, 12621, Berlin, Germany
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - J Sehouli
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Mechsner
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
19
|
Burks C, Lee M, DeSarno M, Findley J, Flyckt R. Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:587-597. [PMID: 33310168 DOI: 10.1016/j.jmig.2020.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to perform an updated analysis of the literature in regard to the surgical management of minimal to mild endometriosis. This study evaluated women of reproductive age with superficial endometriosis to determine if the results of surgical excision compared with those of ablation in improved pain scores postoperatively. DATA SOURCES The following databases were searched from inception to May 2020 for relevant studies: Cochrane Central Register of Controlled Trials, PubMed (MEDLINE), Ovid (MEDLINE), Scopus, and Web of Science. METHODS OF STUDY SELECTION From our literature search, a total of 2633 articles were identified and screened. Ultimately, 4 randomized controlled trials were selected and included in our systematic review. The combined total number of subjects was 346 from these 4 studies, with sample sizes ranging from 24 to 170 participants. Data from 3 of the included studies were able to be compared and analyzed for a meta-analysis. The primary outcome was reduction in the visual analog scale (VAS) score for endometriosis-associated pain (dysmenorrhea, dyschezia, and dyspareunia), with follow-up time ranging from 6 to 60 months postoperatively. TABULATION, INTEGRATION, AND RESULTS Data extracted from each study included the mean reduction in the VAS score from baseline. A random-effects model was used owing to significant heterogeneity across the studies. Statistical analyses were performed using Review Manager 5.3 software (Cochrane Collaboration, London, United Kingdom). The meta-analyses showed no significant differences between the excision and ablation groups in the mean reduction in VAS scores from baseline to 12 months postoperatively for dysmenorrhea (mean difference [MD] -0.03; 95% confidence interval [CI], -1.27 to 1.22; p = .97), dyschezia (MD 0.46; 95% CI, -1.09 to 2.02; p = .56), and dyspareunia (MD 0.10; 95% CI, -2.36 to 2.56; p = .94). In addition, there were no significant differences between the excision and ablation groups in mean VAS scores at the 12-month follow-up and beyond for dysmenorrhea (MD -0.11; 95% CI, -2.14 to 1.93; p = .92), dyschezia (MD 0.01; 95% CI, -0.70 to 0.72; p = .99), and dyspareunia (MD 0.34; 95% CI, -1.61 to 2.30; p = .73). CONCLUSION On the basis of the data from our systematic review and pooled meta-analysis, no significant difference between laparoscopic excision and ablation was noted in regard to improving pain from minimal to mild endometriosis. However, to make definitive conclusions on this topic, larger randomized controlled trials are needed with longer follow-up.
Collapse
Affiliation(s)
- Channing Burks
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt).
| | - Mabel Lee
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt)
| | - Michael DeSarno
- Department of Obstetrics and Gynecology, University of Vermont Medical Center, Burlington, Vermont (Mr. DeSarno and Dr. Findley)
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University of Vermont Medical Center, Burlington, Vermont (Mr. DeSarno and Dr. Findley)
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt)
| |
Collapse
|
20
|
Abdul Karim AK, Abd Aziz NH, Md Zin RR, Mohd Mokhtar N, Shafiee MN. The Effect of Surgical Intervention of Endometriosis to CA-125 and Pain. Malays J Med Sci 2020; 27:7-14. [PMID: 33447130 PMCID: PMC7785265 DOI: 10.21315/mjms2020.27.6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022] Open
Abstract
Endometriosis is an inflammatory condition characterised by the presence of endometrial growth beyond the uterine cavity. It is a debilitating disease requiring multiple modalities of treatment. In considering surgery as the option of treatment, the benefits should outweigh the risk. Besides direct surgical risk, intervention may lead to a reduction of ovarian reserve, in addition to premature menopause and low fecundity. To date, there is an inconclusive evidence to support any specific parameters in monitoring disease progression following surgical intervention. Serum cancer antigen (CA)-125 is expressed by coelomic epithelium and has been extensively studied as a biomarker for endometriosis. Elevated expression of CA-125 has been shown in endometrial tissues and the marker increased indirectly from peritoneal irritation that accompanies an extensive form of endometriosis. Additionally, the visual analogue scale (VAS) scores have been used as an objective measurement for measuring pain, especially in a complex disease such as endometriosis. This review aims to consolidate a series of clinical trials that utilised CA-125 level and VAS score as tools for monitoring patients undergoing surgery for endometriosis.
Collapse
Affiliation(s)
- Abdul Kadir Abdul Karim
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Nor Haslinda Abd Aziz
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Reena Rahayu Md Zin
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Norfilza Mohd Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Mohamad Nasir Shafiee
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| |
Collapse
|
21
|
Abstract
BACKGROUND Endometriosis is associated with pain and infertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. OBJECTIVES To assess the effectiveness and safety of laparoscopic surgery in the treatment of pain and infertility associated with endometriosis. SEARCH METHODS This review has drawn on the search strategy developed by the Cochrane Gynaecology and Fertility Group including searching the Cochrane Gynaecology and Fertility Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, reference lists for relevant trials, and trial registries from inception to April 2020. SELECTION CRITERIA We selected randomised controlled trials (RCTs) that compared the effectiveness and safety of laparoscopic surgery with any other laparoscopic or robotic intervention, holistic or medical treatment, or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS Two review authors independently performed selection of studies, assessment of trial quality and extraction of relevant data with disagreements resolved by a third review author. We collected data for the core outcome set for endometriosis. Primary outcomes included overall pain and live birth. We evaluated the quality of evidence using GRADE methods. MAIN RESULTS We included 14 RCTs. The studies randomised 1563 women with endometriosis. Four RCTs compared laparoscopic ablation or excision with diagnostic laparoscopy only. Two RCTs compared laparoscopic excision with diagnostic laparoscopy only. One RCT compared laparoscopic ablation or excision with laparoscopic ablation or excision and uterine suspension. Two RCTs compared laparoscopic ablation and uterine nerve transection with diagnostic laparoscopy only. One RCT compared laparoscopic ablation with diagnostic laparoscopy and gonadotropin-releasing hormone (GnRH) analogues. Two RCTs compared laparoscopic ablation with laparoscopic excision. One RCT compared laparoscopic ablation or excision with helium thermal coagulator with laparoscopic ablation or excision with electrodiathermy. One RCT compared conservative laparoscopic surgery with laparoscopic colorectal resection of deep endometriosis infiltrating the rectum. Common limitations in the primary studies included lack of clearly described blinding, failure to fully describe methods of randomisation and allocation concealment, and poor reporting of outcome data. Laparoscopic treatment versus diagnostic laparoscopy We are uncertain of the effect of laparoscopic treatment on overall pain scores compared to diagnostic laparoscopy only at six months (mean difference (MD) 0.90, 95% confidence interval (CI) 0.31 to 1.49; 1 RCT, 16 participants; very low quality evidence) and at 12 months (MD 1.65, 95% CI 1.11 to 2.19; 1 RCT, 16 participants; very low quality evidence), where a positive value means pain relief (the higher the score, the more pain relief) and a negative value reflects pain increase (the lower the score, the worse the increase in pain). No studies looked at live birth. We are uncertain of the effect of laparoscopic treatment on quality of life compared to diagnostic laparoscopy only: EuroQol-5D index summary at six months (MD 0.03, 95% CI -0.12 to 0.18; 1 RCT, 39 participants; low quality evidence), 12-item Short Form (SF-12) mental health component (MD 2.30, 95% CI -4.50 to 9.10; 1 RCT, 39 participants; low quality evidence) and SF-12 physical health component (MD 2.70, 95% CI -2.90 to 8.30; 1 RCT, 39 participants; low quality evidence). Laparoscopic treatment probably improves viable intrauterine pregnancy rate compared to diagnostic laparoscopy only (odds ratio (OR) 1.89, 95% CI 1.25 to 2.86; 3 RCTs, 528 participants; I2 = 0%; moderate quality evidence). We are uncertain of the effect of laparoscopic treatment compared to diagnostic laparoscopy only on ectopic pregnancy (MD 1.18, 95% CI 0.10 to 13.48; 1 RCT, 100 participants; low quality evidence) and miscarriage (MD 0.94, 95% CI 0.35 to 2.54; 2 RCTs, 112 participants; low quality evidence). There was limited reporting of adverse events. No conversions to laparotomy were reported in both groups (1 RCT, 341 participants). Laparoscopic ablation and uterine nerve transection versus diagnostic laparoscopy We are uncertain of the effect of laparoscopic ablation and uterine nerve transection on adverse events (more specifically vascular injury) compared to diagnostic laparoscopy only (OR 0.33, 95% CI 0.01 to 8.32; 1 RCT, 141 participants; low quality evidence). No studies looked at overall pain scores (at six and 12 months), live birth, quality of life, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy and miscarriage. Laparoscopic ablation versus laparoscopic excision There was insufficient evidence to determine whether there was a difference in overall pain, measured at 12 months, for laparoscopic ablation compared with laparoscopic excision (MD 0.00, 95% CI -1.22 to 1.22; 1 RCT, 103 participants; very low quality evidence). No studies looked at overall pain scores at six months, live birth, quality of life, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy, miscarriage and adverse events. Helium thermal coagulator versus electrodiathermy We are uncertain whether helium thermal coagulator compared to electrodiathermy improves quality of life using the 30-item Endometriosis Health Profile (EHP-30) at nine months, when considering the components: pain (MD 6.68, 95% CI -3.07 to 16.43; 1 RCT, 119 participants; very low quality evidence), control and powerlessness (MD 4.79, 95% CI -6.92 to 16.50; 1 RCT, 119 participants; very low quality evidence), emotional well-being (MD 6.17, 95% CI -3.95 to 16.29; 1 RCT, 119 participants; very low quality evidence) and social support (MD 5.62, 95% CI -6.21 to 17.45; 1 RCT, 119 participants; very low quality evidence). Adverse events were not estimable. No studies looked at overall pain scores (at six and 12 months), live birth, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy and miscarriage. AUTHORS' CONCLUSIONS Compared to diagnostic laparoscopy only, it is uncertain whether laparoscopic surgery reduces overall pain associated with minimal to severe endometriosis. No data were reported on live birth. There is moderate quality evidence that laparoscopic surgery increases viable intrauterine pregnancy rates confirmed by ultrasound compared to diagnostic laparoscopy only. No studies were found that looked at live birth for any of the comparisons. Further research is needed considering the management of different subtypes of endometriosis and comparing laparoscopic interventions with lifestyle and medical interventions. There was insufficient evidence on adverse events to allow any conclusions to be drawn regarding safety.
Collapse
Affiliation(s)
- Celine Bafort
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Yusuf Beebeejaun
- King's Fertility, King's College Hospital NHS Foundation Trust, London, UK
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Bosteels
- Academic Centre for General Practice, Cochrane Belgium, Leuven, Belgium
| | - James Mn Duffy
- Institute for Women's Health, University College London, London, UK
- King's Fertility, Fetal Medicine Research Institute, London, UK
| |
Collapse
|
22
|
Al-Inizi S. Re: Laparoscopic ablation or excision with helium thermal coagulator versus electrodiathermy for the treatment of mild-to-moderate endometriosis: randomised controlled trial. BJOG 2020; 127:1715-1716. [PMID: 32881374 DOI: 10.1111/1471-0528.16451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Shamma Al-Inizi
- Department of Obstetrics and Gynaecology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| |
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Misra G, Sim J, El‐Gizawy Z, Watts K, Jerreat S, Coia T, Ritchie J, O'Brien S. Laparoscopic ablation or excision with helium thermal coagulator versus electrodiathermy for the treatment of mild‐to‐moderate endometriosis: randomised controlled trial. BJOG 2020; 127:1528-1535. [DOI: 10.1111/1471-0528.16279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- G Misra
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - J Sim
- School of Primary, Community and Social Care Keele University Keele Staffordshire UK
| | - Z El‐Gizawy
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - K Watts
- Research and Innovation University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - S Jerreat
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - T Coia
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - J Ritchie
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| | - S O'Brien
- Maternity Unit University Hospitals of North Midlands Royal Stoke University Hospital Stoke‐on‐Trent Staffordshire UK
| |
Collapse
|
25
|
Budden A, Ravendran K, Abbott JA. Identifying the Problems of Randomized Controlled Trials for the Surgical Management of Endometriosis-associated Pelvic Pain. J Minim Invasive Gynecol 2020; 27:419-432. [DOI: 10.1016/j.jmig.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022]
|
26
|
Goldberg JM, Falcone T, Diamond MP. Current controversies in tubal disease, endometriosis, and pelvic adhesion. Fertil Steril 2019; 112:417-425. [DOI: 10.1016/j.fertnstert.2019.06.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 12/20/2022]
|
27
|
Purbadi S, Aprilia B, Novianti L. Evidence-based case report: How to deal with unpredicted endometriosis nodule closed to ureter and rectum during laparoscopy. Int J Surg Case Rep 2019; 61:280-284. [PMID: 31401435 PMCID: PMC6699556 DOI: 10.1016/j.ijscr.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Endometriosis is characterized by the growth of endometrial-like tissue within and outside the pelvic cavity. Peritoneum nodules invaded more than 5 mm representing the commonest form of deep infiltrating endometriosis nodules might challenge inexperienced operator due to its location near ureter and the rectum. The aim is to provide important steps on how to deal with unexpected peritoneal endometrial nodules located closed to ureter and rectum. PRESENTATION OF CASE A 43-year-old female underwent laparoscopic cystectomy after being diagnosed to have right endometriosis cyst. The researchers found multiple endometriosis nodules located closed to rectum and ureter after performing cystectomy. A search was conducted on PubMed® with the keywords of "Peritoneal endometriosis nodule" AND "rectovaginal endometriosis nodule" AND "Surgical ablation" OR "Surgical excision" AND "Laparoscopy" AND "Pelvic pain". Reference lists of relevant articles were searched for other possible relevant studies. After selecting the articles, the critical review was performed based on a standardized appraisal form for the treatment study. DISCUSSION Three eligible studies were appraised to assess the surgery outcome (dyspareunia), based on ablation and excision criteria. The pain was decreased during 6 months of follow up, with no difference in both techniques. The minimal requirement to remove the posterior nodules is knowledge of pelvic retroperitoneal anatomy. CONCLUSION In all endometriosis cases which require surgery will need to be performed by an experienced operator. If rectovaginal endometriosis nodule was unexpectedly found during intraoperative and recognition of rectum and ureter must be done, knowledge of retroperitoneal anatomy is required.
Collapse
Affiliation(s)
- Sigit Purbadi
- Division of Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Salemba Raya Street No.5, Kenari, Senen, 10430, Jakarta, Indonesia.
| | - Bella Aprilia
- Department of Obstetrics and Gynecology, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Salemba Raya Street No.5, Kenari, Senen, 10430, Jakarta, Indonesia
| | - Lisa Novianti
- Faculty of Medicine Gadjah Mada University, Farmako Street, Depok, Sleman, Jogjakarta 55281, Indonesia
| |
Collapse
|
28
|
Falcone T, Wilson JR. Surgical Treatment of Endometriosis: Excision Versus Ablation of Peritoneal Disease. J Minim Invasive Gynecol 2019; 26:1-2. [DOI: 10.1016/j.jmig.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|