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Crestani A, de Labrouhe E, Le Gac M, Kolanska K, Ferrier C, Touboul C, Dabi Y, Darai E. To drain or not to drain: A propensity score analysis of abdominal drainage after colorectal surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol 2024; 297:227-232. [PMID: 38691975 DOI: 10.1016/j.ejogrb.2024.04.028] [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: 03/31/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
AIM To assess the benefit of prophylactic abdominal drainage (AD) after colorectal surgery for endometriosis. METHODS We conducted a retrospective study of 215 patients who underwent colorectal surgery for endometriosis using a mini-invasive approach in our center from February 2019 to July 2023. A propensity score matched (PSM) analysis (1:1 ratio) identified two groups of patients with similar characteristics. Postoperative outcomes were then compared. RESULTS In the unmatched cohort, 151 patients (70 %) had AD at the end of surgery and 64 (30 %) did not. Clinical characteristics and surgical procedures were comparable between the groups after PSM. After PSM, AD was associated with a longer hospital stay (p < 0.001) and a greater number of postoperative complications (p = 0.03). There were no differences for readmission, repeat surgery, or severe postoperative complications. CONCLUSION In this retrospective cohort of patients undergoing colorectal resection for endometriosis using a mini-invasive approach, prophylactic AD was not found to be beneficial.
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Affiliation(s)
- Adrien Crestani
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux 33000, France.
| | - Eric de Labrouhe
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France
| | - Marjolaine Le Gac
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France
| | - Kamila Kolanska
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
| | - Clément Ferrier
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
| | - Yohann Dabi
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
| | - Emile Darai
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
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Barra F, Ferrero S, Zorzi C, Evangelisti G, Perrone U, Valente I, Capezzuoli T, D'Ancona G, Bogliolo S, Roviglione G, Ceccaroni M. "From the tip to the deep of the iceberg": Parametrial involvement in endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 94:102493. [PMID: 38581882 DOI: 10.1016/j.bpobgyn.2024.102493] [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: 03/02/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
Deep endometriosis (DE) can be localized in the parametrium, a complex bilateral anatomical structure, sometimes necessitating intricate surgical intervention due to the potential involvement of autonomic nerves, uterine artery, and ureter. If endometriotic ovarian cysts have been considered metaphorically representative of "the tip of the iceberg" concerning concealed DE lesions, it is reasonable to assert that parametrial lesions should be construed as the most profound region of this iceberg. Also, based on a subdual clinical presentation, a comprehensive diagnostic parametrial evaluation becomes imperative to strategize optimal management for patients with suspected DE. Recently, the ULTRAPARAMETRENDO studies aimed to evaluate the role of transvaginal ultrasound for parametrial endometriosis, showing distinctive features, such as a mild hypoechoic appearance, starry morphology, irregular margins, and limited vascularization. The impact of medical therapy on parametrial lesions has not been described in the current literature, primarily due to the lack of adequate detection at imaging. The extension of DE into the parametrium poses significant challenges during the surgical approach, thereby increasing the risk of intra- and postoperative complications, mainly if performed by centers with low expertise and following multiple surgical procedures where parametrial involvement has gone unrecognized. Over time, the principles of nerve-sparing surgery have been incorporated into the surgical DE treatment to minimize iatrogenic damage and potentially reduce the risk of functional complications.
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Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy; Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy.
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Giulio Evangelisti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Unit of Obstetrics and Gynecology, San Paolo Hospital - ASL2, Savona, 17100, Italy
| | - Umberto Perrone
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Irene Valente
- Unit of Radiology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Stefano Bogliolo
- Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
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Crestani A, Merlot B, Goualard PH, Grigoriadis G, Chanavaz Lacheray I, Dennis T, Roman H. Bowel endometriosis: Surgical customization is demanding. Best Pract Res Clin Obstet Gynaecol 2024; 94:102495. [PMID: 38593673 DOI: 10.1016/j.bpobgyn.2024.102495] [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: 01/28/2024] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-made surgery will always be to preserve the organ. The surgeon then has three options: shaving, discoid resection and segmental resection. The more extensive the resection, the greater the risk of severe short- and long-term complications. Surgery must therefore be adapted to the patient's specific situation and needs. Moreover, personalized care must extend beyond surgery. It must begin before the operation, preparing the patient for the operation like an athlete before a race, and continue afterwards by adapting the follow-up to the surgery performed.
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Affiliation(s)
- Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France.
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates
| | - Paul-Henri Goualard
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | | | - Isabelle Chanavaz Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
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Arena A, Degli Esposti E, Pazzaglia E, Orsini B, Cau I, Govoni F, Raimondo D, Palermo R, Lenzi J, Casadio P, Seracchioli R. Not All Bad Comes to Harm: Enhanced Recovery After Surgery for Rectosigmoid Endometriosis. J Minim Invasive Gynecol 2024; 31:49-56. [PMID: 37839779 DOI: 10.1016/j.jmig.2023.10.011] [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: 07/10/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
STUDY OBJECTIVE To assess the impact of implementing an enhanced recovery after surgery (ERAS) protocol on the length of hospitalization in women undergoing laparoscopy for rectosigmoid deep infiltrating endometriosis (DIE). DESIGN A retrospective cohort study. SETTING An academic referral center for endometriosis and minimally invasive gynecologic surgery. PATIENTS Women aged between 18 and 50 years scheduled for laparoscopic excision (shaving, full-thickness anterior wall resection, segmental resection) of rectosigmoid endometriosis between February 2017 and February 2023. INTERVENTIONS We divided patients into 2 groups (non-ERAS and ERAS) based on the timing of surgery (before or after March 5, 2020). Starting from this day, restrictions were issued to limit the spread of the coronavirus disease 2019 pandemic, inducing our group to implement an ERAS protocol for patients hospitalized after surgery for posterior DIE. MEASUREMENTS AND MAIN RESULTS We included 579 patients in the analysis, 316 (54.6%) in the non-ERAS group and 263 (45.4%) in the ERAS group. In the ERAS group, we observed a shorter length of hospital stay (5.8 ± 3.1 days vs 4.8 ± 2.9 days; p <.001) and lower complications rates (33, 12.5% vs 60, 19.0%; p = .04), despite a decreased frequency of conservative surgical approaches (shaving procedures 121 vs 196; p <.001). Repeated surgery or hospital readmissions owing to postdischarge complications were infrequent, with no significant differences between the 2 groups. The multiple linear regression analysis strengthened our results given the higher prevalence of bowel resection surgeries (both full-thickness anterior wall or segmental), showing that patients managed with a multimodal protocol had an overall reduction of hospital stay by 1.5 days. CONCLUSION The implementation of an ERAS program in patients undergoing laparoscopic surgery for DIE is associated with a significant reduction in hospital stay, without an increase in perioperative or postoperative complication rates.
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Affiliation(s)
- Alessandro Arena
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Eugenia Degli Esposti
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Enrico Pazzaglia
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli).
| | - Benedetta Orsini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Irene Cau
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Francesca Govoni
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli)
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli)
| | - Roberto Palermo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Jacopo Lenzi
- Department of biomedical and neuromotor sciences, Alma mater Studiorum, University of Bologna, Bologna, Italy (Dr. Lenzi)
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli)
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
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Shields J, Lin E, Kho K. Beyond the Scalpel: Broadening Our Focus to Optimize Surgical Experiences. J Minim Invasive Gynecol 2023; 30:425-426. [PMID: 37062459 DOI: 10.1016/j.jmig.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Jessica Shields
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (all authors).
| | - Emily Lin
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (all authors)
| | - Kimberly Kho
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (all authors)
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