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Ceccaroni M, D'Ancona G, Roviglione G, Choi S, Capezzuoli T, Puppo A, Drampyan A, Barra F. Tailoring radicality in diaphragmatic surgery for deep endometriosis: A matter of choice. Best Pract Res Clin Obstet Gynaecol 2024; 95:102499. [PMID: 38710608 DOI: 10.1016/j.bpobgyn.2024.102499] [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: 03/05/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024]
Abstract
Diaphragmatic endometriosis (DpE) is a rare disease localization which represents an important clinical challenge. The main criticisms toward the proper DpE management consist of poor consensus on both surgical indications and the choice between different surgical techniques available to treat the disease. Furthermore, only weak recommendations are provided by current guidelines and surgical management is mostly based on surgeon's experience. As consequence, the lack of standardization about the surgical treatment led to the risk of under- or over-treatments in patients suffering from this form of endometriosis. The latest evidence-based data suggest to adopt a lesion-oriented surgical approach serving as a guide in daily surgical activities, in order to ensure a tailored radicality and reduce the rate of surgery-related complications. Diaphragmatic endometriosis surgery should be performed only by expert surgeons with an extensive oncogynecologic expertise since it represents a technically demanding procedure. A multidisciplinary approach is also mandatory in order to adequately select and treat these patients by minimizing the risk of additional morbidity.
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Affiliation(s)
- Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Sarah Choi
- Sydney Women's Endosurgery Centre, Women's & Children's Health, St. George Hospital, South Eastern Sydney Local Health District, New South Wales, 2217, Australia
| | - Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Andrea Puppo
- Clinic of Obstetrics and Gynecology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Ashot Drampyan
- Department of Endoscopic Gynecology, Republic Institute of Reproductive Health, Perinatology, Obstetrics and Gynecology, Yerevan, Armenia
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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D'Ancona G, Merlot B, Chanavaz-Lacheray I, Braund S, Kade S, Dennis T, Roman H. Robotic-assisted Laparoscopy Excision of a Severe Form of Diaphragmatic Endometriosis: A Retrospective Study of 60 Patients. J Minim Invasive Gynecol 2024:S1553-4650(24)00261-9. [PMID: 38866098 DOI: 10.1016/j.jmig.2024.06.002] [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: 02/10/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
STUDY OBJECTIVE To assess the feasibility, effectiveness, and safety of the robotic surgical approach in the treatment of severe diaphragmatic endometriosis (DE). DESIGN Retrospective single-center study using data prospectively recorded in the Franco-European Multidisciplinary Institute of Endometriosis database and the National Observatory for Endometriosis database. SETTING Tertiary referral center. Endometriosis care center. PATIENTS Sixty consecutive patients undergoing robotic excision of severe DE from January 2020 to July 2023. INTERVENTIONS Robotic excision of severe DE. MEASUREMENT AND MAIN RESULTS Categorical and continuous variables were evaluated and compared using descriptive statistics. A p value of <.05 was considered statistically significant. Full-thickness diaphragmatic resection was performed in 76.7% of patients (46 of 60) and partial diaphragmatic muscle resection in 10% of cases (6 of 60). Peritoneal stripping technique was performed in 60% of patients (36 of 60), divided as follows: as the only technique in the case of extensive superficial diaphragmatic involvement in 13.3% of cases (8 of 60), in addition to full-thickness or partial diaphragmatic resection in the case of concomitant multiple foci in 46.7% of patients (28 of 60). Median operative time was 79.6 minutes with no statistically significative difference related to the surgeon performing surgery (p >.05). Intraoperative and postoperative complications occurred in 1.7% (1 of 60) and 6.6% of cases (4 of 60), respectively. Diaphragmatic hernia (Clavien-Dindo 3b) was the most common postoperative complication and required surgical repair in all cases. Median hospital stay was 24 hours. The rate of patients with complete recovery from DE symptoms has gradually increased during follow-up, reaching 89% after 12 months from surgery. CONCLUSION In this case series, robotic treatment of severe DE in expert hands was feasible, effective, and safe.
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Affiliation(s)
- Gianmarco D'Ancona
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. D'Ancona, Merlot, Chanavaz-Lacheray, Dennis, and Roman); Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy (Dr. D'Ancona).
| | - Benjamin Merlot
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. D'Ancona, Merlot, Chanavaz-Lacheray, Dennis, and Roman); Franco-European Multidisciplinary Institut of Endometriosis - Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates (Drs. Merlot, Kade, and Roman)
| | - Isabella Chanavaz-Lacheray
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. D'Ancona, Merlot, Chanavaz-Lacheray, Dennis, and Roman)
| | - Sophia Braund
- Department of Gynecology and Obstetrics, CHU Rouen, France (Dr. Braund)
| | - Sandesh Kade
- Franco-European Multidisciplinary Institut of Endometriosis - Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates (Drs. Merlot, Kade, and Roman)
| | - Thomas Dennis
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. D'Ancona, Merlot, Chanavaz-Lacheray, Dennis, and Roman)
| | - Horace Roman
- Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. D'Ancona, Merlot, Chanavaz-Lacheray, Dennis, and Roman); Franco-European Multidisciplinary Institut of Endometriosis - Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates (Drs. Merlot, Kade, and Roman); Department of Gynecology and Obstetrics, CHU Rouen, France (Dr. Braund); Department of Gynecology and Obstetrics, Medical university Aarhus, Denmark (Dr. Roman)
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Issard J, Vaudelin C, Imberton D, Vayssette A, Leroux M, Giol M, Khalife T, Camuset J, Debrosse D, Assouad J, Etienne H. In endometriosis-related pneumothorax surgery, presence of endometriotic nodules increases postoperative air leaks and long-term relapse. Eur J Obstet Gynecol Reprod Biol 2024; 296:1-5. [PMID: 38387250 DOI: 10.1016/j.ejogrb.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/07/2024] [Accepted: 02/18/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Justin Issard
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris.
| | - Clémence Vaudelin
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Diane Imberton
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Anna Vayssette
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Marielle Leroux
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Mihaela Giol
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Theresa Khalife
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Juliette Camuset
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Denis Debrosse
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Jalal Assouad
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
| | - Harry Etienne
- Department of Thoracic and Vascular Surgery, Hôpital Tenon, APHP, Paris
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Piriyev E, Römer T. Diaphragm endometriosis: Random localization or extended form of pelvis endometriosis. A large comparative analysis of 202 cases. Eur J Obstet Gynecol Reprod Biol 2024; 294:117-122. [PMID: 38237309 DOI: 10.1016/j.ejogrb.2024.01.020] [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: 12/19/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE The aim of this study was to investigate and present the clinical characteristics of diaphragm endometriosis, to approach the pathogenetic mechanisms, and to answer the question of whether this disease can be considered an extended form of pelvic endometriosis. STUDY DESIGN It was a retrospective comparative one-to-one analysis of 202 cases. Two groups of patients were compared: Group 1 patients with diaphragm endometriosis vs Group 2 (control group) with pelvis endometriosis, each with 101 patients. RESULTS Patients with diaphragm endometriosis had extreme significantly higher prevalence of severe pelvis endometriosis included deep infiltrated endometriosis and severe adhesions in term of complete Douglas obliteration (p value = 0.0001). There was neither age nor BMI difference in two groups. Besides of cyclic shoulder or upper abdomen pain there was no difference of symptoms. CONCLUSION Diaphragm endometriosis is a rare condition with an approximate prevalence of 1.1% of all endometriosis cases. Since the symptoms are very specific and patients do not associate the pain with diaphragmatic endometriosis, the symptoms should be asked about explicitly. If patients with diaphragmatic endometriosis have no symptoms, the lesions do not necessarily need to be removed. The pathogenesis is still unclear. The authors of this study consider this disease to be an extended form of severe pelvic and deep infiltrated endometriosis. However, the right-side dominance still cannot be explained. Further research is needed to fully understand the origin of diaphragmatic endometriosis.
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Affiliation(s)
- Elvin Piriyev
- University Witten-Herdecke, Germany; Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal, Germany.
| | - Thomas Römer
- University of Cologne, Germany; Department of Obstetrics and Gynecology, Academic Hospital Cologne Weyertal, Germany
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Bahrami F, Maheux-Lacroix S, Bougie O, Boutin A. Determinants of Perioperative Complications in Day-Surgery for Endometriosis: A Retrospective Cohort. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102227. [PMID: 37741619 DOI: 10.1016/j.jogc.2023.102227] [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: 05/16/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVES Endometriosis is a common gynaecologic disease for which surgery is often required. Our objective was to evaluate the potential determinants of perioperative complications in day-surgeries for endometriosis. METHODS We conducted a retrospective cohort study of patients undergoing day-surgeries for endometriosis using Canadian administrative data from between 2015 and 2019. A multilevel logistic model with a random intercept at the centre level was created to assess the association between potential determinants, including age, site(s) of endometriosis lesion, centre-volume, surgical intervention, and a composite outcome of complications or specific complications. RESULTS We observed a higher risk of complications associated with greater age (40-44 vs. 20-24 years, adjusted odds ratio [aOR] 1.58; 95% CI 1.26-1.98); hysterectomies (aOR 2.29; 95% CI 1.73-3.06) compared with minor conservative surgery; lesions of the bowel or urinary tract system (aOR 1.54; 95% CI 1.16-2.06), and extra-pelvic sites of endometriosis (aOR 1.24; 95% CI 1.07-1.52) compared with endometriosis of the uterus; and with comorbidities (aOR 1.59; 95% CI 1.09-2.32). Endometriosis lesions to the bowel and urinary tract system and to extra-pelvic sites (compared with no endometriosis at the site) were associated with a greater risk of accidental damages (aOR 1.84; 95% CI 1.43-2.37) and urinary system complications (aOR 1.75; 95% CI 1.24-2.48), respectively. Among patients undergoing hysterectomies compared with those undergoing minor conservative surgery, infectious complications (aOR 8.56; 95% CI 4.70-15.59) and accidental damages (aOR 2.31; 95% CI 1.70-3.14) were more frequent. CONCLUSIONS Complications in day-surgeries for endometriosis are more frequent with older age, hysterectomy, comorbidities, and endometriosis of the bowel, urinary tract system, and extra-pelvic locations. More extensive disease is associated with more extensive surgical dissection and a higher risk of complications.
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Affiliation(s)
- Foruzan Bahrami
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Québec City, QC
| | - Sarah Maheux-Lacroix
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Québec City, QC; Department of Obstetrics and Gynaecology, Université Laval, Québec City, QC
| | - Olga Bougie
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON
| | - Amélie Boutin
- Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Québec City, QC; Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Québec City, QC; Department of Pediatrics, Université Laval, Québec City, QC.
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Naem A, Andrikos A, Constantin AS, Khamou M, Andrikos D, Laganà AS, De Wilde RL, Krentel H. Diaphragmatic Endometriosis-A Single-Center Retrospective Analysis of the Patients' Demographics, Symptomatology, and Long-Term Treatment Outcomes. J Clin Med 2023; 12:6455. [PMID: 37892593 PMCID: PMC10607902 DOI: 10.3390/jcm12206455] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Diaphragmatic endometriosis is rare and forms 0.67-4.7% of all endometriosis cases. Evidence regarding its optimal management is lacking. In this study, we retrospectively analyzed the patient characteristics and long-term treatment outcomes of diaphragmatic endometriosis patients. Over a 4-year period, 23 patients were diagnosed with diaphragmatic endometriosis. The majority of patients had coexisting deep pelvic endometriosis. Cyclic upper abdominal pain was reported by 60.9% of patients, while cyclic chest and shoulder pain were reported by 43.5% and 34.8% of patients, respectively. Most patients were treated with laparoscopic lesion ablation, while 21.1% were treated with minimally invasive excision. The mean follow-up time was 23.7 months. Long-lasting resolution of the chest, abdominal, and shoulder pain occurred in 50%, 35.7%, and 25% of patients, respectively. Nonetheless, 78.9% of patients reported major improvement in their symptoms postoperatively. Significantly higher rates of postoperative shoulder, abdominal, and chest pain were observed in patients who received postoperative hormonal therapy compared with those who did not. All patients treated expectantly remained stable. Therefore, we recommend treating diaphragmatic endometriosis only in symptomatic patients. The risk of incomplete surgery should be minimized by a multidisciplinary diagnostic and therapeutic approach with a careful assessment of the diaphragm and the thoracic cavity.
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Affiliation(s)
- Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; (A.A.); (D.A.); (H.K.)
- Faculty of Mathematics and Computer Science, University of Bremen, 28359 Bremen, Germany
| | - Argyrios Andrikos
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; (A.A.); (D.A.); (H.K.)
| | | | - Michael Khamou
- Department of Radiology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany
| | - Dimitrios Andrikos
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; (A.A.); (D.A.); (H.K.)
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, 26121 Oldenburg, Germany
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; (A.A.); (D.A.); (H.K.)
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Agossou M, Sanchez BG, Alauzen PH, Olivier M, Cécilia-Joseph E, Chevallier L, Jean-Laurent M, Aline-Fardin A, Dramé M, Venissac N. Thoracic Endometriosis Syndrome (TES) in Martinique, a French West Indies Island. J Clin Med 2023; 12:5578. [PMID: 37685644 PMCID: PMC10488738 DOI: 10.3390/jcm12175578] [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: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Endometriosis is a female disease that affects 5-10% of women of childbearing age, with predominantly pelvic manifestations. It is currently declared as a public health priority in France. Thoracic endometriosis syndrome (TES) is the most common extra-pelvic manifestation. OBJECTIVE The objective of this study was to describe the epidemiological and clinical characteristics, and outcomes of patients with TES in Martinique. PATIENTS AND METHODS We performed a descriptive, retrospective study including all patients managed at the University Hospital of Martinique for TES between 1 January 2004 and 31 December 2020. RESULTS During the study period, we identified 479 cases of pneumothorax, of which 212 were women (44%). Sixty-three patients (30% of all female pneumothorax) were catamenial pneumothorax (CP) including 49 pneumothoraxes alone (78% of catamenial pneumothorax) and 14 hemopneumothorax (22% of catamenial pneumothorax). There were 71 cases of TES, including 49 pneumothoraxes (69%), 14 hemopneumothoraxes (20%) and 8 hemothorax (11%). The annual incidence of TES was 1.1 cases/100,000 inhabitants. The prevalence of TES was 1.2/1000 women aged from 15 to 45 years and the annual incidence of TES for this group was 6.9/100,000. The annual incidence of CP was 1 case/100,000 inhabitants. The average age at diagnosis was 36 ± 6 years. Eight patients (11%) had no prior diagnosis of pelvic endometriosis (PE). The mean age at pelvic endometriosis diagnosis was 29 ± 6 years. The mean time from symptom onset to diagnosis was 24 ± 50 weeks, and 53 ± 123 days from diagnosis to surgery. Thirty-two patients (47%) had prior abdominopelvic surgery. Seventeen patients (24%) presented other extra-pelvic localizations. When it came to management, 69/71 patients (97%) underwent surgery. Diaphragmatic nodules or perforations were found in 68/69 patients (98.5%). Histological confirmation was obtained in 55/65 patients who underwent resection (84.6%). Forty-four patients (62%) experienced recurrence. The mean time from the initial treatment to recurrence was 20 ± 33 months. The recurrence rate was 16/19 (84.2%) in patients who received medical therapy only, 11/17 (64.7%) in patients treated by surgery alone, and 17/31 (51.8%) in patients treated with surgery and medical therapy (p = 0.03). CONCLUSIONS We observed a very high incidence of TES in Martinique. The factors associated with this high incidence in this specific geographical area remain to be elucidated. The frequency of recurrence was lower in patients who received both hormone therapy and surgery.
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Affiliation(s)
- Moustapha Agossou
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Bruno-Gilbert Sanchez
- Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France
| | - Paul-Henri Alauzen
- Department of Respiratory Medicine, CHU of Martinique, 97261 Fort-de-France, France
| | - Maud Olivier
- Department of Thoracic and Cardiovascular Surgery, CHU of Martinique, 97261 Fort-de-France, France
| | - Elsa Cécilia-Joseph
- Department of Medical Information, CHU of Martinique, 97261 Fort-de-France, France;
| | - Ludivine Chevallier
- Department of Gynecology and Obstetrics, CHU of Martinique, 97261 Fort-de-France, France
| | - Mehdi Jean-Laurent
- Department of Gynecology and Obstetrics, CHU of Martinique, 97261 Fort-de-France, France
| | - Aude Aline-Fardin
- Department of Pathology, CHU of Martinique, 97261 Fort-de-France, France
| | - Moustapha Dramé
- Department of Clinical Research and Innovation, CHU of Martinique, 97261 Fort-de-France, France
- EpiCliV Research Unit, Faculty of Medicine, University of the French West Indies, 97261 Fort-de-France, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, CHRU of Lille, 59000 Lille, France;
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Pagano F, Schwander A, Vaineau C, Laura K, Nirgianakis K, Imboden S, Mueller MD. True Prevalence of Diaphragmatic Endometriosis and Its Association with Severe Endometriosis: A Call for Awareness and Investigation. J Minim Invasive Gynecol 2023; 30:329-334. [PMID: 36669679 DOI: 10.1016/j.jmig.2023.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE To identify characteristics indicating preoperatively the presence of diaphragmatic endometriosis (DE). DESIGN Comparison of characteristics of patients with diaphragmatic endometriosis (DE) with characteristics of patients with abdominal endometriosis without diaphragmatic involvement, in a prospective cohort study. SETTING Tertiary referral center; endometriosis center. PATIENTS A total of 1372 patients with histologically proven endometriosis. INTERVENTIONS Surgery performed laparoscopically under general anesthesia. All patients with suspected endometriosis underwent a complete bilateral inspection of the diaphragm. MEASUREMENTS AND MAIN RESULTS Demographic and clinical pathologic characteristics were evaluated using basic descriptive statistics (comparison of the groups using the χ2 test and the Mann-Whitney t test). A logistic regression analysis was performed to evaluate the relationship (hazard ratio) between symptoms and the presence of DE. DE was diagnosed in 4.7% of the patients (65 of 1372). There was no significant difference between the 2 groups (patients with abdominal endometriosis with or without DE) with regard to typical endometriosis pain (dysmenorrhea, dyschezia, dysuria, and/or dyspareunia). However, in the DE group, diaphragmatic pain was present significantly more often preoperatively (27.7% vs 1.8%, p <.001). Four DE patients (6.1 %) were asymptomatic (with infertility the indication for surgery). In the DE group, 78.4 % had advanced stages of endometriosis (revised American Fertility Society III° or IV°); the left lower pelvis was affected in more patients (73.8%). In cases of ovarian endometriosis, patients with DE showed a significantly higher prevalence of left ovaries involvement (left 63% vs right 35.7%, p <.001). Patients with DE had a significantly higher rate of infertility (49.2% vs 28.7%, p <.05). CONCLUSION Patients with shoulder pain, infertility, and/or endometriosis in the left pelvis have a significant higher risk of DE and therefore need specific preoperative counseling and if indicated surgical treatment.
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Affiliation(s)
- Flavia Pagano
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Adriana Schwander
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Cloé Vaineau
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Knabben Laura
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Konstantinos Nirgianakis
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Sara Imboden
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors)
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, Bern University Hospital and University of Bern, Bern, Switzerland (all authors).
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