1
|
Noar M, Mathias J, Kolatkar A. Gastrointestinal Myoelectrical Activity (GIMA) Biomarker for Noninvasive Diagnosis of Endometriosis. J Clin Med 2024; 13:2866. [PMID: 38792407 PMCID: PMC11122642 DOI: 10.3390/jcm13102866] [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: 04/07/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Endometriosis represents substantial direct and indirect healthcare costs impacted by an absence of uniformly accurate, non-invasive diagnostic tools. We endeavored to demonstrate gastrointestinal myoelectrical activity (GIMA) biomarkers, unique to endometriosis, will allow non-invasive, uniformly accurate diagnosis or exclusion of endometriosis. Methods: Prospective open-label comparative study of 154 patients, age ≥ 18, with or without diagnosed endometriosis. Population included 62 non-endometriosis controls (Cohort 1), 43 subjects with surgically/histologically confirmed endometriosis (Cohort 2), and 49 subjects with abdominal pain and negative imaging (Cohort 3). Non-invasive electroviscerography (EVG) recorded GIMA biomarkers from three abdominal electrodes before and 30 min post water load protocol. Cohort 2 had postoperative EVG and Cohort 3 had preoperative EVG. Calculated specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and predictive probability or C-statistic used univariate, multivariate, linear, and logistical regression analyses of the area under the curve (AUC) at all frequency and time points, including age and pain covariants. Results: The non-endometriosis cohort differed significantly from the endometriosis cohorts (p < 0.001) for median (IQR) and AUC percent frequency distribution of power at baseline, 10 min, 20 min, and 30 min post water load at all frequency ranges: 15-20 cpm, 30-40 cpm, and 40-50 cpm. The endometriosis cohorts were statistically similar (p > 0.05). GIMA biomarker threshold scoring demonstrated 95%/91% sensitivity and PPV, 96%/95% specificity and NPV, and a C-statistic of >99%/98%, respectively, for age subsets. GIMA biomarkers in Cohort 3 predicted 47/49 subjects positive and 2/49 negative for endometriosis, confirmed surgically. Hormonal therapy, surgical stage, nor pain score affected diagnostic accuracy. Conclusions: EVG with GIMA biomarker detection distinguished participants with and without endometriosis based upon endometriosis-specific GIMA biomarkers threshold scoring.
Collapse
Affiliation(s)
- Mark Noar
- Endometriosis and Neuroenterology Research Institute, 53 Loveton Circle, Sparks Glencoe, MD 21152, USA
| | - John Mathias
- Woman’s Hospital of Texas, 7600 Fannin Street, Houston, TX 77054, USA;
- Gastrointestinal Consultants of Houston, 7501 Fannin St., Suite 705, Houston, TX 77054, USA
| | - Ajit Kolatkar
- Specialty Business Center, Integrative Ayurveda Gastroenterology and Nutrition Initiative, 202, Balewadi, Pune 411045, Maharashtra, India;
| |
Collapse
|
2
|
Laguerre MD, Arkerson BJ, Robinson MA, Moawad NS. Outcomes of laparoscopic management of chronic pelvic pain and endometriosis. J OBSTET GYNAECOL 2022; 42:146-152. [PMID: 34009084 DOI: 10.1080/01443615.2021.1882967] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study was designed to determine the rates of reoperation following laparoscopic management of endometriosis, with additional aims to examine long-term fertility and quality of life outcomes. This is a retrospective study and a prospective questionnaire of subjects who underwent laparoscopic surgery for pelvic pain and/or endometriosis from 2010 to 2015. The rate of reoperation was 8.60%. Following surgery, 83.3% of previously infertile subjects with endometriosis attempted to conceive with an 80.0% success rate. Subjects had significant improvement in each quality of life measurement and most sexual function indices analysed.Impact StatementWhat is already known on this subject? Endometriosis is estimated to affect around 35-50% of women experiencing chronic pelvic pain and/or infertility. Surgical management of endometriosis is recommended for patients who desire fertility, are afflicted by a more severe form of endometriosis, or have had persistent or recurrent pain in spite of medical management.What the results of this study add? The overall rate of reoperation for subjects was low at 8.6%. The majority of infertile patients were able to conceive following surgery.What the implications are of these findings for clinical practice and/or further research? Laparoscopic management of endometriosis is an effective management tool with low rates of reoperation and high efficacy in treating infertility caused by endometriosis.
Collapse
Affiliation(s)
| | | | - Matthew A Robinson
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Nash S Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of Florida, Gainesville, FL, USA
| |
Collapse
|
3
|
Koninckx PR, Ussia A, Wattiez A, Adamyan L, Martin DC, Gordts S. The severity and frequency distribution of endometriosis subtypes at different ages: a model to understand the natural history of endometriosis based on single centre/single surgeon data. Facts Views Vis Obgyn 2021; 13:209-219. [PMID: 34555875 PMCID: PMC8823267 DOI: 10.52054/fvvo.13.3.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background and Objective to study the natural history of endometriosis. Materials and methods the analysis of all women (n=2086) undergoing laparoscopy for pelvic pain and endometriosis between 1988 and 2011 at University Hospital Gasthuisberg. Main outcome measures the severity of subtle, typical, cystic and deep endometriosis in adult women, with or without a pregnancy, as estimated by their pelvic area and their volume. Results the number of women undergoing a laparoscopy increased up to 28 years of age and decreased thereafter. Between 24 and 44 years, the severity and relative frequencies of subtle, typical, cystic and deep lesions did not vary significantly. The number of women younger than 20 years was too small to ascertain the impression of less severe lesions. The severity of endometriosis lesions was not less in women with 1 or more previous pregnancies or with previous surgery. There was no bias over time since the type and severity of endometriosis lesions remained constant between 1988 and 2011. Conclusions severity of endometriosis does not increase between 24 and 44 years of age, suggesting that growth is limited by intrinsic or extrinsic factors. Severity was not lower in women with a previous pregnancy. What is new considering the time needed for lesions to become symptomatic together with the diagnostic delay, the decreasing number of laparoscopies after age 28 is compatible with a progressively declining risk of initiating endometriosis lesions after menarche, the remaining women being progessively less susceptible.
Collapse
|
4
|
Guo SW, Martin DC. The perioperative period: a critical yet neglected time window for reducing the recurrence risk of endometriosis? Hum Reprod 2020; 34:1858-1865. [PMID: 31585460 DOI: 10.1093/humrep/dez187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/11/2019] [Indexed: 12/11/2022] Open
Abstract
While surgery is commonly the management of symptomatic endometriosis when patients do not respond to medical or supportive therapy, recurrence after surgery poses a serious challenge, and repeat surgery increases the risk of premature ovarian failure, adhesion and organ injury. Conceivably, the recurrent endometriotic lesions could arise from minimal residual lesions (MRLs) or from de novo lesions. However, several lines of evidence suggest that the former is more likely. So far, most, if not all, efforts to combat recurrence have been focused on postoperative medication of hormonal drugs to reduce recurrence risk through lesional dormancy and possibly atrophy. However, the perioperative period may exert a disproportionally high impact on the risk of recurrence; it is likely to be amendable for possible intervention but has been generally neglected. Indeed, many perioperative factors are known to or conceivably could facilitate the recurrence of endometriosis through the suppression of cell-mediated immunity due to the activation of adrenergic signaling and the release of prostaglandins. Perioperative use of β-blockers and/or nuclear factor κB/jCycloxygenase 2 (NF-κB/COX-2) inhibitors may boost the cell-mediated immunity suppressed by surgery, resulting in the partial or even complete removal of MRLs and reduced recurrence risk. This is both biologically plausible and supported by a recent experimental study. We call for more research on possible perioperative interventions to reduce the recurrence risk of endometriosis. The potential payoff might be a substantial reduction in the risk of recurrence and cost when compared with the traditional approach of postoperative intervention.
Collapse
Affiliation(s)
- Sun-Wei Guo
- Shanghai OB/GYN Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Dan C Martin
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institutional Review Board, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
5
|
Harris A, McCaughey T, Tsaltas J, Davies-Tuck M, Ratner R, Najjar H, Barel O. Endometriosis-related pelvic pain following laparoscopic surgical treatment. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520926038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Endometriosis is a common, often-debilitating disease, affecting women of reproductive age. Pain is a common symptom of the disease and is commonly treated by surgery, medical therapy, or a combination of the two. This study aimed to evaluate the rates of ongoing pain post laparoscopic excision and the risk factors for ongoing pain symptoms. Methods: This retrospective cohort study analyzed the medical records of all patients who underwent laparoscopic surgery for endometriosis in a large tertiary healthcare service in Australia between January 2009 and September 2016. Results were analyzed using SPSS statistics version 11. Results: A total of 972 patients met the inclusion criteria; of these, 398 had follow-up at our hospital network and were included in the final analysis. The median age was 34.5 years, 69.6% were of Caucasian ethnicity, and the median body mass index was 25.9; 70.6% of our patients reported decreased pain after surgery. Patients who suffered from chronic pain were twice as likely to experience ongoing pain, while patients with stage 3–4 endometriosis were found to have 65% reduced odds of pain at follow-up (95% confidence interval = 0.22–0.61, p < 0.001). In univariate analysis of non-Caucasian patients, those who had a specialist endometriosis surgeon perform the surgery had significantly higher incidence of symptom improvement (58% reduced odds of recurrent pain and 40% reduced odds, p < 0.05, accordingly). Conclusion: The prevalence and severity of pain associated with endometriosis mandates a thorough understanding of the effectiveness of current management. Our article highlights the utility of laparoscopic surgery in treating endometriosis-associated pain.
Collapse
Affiliation(s)
- Amani Harris
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Tristan McCaughey
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- The Royal Women’s Hospital, Melbourne, VIC, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Roni Ratner
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
| | - Haider Najjar
- Gynaecological Endoscopy and Endometriosis Surgery Unit, Monash Health and Monash University, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Oshri Barel
- Obstetrics and Gynecology, Assuta Medical Center, Ben-Gurion University of the Negev, Ashdod, Israel
- Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
6
|
Singh SS, Gude K, Perdeaux E, Gattrell WT, Becker CM. Surgical Outcomes in Patients With Endometriosis: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:881-888.e11. [PMID: 31718952 DOI: 10.1016/j.jogc.2019.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Among women treated surgically for endometriosis-associated pain, comprehensive data are lacking on the proportions of patients who experience little or no symptom relief, develop recurrent symptoms, or require further surgical treatment for endometriosis. The aim of this study was to assess the efficacy of surgical procedures used to treat endometriosis-associated pain. METHODS Medline and Embase were searched on October 13, 2016. Articles referring to women undergoing surgery for the treatment of endometriosis-associated pain were screened by two independent investigators. For each included treatment arm, data were extracted for the proportion of patients reporting partial or no improvement after surgery for endometriosis-associated pain, pain recurrence, or requirement for further surgery. RESULTS A total of 38 studies were included. Most studies did not report relevant outcomes to evaluate pain (71.1%) and recurrent surgery (68.4%). Of the women who underwent lesion excision, 11.8% reported no improvement in pain, and 22.6% underwent further surgery. Postoperative pain, recurrent pain, and adverse events were reported by 34.3%, 28.7%, and 14.8%, respectively, of patients who underwent excision or ablation of endometriosis combined with pelvic denervation and in 25.0%, 15.8%, and 8.1% of women who underwent lesion excision alone. Of the patients who were treated surgically for deep endometriosis affecting the bowel and/or bladder, 7.0% experienced recurrent symptoms, and 4.1% underwent further surgery. CONCLUSION This review supports the findings of previous studies and highlights the need for standardized reporting and more detailed follow-up after surgery for endometriosis-associated pain.
Collapse
Affiliation(s)
- Sukhbir S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital & University of Ottawa, Ottawa, ON.
| | - Kerstin Gude
- Global Pharmacovigilance, Bayer AG, Berlin, Germany
| | | | - William T Gattrell
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, United Kingdom; Department of Mechanical Engineering and Mathematical Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Christian M Becker
- Endometriosis Care and Research (CaRe) Centre, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
7
|
Ceccaroni M, Bounous VE, Clarizia R, Mautone D, Mabrouk M. Recurrent endometriosis: a battle against an unknown enemy. EUR J CONTRACEP REPR 2019; 24:464-474. [PMID: 31550940 DOI: 10.1080/13625187.2019.1662391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recurrence of endometriosis after conservative surgery is not an uncommon finding. There is no uniformity, however, on what the term 'recurrence' means. Recurrence is variously defined in the literature as the relapse of pain, clinical or instrumental detection of an endometriotic lesion, repeat rise in CA 125 levels, or evidence of recurrence found during repeat surgery. Consequently, the reported recurrence rate varies widely (0-89%) in the different series, depending on its definition and the type of study performed. As endometriosis recurrence seems to be an indeterminate enemy, we set out to examine exactly what we were fighting in our everyday battle. In this narrative review, we aimed to seek an answer to questions related to endometriosis recurrence, some of which are often asked by our patients.
Collapse
Affiliation(s)
- Marcello Ceccaroni
- Department of Obstetrics and Gynaecology, Gynaecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Valentina Elisabetta Bounous
- Department of Surgical Sciences, Unit of Gynaecology and Obstetrics, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Roberto Clarizia
- Department of Obstetrics and Gynaecology, Gynaecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Daniele Mautone
- Department of Obstetrics and Gynaecology, Gynaecological Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy
| | - Mohamed Mabrouk
- Minimally Invasive Pelvic Surgery Unit, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
8
|
Carvalho N, Margatho D, Cursino K, Benetti-Pinto CL, Bahamondes L. Control of endometriosis-associated pain with etonogestrel-releasing contraceptive implant and 52-mg levonorgestrel-releasing intrauterine system: randomized clinical trial. Fertil Steril 2019; 110:1129-1136. [PMID: 30396557 DOI: 10.1016/j.fertnstert.2018.07.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the efficacy of an etonogestrel (ENG)-releasing contraceptive implant or the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) in the control of endometriosis-associated pelvic pain. DESIGN Noninferiority randomized clinical trial in which women with endometriosis were assigned to use an ENG implant (experimental treatment) or an LNG-IUS (active comparator). Monthly follow-up visits were conducted up to 6 months. SETTING University teaching hospital. PATIENT(S) One hundred three women, with endometriosis-associated chronic pelvic pain, dysmenorrhea, or both for more than 6 months. In cases of deep endometriosis, vaginal ultrasonography and magnetic resonance imaging were used as additional diagnostic tools. INTERVENTION(S) The ENG implant or the LNG-IUS were inserted within the first 5 days of the menstrual cycle. MAIN OUTCOME MEASURE(S) Daily scores of noncyclic pelvic pain and dysmenorrhea were evaluated using a daily visual analogue scale. Health-related quality of life was evaluated using the Endometriosis Health Profile-30 questionnaire at baseline and up to 6 months. Bleeding patterns were assessed daily from a menstrual calendar. RESULT(S) Both contraceptives improved significantly the mean visual analogue scale endometriosis-associated pelvic pain and dysmenorrhea, without significant differences between treatment group profiles. Health-related quality of life improved significantly in all domains of the core and modular segments of the Endometriosis Health Profile-30 questionnaire, with no difference between both treatment groups. The most common bleeding patterns at 180 days of follow-up were amenorrhea and infrequent bleeding and infrequent bleeding and spotting among ENG implant and LNG-IUS users, respectively. CONCLUSION(S) In this noninferiority study both contraceptives improved significantly pelvic pain, dysmenorrhea, and health-related quality of life in endometriosis. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov under number NCT02480647.
Collapse
Affiliation(s)
- Nelsilene Carvalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paolo, Brazil
| | - Deborah Margatho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paolo, Brazil
| | - Kleber Cursino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paolo, Brazil
| | - Cristina L Benetti-Pinto
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paolo, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paolo, Brazil.
| |
Collapse
|
9
|
Giampaolino P, Della Corte L, Saccone G, Vitagliano A, Bifulco G, Calagna G, Carugno J, Di Spiezio Sardo A. Role of Ovarian Suspension in Preventing Postsurgical Ovarian Adhesions in Patients with Stage III-IV Pelvic Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2018; 26:53-62. [PMID: 30092363 DOI: 10.1016/j.jmig.2018.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Endometriosis is a benign complex gynecologic condition with high morbidity that affects women of reproductive age. Pelvic adhesion formation represents a serious clinical challenge in the management of patients with endometriosis. Several interventions aimed at reducing postoperative ovarian adhesion formation have been proposed in recent years. Here we summarize the published evidence on the efficacy of ovarian suspension in preventing postoperative ovarian adhesion formation in women undergoing laparoscopic surgery for stage III-IV endometriosis. The research was conducted using electronic databases. A review of the abstracts of all references retrieved from the search was conducted. Selection criteria for the systematic review included all randomized controlled trials (RCTs) and nonrandomized studies (NRSs) of premenopausal women diagnosed with stage III-IV pelvic endometriosis who underwent ovarian suspension or no ovarian suspension (control group). The RCTs were eligible for meta-analysis. Eight studies, 2 RCTs and 6 NRSs, were included in the systematic review. In all 8 studies, ovarian suspension was performed during surgery for stage III-IV endometriosis. The site of the suspension was the anterior abdominal wall in 76.8% of the cases. Five studies reported the use of polypropylene as suture for the suspension. Removal of the suspension suture in the postoperative period was reported in 6 studies. Pooled data from a meta-analysis of the RCTs show that women who underwent ovarian suspension had a significantly lower incidence of postoperative adhesion formation, particularly of moderate to severe adhesions. Ovarian suspension may reduce the rate and severity of postoperative adhesions formation in women undergoing laparoscopy for the treatment of stage III-IV endometriosis; however, RCTs with larger sample sizes are needed.
Collapse
Affiliation(s)
- Pierluigi Giampaolino
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gabriele Saccone
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Amerigo Vitagliano
- Department of Woman's and Child's Health, University of Padua, Padua, Italy (Dr Vitagliano)
| | - Giuseppe Bifulco
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gloria Calagna
- Department of Obstetrics and Gynecology, "Villa Sofia Cervello" University of Palermo, Palermo, Italy (Dr Calagna)
| | - Jose Carugno
- UHealth Obstetrics & Gynecology, Miller School of Medicine, University of Miami, Miami, Florida (Dr Carugno)
| | - Attilio Di Spiezio Sardo
- From the Departments of Public Health (Drs Giampaolino and Di Spiezio Sardo) and Neuroscience and Reproductive and Odontostomatological Sciences (Drs Della Corte, Saccone, and Bifulco), School of Medicine, University of Naples Federico II, Naples, Italy.
| |
Collapse
|
10
|
de Sanctis V, Matalliotakis M, Soliman AT, Elsefdy H, Di Maio S, Fiscina B. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract Res Clin Obstet Gynaecol 2018; 51:138-150. [PMID: 29548642 DOI: 10.1016/j.bpobgyn.2018.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/23/2018] [Indexed: 12/22/2022]
Abstract
Endometriosis (EM) occurring in adolescents presents distinct clinical and histologic characteristics compared to the disease in women. Because the symptoms of EM are nonspecific, often overlapping with those experienced in a range of gynecological and gastrointestinal conditions, the process of reaching a diagnosis of EM is often delayed. The diagnosis of EM is suspected depending on the history and the symptoms and signs, is corroborated by physical examination and imaging techniques, and is finally proved by histological examination of specimens collected during laparoscopy. Currently, there is insufficient evidence to make strong recommendations for management in adolescents who may have EM. This short report reviews some peculiarities of EM in adolescents and provides an update of recent knowledge of the diagnosis and treatment of EM. We hope that the present contribution may help to bring more attention to the clinical diagnosis of EM and consequently aid in decreasing diagnostic delay.
Collapse
Affiliation(s)
| | - Michail Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Crete, Greece; Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine University of Crete, Heraklion, Greece
| | - Ashraf T Soliman
- Department of Pediatrics, Division of Endocrinology, Alexandria University Children's Hospital, Alexandria, Egypt
| | - Heba Elsefdy
- Department of Pediatrics, Ain Shams University, Egypt
| | | | | |
Collapse
|
11
|
Alborzi S, Hosseini-Nohadani A, Poordast T, Shomali Z. Surgical outcomes of laparoscopic endometriosis surgery: a 6 year experience. Curr Med Res Opin 2017; 33:2229-2234. [PMID: 28760003 DOI: 10.1080/03007995.2017.1362377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of the present study was to review 6 year experience on the surgical outcomes of laparoscopic endometriosis surgery. METHODS A cohort study was performed in Shiraz University of Medical Sciences using data from medical records of 1315 cases of patients with endometriosis undergoing laparoscopic surgery with follow-up of 6 to 72 months. RESULTS This study concerned a cohort of 1315 patients diagnosed with endometriosis operated between April 2010 and April 2016, 1086 (82.5%) of whom were in stage III and IV; 968 (73.61%) had endometrioma (regardless of having deep infiltrative endometriosis [DIE] or peritoneal involvement) and 347 (26.39%) of patients had either DIE or peritoneal involvement without endometrioma. Regarding the patients, unilateral endometrioma was statistically significant in the left ovary (p = .002). One hundred and thirty-three (10.7%) rectal wall, 7 (0.32%) sigmoid colon, 4 (0.18%) vagina, 125 (5.6%) ureter and 33 (1.52) bladder involvements were detected. Prior to operation, the pain VAS score was 8.23 ± 2.03, which decreased to 4.46 ± 2.47 in 93.07% of patients. Fifty-three patients (6.56%) needed reoperation. Sixty-six (33.1%) infertile women had spontaneous pregnancy and 15 (25%) became pregnant using intrauterine insemination (IUI) or assisted reproductive technique (ART) post-operatively. CONCLUSION Surgical treatment of endometriosis seems to be an effective treatment. DIE can be present in the absence of endometrioma. The rate of left endometrioma is higher due to the pressure effect of the sigmoid colon. Nonetheless, if an expert surgeon performs this procedure, not only the rate of post-operative complications, but also the possibility of recurrence would decrease.
Collapse
Affiliation(s)
- S Alborzi
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - A Hosseini-Nohadani
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - T Poordast
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Z Shomali
- a Department of Obstetrics and Gynecology , Shiraz University of Medical Sciences , Shiraz , Iran
| |
Collapse
|
12
|
Seong SJ, Kim D, Lee KH, Kim TJ, Chung HH, Chang SJ, Lee EJ. Role of Hormone Therapy After Primary Surgery for Endometrioma: A Multicenter Retrospective Cohort Study. Reprod Sci 2016; 23:1011-8. [PMID: 26763524 DOI: 10.1177/1933719115625841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Endometriosis is a major cause of disability in women, and 40% to 50% of patients experience disease recurrence by 5 years after surgery. This multicenter retrospective cohort study (N = 588) determined the rate and risk factors for recurrent endometrioma after primary surgery and examined the role of postoperative hormone therapy. When recurrence was defined by sonographic identification of the endometrioma (≥20 mm in size), 61 (10.4%) patients experienced disease recurrence. The cumulative recurrence rates at 1, 2, 3, and 5 years after surgery were 2.2%, 4.9%, 6.9%, and 9.8%, respectively. To determine the risk factors for recurrence, the clinical factors of patients with and without recurrence were compared. There was a significantly increased risk of recurrence with posterior cul-de-sac (PCDS) obliteration (P = .031) and higher serum cancer antigen 125 (CA125) level (P = .005). A longer postoperative hormonal therapy duration (P < .01), absence of PCDS obliteration (P = .036), and lower serum CA125 level (P = .014) were associated with longer recurrence-free interval on multivariate analysis using the Cox regression model. Postoperative hormone therapy prolonged the interval from the time of surgery to the first recurrence. However, it did not prolong the interval from the end of treatment to the first recurrence. Our results indicate that although long-term postoperative hormone therapy might maintain minimal disease status, it does not control residual disease. Therefore, persistent hormone suppression should be used to prevent disease recurrence.
Collapse
Affiliation(s)
- Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Daeyeon Kim
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Keun-Ho Lee
- Department of Obstetrics and Gynecology, The Catholic University, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Sungkyunkwan University, Seoul, Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, Korea
| | - Suk-Joon Chang
- Department of Obstetrics and Gynecology, Ajou University, Suwon, Korea
| | - Eun-Ju Lee
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Koga K, Takamura M, Fujii T, Osuga Y. Prevention of the recurrence of symptom and lesions after conservative surgery for endometriosis. Fertil Steril 2015; 104:793-801. [DOI: 10.1016/j.fertnstert.2015.08.026] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/20/2015] [Accepted: 08/24/2015] [Indexed: 01/02/2023]
|
14
|
Medical treatment of ureteral obstruction associated with ovarian remnants and/or endometriosis: report of three cases and review of the literature. J Minim Invasive Gynecol 2014; 22:462-8. [PMID: 25533869 DOI: 10.1016/j.jmig.2014.12.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVE Experience with low-dose intermittent danazol or prolonged gonadotropin-releasing hormone agonist (GnRH-a) with and without add-back therapy in endometriosis-associated ureteral obstruction. DESIGN Retrospective case series (Canadian Task Force classification II-2). SETTING University-affiliated teaching hospital. PATIENTS Three women with endometriosis-associated ureteral obstruction. INTERVENTION The regimen of GnRH-a alone or with add-back included (1) leuprolide acetate 3.75 mg intramuscularly monthly; (2) micronized 17α-estradiol 1 mg/day by mouth; (3) pulsed norethinedrone 0.35 mg/day by mouth, 2 days on and/or 2 days off; and (4) letrozole 2.5 mg by mouth for the first 5 days of the first GnRH-a injection. Danazol, 100 mg/day by mouth, was prescribed as a regimen of 3 months on, 3 months off, for 4 years. MEASUREMENTS AND MAIN RESULTS The first case was a 50-year-old woman, gravida 3, para 3, body mass index (BMI) 27 kg/m(2), with multiple surgeries, including hysterectomy and bilateral salpingo-oophorectomy (HBSO), and history of a stroke. She presented with right-sided pain and hydro-uretero-nephrosis. Magnetic resonance imaging identified a right adnexal cyst (4.5 × 3.4 × 2.4 cm). She was treated with leuprolide acetate monthly injections and a ureteric stent. The cyst, pain, and hydro-uretero-nephrosis resolved after 12 months. The second case was a 45-year-old woman, G2P2, BMI 28 kg/m(2) with multiple surgeries, including HBSO. She presented with left-sided pelvic pain. Ultrasound identified a left adnexal cyst and hydronephrosis. After 3 months of leuprolide acetate and add-back therapy, the cyst, pain, and hydronephrosis resolved. The third case was a 46-year-old woman, G2P2, BMI 25 kg/m(2), who presented with left flank and pelvic pain. Magnetic resonance imaging indicated moderate left hydronephrosis and left adnexal pelvic side-wall involvement with possible endometriosis. Due to many previous surgeries, this patient was a high-risk surgical candidate, and therefore, she was offered medical therapy. After a normal serum liver and lipid profile, she was started on danazol, 100 mg/day for 3 months. After 3 months of therapy, there was complete resolution of the patient's hydronephrosis and pain. She was then advised to continue with a 3-month on, 3-month off regimen. She discontinued the danazol and remained asymptomatic with no recurrence of hydronephrosis at 3 years. CONCLUSIONS Low-dose intermittent danazol or GnRH-a alone or with add-back, may be effective long-term therapies in endometriosis-associated ureteral obstruction when surgery is contraindicated, refused, or difficult to perform.
Collapse
|
15
|
Jacobson TZ, Duffy JMN, Barlow DH, Koninckx PR, Garry R. WITHDRAWN: Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 2014; 2014:CD001300. [PMID: 25130257 PMCID: PMC10734376 DOI: 10.1002/14651858.cd001300.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This review has been replaced by a review entitled 'Laparoscopic surgery for endometriosis', published in issue 4 of The Cochrane Library, 2014. The editorial group responsible for this previously published document have withdrawn it from publication.
Collapse
Affiliation(s)
- Tal Z Jacobson
- Mater Mother's HospitalDepartment of Obstetrics and GynaecologySouth BrisbaneBrisbaneQueenslandAustralia4101
| | - James MN Duffy
- Balliol College, University of OxfordNuffield Department of Primary Care Health SciencesNew Radcliffe House58 Turner StreetOxfordOxfordshireUKOX2 6NW
| | | | - Philippe R Koninckx
- Univ. Hospital Leuven, Campus GasthuisbergDepartment of Obstetrics & GynecologyHerestraat 49BLeuvenBelgiumB‐3000
| | - Ray Garry
- University of Teeside and South Cleveland Hospital, MiddlesbroughGynaecological Surgery94 WestgateGuisboroughYorkshireUKTS14 6AP
| | | |
Collapse
|
16
|
Unlü C, Yıldırım G. Ovarian cystectomy in endometriomas: Combined approach. J Turk Ger Gynecol Assoc 2014; 15:177-89. [PMID: 25317047 DOI: 10.5152/jtgga.2014.1111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
Endometrioma is one of the most frequent adnexal masses in the premenopausal population, but the recommended treatment is still a subject of debate. Medical therapy is inefficient and can not be recommended in the management of ovarian endometriomas. The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent. While the surgical treatment of choice is surgical laparoscopy, for conservative treatment, the preferred method is modified combined cystectomy. Cystectomy can be destructive for the ovary, whereas ablation may be incomplete, with a greater risk of recurrence. To the best of our knowledge, the modified combined technique seems to be more efficient in the treatment of endometriomas.
Collapse
Affiliation(s)
- Cihat Unlü
- Department of Obstetrics and Gynecology, Acıbadem University, Bakırköy Acıbadem Hospital, İstanbul, Turkey
| | - Gazi Yıldırım
- Department of Obstetrics and Gynecology, Yeditepe University Hospital, İstanbul, Turkey
| |
Collapse
|
17
|
Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-014-0854-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Redwine DB, Hopton EN. Reply: Searching for truth. Hum Reprod 2014; 29:1595-6. [PMID: 24838705 DOI: 10.1093/humrep/deu098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
19
|
Recurrence of ovarian endometrioma after second-line, conservative, laparoscopic cyst enucleation. Am J Obstet Gynecol 2014; 210:216.e1-6. [PMID: 24215855 DOI: 10.1016/j.ajog.2013.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/06/2013] [Accepted: 11/05/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to evaluate the cumulative recurrence rate of endometrioma after a second-line, conservative, laparoscopic endometriotic cyst enucleation and to analyze the factors that influence the recurrence of endometrioma. STUDY DESIGN A multicenter retrospective cohort study was performed at 3 gynecologic surgery centers from January 2000 through December 2010. Patients surgically treated by laparoscopic enucleation of endometriotic cysts on 2 previous occasions were selected. All patients were aged <40 years at the time of the primary surgery and were followed up for at least 6 months. Endometrioma recurrence was considered when transvaginal sonography indicated a cystic mass with a diameter of ≥20 mm. RESULTS In total, 183 patients were followed up for 33.2 ± 27.7 months (range, 6-121 months). Thirty-eight (20.8%) patients experienced recurrence after the second-line surgery and 24 (13.1%) patients underwent a third surgery. The median time to recurrence was 24 ± 3.36 months (SEM) (range, 3-72 months). The cumulative recurrence rates per patient at 12, 24, 36, and 60 months after the second-line surgery were 7.7%, 13.7%, 21.3%, and 37.5%, respectively. After multivariate analysis and analysis of covariance, the revised American Fertility Society score and stage were significantly higher in patients who experience a third recurrence of endometrioma. CONCLUSION The cumulative recurrence rate of ovarian endometrioma after a second-line surgery appears to be correlated to the duration of follow-up. Severe endometriosis at the second-line surgery seems to be a factor associated with a high recurrence risk. Physicians should be cautious with regard to the postoperative management of these patients.
Collapse
|
20
|
Hoo WL, Stavroulis A, Pateman K, Saridogan E, Cutner A, Pandis G, Tong ENC, Jurkovic D. Does ovarian suspension following laparoscopic surgery for endometriosis reduce postoperative adhesions? An RCT. Hum Reprod 2014; 29:670-6. [DOI: 10.1093/humrep/deu007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Yeung P, Tu F, Bajzak K, Lamvu G, Guzovsky O, Agnelli R, Peavey M, Winer W, Albee R, Sinervo K. A pilot feasibility multicenter study of patients after excision of endometriosis. JSLS 2013; 17:88-94. [PMID: 23743377 PMCID: PMC3662751 DOI: 10.4293/108680812x13517013317833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A multicenter prospective study evaluating the management of endometriosis comparing excision versus ablation is needed using primary outcomes other than chronic pelvic pain. Objective: To serve as a pilot feasibility study for a randomized study of excision versus ablation in the treatment of endometriosis by (1) estimating the magnitude of change in symptoms after excision only at multiple referral centers and (2) determining the proportion of women willing to participate in a randomized trial. Methods: We performed a multicenter prospective study of women undergoing excision for endometriosis (Canadian Task Force class II-3) at Duke University Center for Endometriosis Research & Treatment (currently the Saint Louis University Center for Endometriosis), Center for Endometriosis Care, Northshore University Health System, Memorial University (Canada), and Florida Hospital. The study comprised 100 female patients, aged 18 to 55 years, with endometriosis-suspected pelvic pain. The intervention was laparoscopic excision only of the abnormal peritoneum suspicious for endometriosis. The main outcome measures were quality of life, pelvic pain, dysmenorrhea, dyspareunia, and bowel and bladder symptoms. Results: The mean follow-up period was 8.5 months. Excision of endometriosis showed a significant reduction in all pain scores except bowel symptoms, as well as significant improvement in quality of life. Of the patients, 84% were willing to participate in a randomized study. Conclusions: Quality of life is a needed primary outcome for any randomized study comparing excision versus ablation. A multicenter comparative trial is feasible, although quality assurance would have to be addressed. Patients were willing to be randomized even at surgical referral centers.
Collapse
Affiliation(s)
- Patrick Yeung
- Department of Obstetrics, Gynecology & Women's Health, Saint Louis University, St. Louis, MO, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Wang YF, Chang MY, Chiang RD, Hwang LJ, Lee CM, Wang YH. Mining Medical Data: A Case Study of Endometriosis. J Med Syst 2013; 37:9899. [DOI: 10.1007/s10916-012-9899-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/06/2012] [Indexed: 12/01/2022]
|
23
|
VERCELLINI PAOLO, DE MATTEIS SARA, SOMIGLIANA EDGARDO, BUGGIO LAURA, FRATTARUOLO MARIAPINA, FEDELE LUIGI. Long-term adjuvant therapy for the prevention of postoperative endometrioma recurrence: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2012; 92:8-16. [DOI: 10.1111/j.1600-0412.2012.01470.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
24
|
Abstract
BACKGROUND Rectal endometriosis can cause debilitating symptoms. Rectal resection in this setting has been shown to improve symptoms; however, there remain some reservations about this intervention because of the risk of complications such as anastomotic leak and rectovaginal fistula. OBJECTIVE The aim of this study is to review our experience with rectal resection in patients with rectal endometriosis. DATA SOURCES Hospital records and prospectively maintained electronic databases of an endogynecologist and colorectal surgeon were reviewed. STUDY SELECTION This is a retrospective study of consecutive patients who underwent rectal resection for endometriosis from 2001 to 2010. INTERVENTIONS All patients underwent either disc or segmental resection of the rectum. MAIN OUTCOME MEASURES Outcomes of interest were operative complications and recurrence requiring surgical reintervention. RESULTS Ninety-one patients underwent 92 resections for endometriosis. Sixty-five (71%) were disc resections, 25 (27%) were segmental resections, and 1 patient underwent both disc and segmental resections. Eighty-one (88%) procedures were completed laparoscopically. Patients requiring segmental resection had more extensive disease, and this was associated with open conversion (p ≤ 0.0001). Average duration of procedure was 209 minutes. Three patients (3%) required defunctioning ileostomies. Intramural endometriosis was confirmed in 96.7% of specimens. Complications occurred in 13 patients (15%); 4 were minor. Three patients had small pelvic collections treated with antibiotics, 5 patients required transfusion for bleeding (3 intraoperative, 2 anastomotic bleeds that settled conservatively), and 1 patient sustained ureteric injury that was reimplanted with no sequelae. None had anastomotic leak or rectovaginal fistula. Ten patients (11%) required reintervention for recurrent symptoms. Of these, 8 (8.8%) patients were found to have recurrent endometriosis. No correlation could be found between involved margins on pathology and need for redo surgery. LIMITATIONS : This study is limited by its retrospective nature. CONCLUSIONS Laparoscopic rectal resection for deeply infiltrative endometriosis is feasible and safe, and it provides durable symptom control with acceptable recurrence rates.
Collapse
|
25
|
Crispi CP, de Souza CAP, Oliveira MAP, Dibi RP, Cardeman L, Sato H, Schor E. Endometriosis of the Round Ligament of the Uterus. J Minim Invasive Gynecol 2012; 19:46-51. [DOI: 10.1016/j.jmig.2011.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 09/02/2011] [Accepted: 09/08/2011] [Indexed: 10/15/2022]
|
26
|
Burghaus S, Klingsiek P, Fasching PA, Engel A, Häberle L, Strissel PL, Schmidt M, Jonas K, Strehl JD, Hartmann A, Lermann J, Boosz A, Thiel FC, Müller A, Beckmann MW, Renner SP. Risk Factors for Endometriosis in a German Case-Control Study. Geburtshilfe Frauenheilkd 2011; 71:1073-1079. [PMID: 25253901 DOI: 10.1055/s-0031-1280436] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 11/07/2011] [Accepted: 11/07/2011] [Indexed: 12/31/2022] Open
Abstract
Objective: The etiology of endometriosis is still a research field in which few consistent data are available. Large case-control studies or even cohort studies are rare, and most of the published data are conflicting. The aim of the present study was therefore to examine common epidemiological and endometriosis-specific risk factors in a German case-control study. Design: From 2001 to 2010, a pool of 595 laparoscopically confirmed cases and 475 controls were recruited in a hospital-based setting. After matching for age, 298 cases and 300 controls remained in the pool. Age at menarche, menstrual cycle length, duration of menstrual bleeding, number of pregnancies, live births, miscarriages, use of contraceptive pills, body mass index (BMI), and smoking status were analyzed with logistic regression models predicting endometriosis case-control status. Results: Menstrual cycle length, duration of menstrual bleeding, number of pregnancies, number of miscarriages, and smoking status, as relevant predictors for endometriosis case-control status, were identified as risk factors for endometriosis. Other factors such as age at menarche, number of live births, ever having used contraceptive pills, and BMI were not predictive. Conclusions: This hospital-based case-control study reproduced most of the familiar risk factors. Comparison of this study with others reveals a wide variety of effect sizes and directions of association with risk factors and may increase the information available about the characteristics of the patient population being treated in the relevant hospital setting.
Collapse
Affiliation(s)
- S Burghaus
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - P Klingsiek
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - P A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - A Engel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - L Häberle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - P L Strissel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M Schmidt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - K Jonas
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - J D Strehl
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - A Hartmann
- Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen
| | - J Lermann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - A Boosz
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - F C Thiel
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - A Müller
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| | - S P Renner
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University , Erlangen-Nuremberg, Erlangen
| |
Collapse
|
27
|
Trew G, Pistofidis G, Pados G, Lower A, Mettler L, Wallwiener D, Korell M, Pouly JL, Coccia ME, Audebert A, Nappi C, Schmidt E, McVeigh E, Landi S, Degueldre M, Konincxk P, Rimbach S, Chapron C, Dallay D, Röemer T, McConnachie A, Ford I, Crowe A, Knight A, Dizerega G, Dewilde R. Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 2011; 26:2015-27. [PMID: 21632697 DOI: 10.1093/humrep/der135] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gynaecological laparoscopic surgery outcomes can be compromised by the formation of de novo adhesions. This randomized, double-blind study was designed to assess the efficacy and safety of 4% icodextrin solution (Adept(®)) in the reduction of de novo adhesion incidence compared to lactated Ringer's solution (LRS). METHODS Patients undergoing laparoscopic surgery for removal of myomas or endometriotic cysts were treated with randomized solution as an intra-operative irrigant and 1l post-operative instillate. De novo adhesion incidence (number of sites with adhesions), severity and extent were independently scored at a second-look procedure and the efficacy of the two solutions compared. The effect of surgical covariates on adhesion formation was also investigated. Initial exploratory analysis of individual anatomical sites of clinical importance was progressed. RESULTS Of 498 patients randomized, 330 were evaluable (160 LRS--75% myomectomy/25% endometriotic cysts; 170 Adept--79% myomectomy/21% endometriotic cysts). At study completion, 76.2% LRS and 77.6% Adept had ≥ 1 de novo adhesion. The mean (SD) number of de novo adhesions was 2.58 (2.11) for Adept and 2.58 (2.38) for LRS. The treatment effect difference was not significant (P = 0.909). Assessment of surgical covariates identified significant influences on the mean number of de novo adhesions regardless of treatment, including surgery duration (P = 0.048), blood loss in myomectomy patients (P = 0.019), length of uterine incision in myomectomy patients (P < 0.001) and number of suture knots (P < 0.001). There were 15 adverse events considered treatment-related in the LRS patients (7.2%) and 18 in the Adept group (8.3%). Of 17 reported serious adverse events (9 LRS; 8 Adept) none were considered treatment-related. CONCLUSIONS The study confirmed the safety of Adept in laparoscopic surgery. The proportion of patients with de novo adhesion formation was considerably higher than previous literature suggested. Overall there was no evidence of a clinical effect but various surgical covariates including surgery duration, blood loss, number and size of incisions, suturing and number of knots were found to influence de novo adhesion formation. The study provides direction for future research into adhesion reduction strategies in site specific surgery.
Collapse
Affiliation(s)
- G Trew
- Reproductive Medicine and Surgery, Hammersmith and Queen Charlotte's Hospital, London W12 OHS, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Hoo WL, Saridogan E, Cutner A, Pandis G, Jurkovic D. Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: a randomised controlled trial. BMC WOMENS HEALTH 2011; 11:14. [PMID: 21569374 PMCID: PMC3119028 DOI: 10.1186/1472-6874-11-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/11/2011] [Indexed: 11/12/2022]
Abstract
Background Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions. Methods A prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded. Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process. The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain. Discussion This controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis. Trial registration ISRCTN: ISRCTN24242218
Collapse
Affiliation(s)
- Wee-Liak Hoo
- Department of Obstetrics and Gynaecology, University College Hospital, London, NW1 2BU, UK.
| | | | | | | | | |
Collapse
|
29
|
Yeung P, Sinervo K, Winer W, Albee RB. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril 2011; 95:1909-12, 1912.e1. [DOI: 10.1016/j.fertnstert.2011.02.037] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 11/25/2022]
|
30
|
Kondo W, Bourdel N, Jardon K, Tamburro S, Cavoli D, Matsuzaki S, Botchorishvili R, Rabischong B, Pouly JL, Mage G, Canis M. Comparison between standard and reverse laparoscopic techniques for rectovaginal endometriosis. Surg Endosc 2011; 25:2711-7. [PMID: 21424199 DOI: 10.1007/s00464-011-1635-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 02/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study was designed to compare the surgical outcomes of standard and reverse laparoscopic techniques for the treatment of rectovaginal endometriosis. METHODS A retrospective study was conducted in a teaching and research hospital (tertiary center), which included 75 women subjected to laparoscopic treatment of rectovaginal endometriosis that required both vaginal resection and rectal surgery. Standard and reverse laparoscopic techniques were compared in 35 and 40 women, respectively. Student's t test, Mann-Whitney test, and Fisher's exact test were performed to compare groups when needed; p < 0.05 was considered statistically significant. RESULTS There was no statistically significant difference in operating time, blood loss, conversion rate, major intraoperative complications, length of hospital stay, and minor postoperative complications between the two techniques. The rate of major postoperative complications for the standard technique was 22.9%, whereas only 5% for the reverse technique (p = 0.02). The rate of postoperative rectovaginal fistula was the same for both techniques. CONCLUSIONS Major postoperative complications were reduced by using the reverse technique.
Collapse
Affiliation(s)
- William Kondo
- Department of Gynecologic Surgery, CHU Estaing, Clermont-Ferrand, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Bayoglu Tekin Y, Dilbaz B, Altinbas SK, Dilbaz S. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril 2011; 95:492-6. [DOI: 10.1016/j.fertnstert.2010.08.042] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 07/27/2010] [Accepted: 08/19/2010] [Indexed: 11/29/2022]
|
32
|
Fertilité des patientes présentant une endométriose traitées par cœlioscopie et AMP. ACTA ACUST UNITED AC 2011; 39:3-7. [DOI: 10.1016/j.gyobfe.2010.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/26/2010] [Indexed: 11/23/2022]
|
33
|
Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27:441-7. [PMID: 20574791 PMCID: PMC2941592 DOI: 10.1007/s10815-010-9436-1] [Citation(s) in RCA: 360] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 05/06/2010] [Indexed: 11/30/2022] Open
Abstract
Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20-25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.
Collapse
Affiliation(s)
- Carlo Bulletti
- Physiopathology of Reproduction, Cattolica's General Hospital and University of Bologna, Polo Scientifico Didattico di Rimini, Bologna, Italy.
| | | | | | | |
Collapse
|
34
|
Ferrero S, Remorgida V, Venturini PL. Current pharmacotherapy for endometriosis. Expert Opin Pharmacother 2010; 11:1123-34. [PMID: 20230308 DOI: 10.1517/14656561003685880] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Medical therapy is the most commonly used treatment for endometriosis. In particular, the administration of hormonal therapies aims to improve symptoms with minimal adverse effects. AREAS COVERED IN THIS REVIEW Observational and randomized studies evaluating the efficacy of medical therapy on symptoms associated with endometriosis were reviewed. We searched Medline, Embase and the Cochrane Library up to December 2009. WHAT THE READER WILL GAIN The reader will obtain information on the available medical therapies used to treat endometriosis-related symptoms either after surgery or as an alternative to the surgical excision of endometriosis. The effectiveness of therapies, the dose of drugs, the length of treatment and the adverse effects are examined. TAKE HOME MESSAGE Medical therapies can efficaciously reduce the severity of pain symptoms caused by endometriosis. Recurrence of symptoms is common after discontinuation of medical therapies; therefore, the choice of the therapy should be based not only on the improvements of symptoms but also on the potential adverse effects and patients' satisfaction.
Collapse
Affiliation(s)
- Simone Ferrero
- San Martino Hospital and University of Genoa, Department of Obstetrics and Gynaecology, Largo Rosanna Benzi 1, 16132, Genoa, Italy.
| | | | | |
Collapse
|
35
|
Berkes E, Bokor A, Rigó J. Treatment of endometriosis with laparoscopic surgery today. Orv Hetil 2010; 151:1137-44. [DOI: 10.1556/oh.2010.28904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Az endometriosis korszerű sebészi kezelésének célja a károsodott kismedencei anatómia helyreállításával az endometriosishoz társuló fájdalomtünetek csökkentése, illetve a teherbe esési esélyek javítása. Cikkünkben a különböző elhelyezkedésű kismedencei endometriosislaesiók eltávolításának műtéti lehetőségeit elemezzük. Az endometriosis sebészi kezelése döntően laparoszkópia útján valósul meg, míg a laparotomia alkalmazási köre egyre inkább beszűkült és csak speciális esetekre korlátozódik. A peritonealis endometriosis laesiói reszekció, elektrokoaguláció vagy lézervaporizáció segítségével kezelhetők, amelyek azonos mértékben csökkentik az endometriosishoz társuló fájdalomtüneteket, illetve javítják a teherbe esési esélyeket. Az endometrioma kezelésében hosszú éveken át kétféle műtéti megoldás terjedt el; a cisztatok eltávolítása az úgynevezett strippingtechnika segítségével, valamint a cisztatok megszüntetése az ablatiós műtéti technikával. Napjainkra egyértelműen bebizonyosodott, hogy a stripping előnyösebb az endometrioma ablatiójával szemben mind a fájdalomtünetek csökkenése, mind a reproduktív funkciók szempontjából. A mélyen infiltráló endometriosis kezelése jelenti a legnagyobb kihívást az endometriosis sebészetében. A mélyen infiltráló laesiók eltávolításában a lézertechnika alkalmazásának jut főszerep. A rectovaginalis septum endometriosisa esetén lézer segítségével a mélyen infiltráló laesio biztonsággal és maradéktalanul eltávolítható. Bélendometriosis esetén az érintett bélszakaszt szegmentális reszekcióval, discreszekcióval vagy az úgynevezett shavingtechnikával távolíthatjuk el. Leggyakrabban a szegmentális reszekciót alkalmazzuk, mivel egyedül ez esetben biztosítható a reszekciós szél biztos épsége. Az ureter endometriosisa esetén kisfokú érintettség mellett ureterolysis, míg obstruktív uropathia fennállásakor az ureter reszekciója javasolható. Az endometriosishoz társuló fájdalom hatékonyabb csökkentését célozza a praesacralis neurectomia és az uterusidegrost-ablatio. Ezen beavatkozások klinikai eredményessége azonban nem egyértelmű, az endometriosis kezelésében betöltött pontos szerepük tisztázása további vizsgálatokat igényel. Az endometriosis sebészetében a folyamatosan fejlődő műtéti technikák az endometriosislaesiók egyre teljesebb és hatékonyabb eltávolítását teszik lehetővé, amelynek köszönhetően egyre eredményesebben kezelhetők az endometriosishoz társuló klinikai tünetek és csökkenthető a betegség kiújulásának veszélye.
Collapse
Affiliation(s)
- Enikő Berkes
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
| | - Attila Bokor
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
| | - János Rigó
- 1 Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
| |
Collapse
|
36
|
Vercellini P, Somigliana E, Viganò P, De Matteis S, Barbara G, Fedele L. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 2010; 21:259-65. [PMID: 20541975 DOI: 10.1016/j.rbmo.2010.04.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 10/09/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
Abstract
Prevention of the recurrence of post-operative endometriosis is crucial for future fertility. The incidence of disease relapse can be influenced by major demographic changes and by the use of long-term adjuvant medical treatment. Decrease in age at menarche, number of pregnancies and duration of breastfeeding and increase in age at first birth all lead to an increase in the overall number of ovulations and menstruations a woman has within a reproductive lifespan. These changes impact during the decade at highest risk for endometriosis, i.e. between 25 and 35 years of age, and may substantially expand the hiatus between first-line surgical treatment and conception attempt. Several lines of evidence suggest that ovulation inhibition reduces the risk of endometriosis recurrence. After pooling the results of a cohort and a randomized controlled trial on long-term post-operative oral contraceptive use, a recurrent endometrioma developed in 26/250 regular users (10%; 95% CI 7-15%) compared with 46/115 never users (40%; 95% CI 31-50%), with a common OR of 0.16 (95% CI 0.04-0.65). After first-line surgery for endometriosis, women should be invited to seek conception as soon as possible. Alternatively, oral contraceptive use until pregnancy is desired should be considered.
Collapse
Affiliation(s)
- Paolo Vercellini
- Department of Obstetrics and Gynaecology, University of Milan and Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
37
|
Coagulation versus excision of primary superficial endometriosis: a 2-year follow-up. Eur J Obstet Gynecol Reprod Biol 2010; 150:195-8. [PMID: 20303642 DOI: 10.1016/j.ejogrb.2010.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 12/04/2009] [Accepted: 02/05/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Even the common mild forms of endometriosis can strongly affect quality of life due to dysmenorrhea, dyspareunia, dyschezia, or subfertility. We compared the effectiveness of the two laparoscopic methods, coagulation versus excision, for intraperitoneal superficial endometriosis with regard to recurrence and symptom control. STUDY DESIGN In a retrospective analysis we evaluated the postoperative follow-up of 79 patients, aged 16-42, with superficial manifestation of endometriosis (median rASRM score 9.2) operated on in the Department of Gynecology and Obstetrics at the Jena University Hospital. Forty-three patients were treated by electrocoagulation and 36 underwent sharp excision. Therapy success was evaluated by using a questionnaire after a mean follow-up of 29 months. Patients were interviewed about pain associated with endometriosis such as dysmenorrhea, dyspareunia, dyschezia and possible medical treatment after surgery. We evaluated the number of surgically proven relapses and questionnaire results using a pain score on an ordinal scale (1-5) for the three categories dysmenorrhea, dyspareunia, and dyschezia. RESULTS Both treatment methods resulted in a low number of endometriosis-related symptoms after surgical intervention and in recurrences of 2.8% in the coagulation group and 18.6% in the excision group. The recurrence rate in the coagulation group was lower (p=0.001). The coagulation group was also presented with a significantly lower postoperative pain score at our long-term follow-up (p=0.0067). CONCLUSION In cases of superficial endometriosis, laparoscopic surgery achieved low recurrence rates and good symptom control. Compared to sharp excision the use of bipolar electrocoagulation might result in fewer endometriosis-related symptoms as well as fewer relapses with need for surgical re-intervention after a more than 2-year interval. Due to the retrospective, non-randomized character of this study the results should be interpreted carefully. Further prospective studies are needed to assess the value of both surgical approaches in the treatment of endometriosis.
Collapse
|
38
|
Surgical treatment of endometriosis in private practice: cohort study with mean follow-up of 3 years. J Minim Invasive Gynecol 2010; 17:42-6. [PMID: 20129331 DOI: 10.1016/j.jmig.2009.09.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/18/2009] [Accepted: 09/24/2009] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To describe our experience with surgical treatment of endometriosis. DESIGN Observational cohort study (Canadian Task Force classification II-2). SETTING Private hospital. PATIENTS One hundred sixty-three patients with histologically confirmed endometriosis who had completed a preoperative questionnaire, had available intraoperative findings and photographic documentation, and had been followed up to 6 years. INTERVENTION Laparoscopic electrosurgical excision of endometriotic implants. MEASUREMENTS AND MAIN RESULTS Patients completed a visual analogue scale (VAS) for 6 components of endometriosis-related symptoms. The EuroQol Group EQ-5D questionnaire was used for evaluation of quality of life. Long-term follow up was performed using a questionnaire and review of patient medical records. Mean (SD; 95% confidence interval) patient age at surgery was 31.01 (8.5; 29.7-32.3) years. The primary symptom at initial consultation was dysmenorrhea in 94 patients (57.67%, nonmenstrual pelvic pain in 44 (27%), dyspareunia in 11 (6.75%), menorrhagia in 8 (4.9%), infertility in 4 (2.45%), and pelvic mass in 2 (1.23%). Thirty-three patients (20%) had undergone previous surgery because of endometriosis. At surgery, endometriosis was stage I in 50 patients (30.67%), stage II in 65 (39.88%), stage III in 23 (14.11%), and stage IV in 25 (15.34%). Other surgical procedures performed with the index surgery were cystoscopy in 48 patients (29.45%), laparoscopic ovarian cystectomy in 24 (14.72%), laparoscopic hysterectomy in 15 (9.2%), laparoscopic appendectomy in 9 (5.5%), sigmoidoscopy in 6 (3.68%), laparoscopic oophorectomy in 6 (3.68%), extensive laparoscopic adhesiolysis in 5 (3.07%) bowel resection in 2 (1.25%), laparoscopic myomectomy in 1 (0.61%), and bladder resection in 1 (0.61%). Surgery proceeded to laparotomy in 6 patients (3.68%). Major surgical complications included bowel perforation, severe pelvic pain 1 week after laparoscopic excision, and temporary numbness of the right side of the perineum in 1 patient each. Minor postoperative complications included urinary tract infection in 3 patients and port site infections that resolved with oral antibiotic therapy in 2 patients. Follow-up was 37.82 (20.09; 34.74-40.92) months. Surgical excision of endometriosis had a positive effect on endometriosis-related symptoms. Four pain scores were reduced, with statistically significant differences (p<.001 and p<.05): dysmenorrhea, pelvic pain not related to menstruation, dyspareunia, and dyschezia. The positive effect of surgical excision on patient quality of life was demonstrated by a statistically significant difference on the EQ-5D index (p<.001) and the EQ-5D VAS (p<.001). Thirty-two (20%) patients underwent a second procedure after the index surgery. Endometriosis stage affects the probability of requiring further surgery because of recurrent symptoms. There was evidence of endometriosis at histologic analysis in only 13 (40.62%) patients who required further surgery. CONCLUSION Laparoscopic excision of endometriosis significantly reduces pain and improves quality of life as measured by both the EQ-5D index and the EQ-5D VAS, with a low complication rate.
Collapse
|
39
|
Surgical treatment of endometriosis: location and patterns of disease at reoperation. Fertil Steril 2010; 93:57-61. [DOI: 10.1016/j.fertnstert.2008.09.085] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 09/03/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
|
40
|
Renner SP, Ekici AB, Maihöfner C, Oppelt P, Thiel FC, Schrauder M, Uenluehan N, Bani MR, Strissel PL, Strick R, Beckmann MW, Fasching PA. Neurokinin 1 receptor gene polymorphism might be correlated with recurrence rates in endometriosis. Gynecol Endocrinol 2009; 25:726-33. [PMID: 19903051 DOI: 10.3109/09513590903159631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Dysmenorrhoea is the major symptom in women with endometriosis. Recently, pain modulation through Neurokinin-1-receptor (NK1R) pathways have been investigated in neuropathic pain patients. Aim of this study was, therefore, to examine the effect of a single nucleotide polymorphism (SNP) of the NK1R gene on the susceptibility for endometriosis and the disease free survival (DFS) after surgery for endometriosis. MATERIAL AND METHODS A case-control study was conducted and germline DNA was isolated. Patients were followed up for a recurrence of the disease up to 4 years. Case-control analyses were performed for parameters of the medical history and the genotype of the NK1R-SNP rs881. Furthermore, DFS probabilities were calculated. RESULTS Concerning the DFS preoperative pain levels and the NK1R genotype were independent predictors for a recurrence with hazard ratios of 2.55 (95% CI: 1.32-4.95) for patients with a high preoperative pain level and 0.44 for patients with a heterozygous or homozygous variant genotype in rs881 (95% CI: 0.21-0.88). CONCLUSION The polymorphism rs811 seems to be associated with a lower recurrence risk in endometriosis patients. Thus, there might be a clinical relevant role of the NK1 pathway in the pain perception of endometriosis patients.
Collapse
Affiliation(s)
- Stefan P Renner
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Hudelist G, Keckstein J, Wright JT. The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis. Fertil Steril 2009; 92:1536-43. [DOI: 10.1016/j.fertnstert.2008.08.086] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 08/13/2008] [Accepted: 08/14/2008] [Indexed: 11/30/2022]
|
42
|
Jacobson TZ, Duffy JMN, Barlow D, Koninckx PR, Garry R. Laparoscopic surgery for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 2009:CD001300. [PMID: 19821276 DOI: 10.1002/14651858.cd001300.pub2] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endometriosis is the presence of endometrial glands or stroma in sites other than the uterine cavity. It is variable in both its surgical appearance and clinical manifestation often with poor correlation between the two. Surgical treatment of endometriosis aims to remove visible areas of endometriosis and restore anatomy by division of adhesions and relieve painful symptoms. OBJECTIVES To assess the efficacy of laparoscopic surgery in the treatment of pelvic pain associated with endometriosis. SEARCH STRATEGY For the update in July 2009 we searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched July 2009), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2009), MEDLINE (1966 July 2009), EMBASE (1980 July 2009), and reference lists of articles. SELECTION CRITERIA Randomised controlled trials were selected comparing the effectiveness of laparoscopic surgery used to treat pelvic pain associated with endometriosis, with other treatment modalities or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS Assessment of trial quality and extraction of relevant data was performed independently by two reviewers. MAIN RESULTS Five studies were included in the meta-analysis, including three full papers and two conference reports. All the randomised controlled trials with the exception of Lalchandani 2003 compared different laparoscopic surgical techniques with diagnotic laparoscopy only. Lalchandani 2003 compared laparoscopic coagulation therapy with diagnostic laparoscopy and medical treatment. Three studies (Abbott 2004; Sutton 1994; Tutunaru 2006) reported the pain scores six months post operatively. Meta-analysis demonstrated an advantage of laparoscopic surgery when compared to diagnostic laparoscopy only (OR of 5.72 95%Cl 3.09 to 10.60 ; 171 participants, three trials, Analysis 1.1). A single study (Tutunaru 2006) reported pain scores twelve months after the procedure. Analysis demonstrated an advantage of laparoscopic surgery when compared to diagnostic laparoscopy only (OR of 7.72 95%Cl 2.97 to 20.06 ; 33 participants, one trial, Analysis 1.1). AUTHORS' CONCLUSIONS Laparoscopic surgery results in improved pain outcomes when compared to diagnostic laparoscopy alone. There were few women diagnosed with severe endometriosis included in the meta-analysis and therefore any conclusions from this meta-analysis regarding treatment of severe endometriosis should be made with caution. It is not possible to draw conclusions from the meta-analysis which specific laparoscopic surgical intervention is most effective.
Collapse
Affiliation(s)
- Tal Z Jacobson
- Department of Obstetrics and Gynaecology, South Auckland Clinical School, Middlemore Hospital, Private Bag 93311, Auckland, New Zealand
| | | | | | | | | |
Collapse
|
43
|
The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adult population. J Pediatr Adolesc Gynecol 2009; 22:257-63. [PMID: 19646673 DOI: 10.1016/j.jpag.2008.11.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/19/2008] [Accepted: 11/19/2008] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVE To evaluate the effect of combined surgical-medical treatment on endometriosis progression in adolescents as measured by disease stage. DESIGN Retrospective chart review. SETTING Two academic medical centers. PARTICIPANTS Sequential cases of young women identified on chart review with chronic pelvic pain unresponsive to dysmenorrheal treatment who underwent initial laparoscopy for diagnosis and surgical destruction of endometriosis. All patients were then treated with standard continuous medical therapy. Patients with exacerbation of pain on anti-endometriosis medical therapy who elected a subsequent laparoscopic procedure were eligible for this study. INTERVENTION Retrospective chart review MAIN OUTCOME MEASURES Endometriosis stage and adhesions at subsequent laparoscopy as compared to the initial surgical procedure. RESULTS 90 patients met inclusion criteria. Eligible patients were 12 to 24 years of age at the time of the initial laparoscopy. The median endometriosis stage at first and second laparoscopy was I. No stage change was observed in 70% of patients, 19% improved by one stage, 1% improved by two stages, and 10% worsened by one stage. Regardless of initial stage, a trend toward disease progression was not observed. There was a significant likelihood for stage improvement at second laparoscopy, with those initially diagnosed as stage II or III most likely to exhibit improvement. CONCLUSIONS Based on the concept that endometriosis can be progressive, these data suggest that combined surgical-medical management retards disease progression in adolescents and young adults.
Collapse
|
44
|
Cheong Y, Tay P, Luk F, Gan HC, Li TC, Cooke I. Laparoscopic surgery for endometriosis: How often do we need to re-operate? J OBSTET GYNAECOL 2009; 28:82-5. [DOI: 10.1080/01443610701811761] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
45
|
Hill NCW, El-Toukhy T, Chandakas S, Grigoriades T, Erian J. Safety of the Helica Thermal Coagulator in treatment of early stage endometriosis. J OBSTET GYNAECOL 2009; 25:52-4. [PMID: 16147696 DOI: 10.1080/01443610400024906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this prospective study was to assess the safety and short-term outcome of the Helica Thermal Coagulator in the laparoscopic treatment of early stage endometriosis. Two hundred and fifty consecutive women with chronic pelvic pain and stage I and II endometriosis (r-AFS classification) were treated laparoscopically with the Helica Thermal Coagulator. No bladder, ureteric or bowel injuries occurred. None of the procedures was converted to laparotomy and there were no major peri-operative complications. The only complication was a vaginal perforation during dissection of the cul-de-sac in a patient with a vaginal vault endometriotic nodule. We conclude that the Helica Thermal Coagulator is a safe alternative for the treatment of mild to moderate endometriosis. Long-term efficacy studies are required to better assess the role of the device in laparoscopic management of endometriosis.
Collapse
Affiliation(s)
- N C W Hill
- Minimal Access Unit, Department of Obstetrics and Gynaecology, The Princess Royal University Hospital, Orpington, Kent, UK.
| | | | | | | | | |
Collapse
|
46
|
Abstract
BACKGROUND Although surgery is currently the treatment of choice for managing endometriosis, recurrence poses a formidable challenge. To delay or to eliminate the recurrence is presently an unmet medical need in the management of endometriosis. To this end, proposals to investigate patterns of recurrence, to develop biomarkers for recurrence and to carry out biomarker-based intervention have been made. METHODS Publications pertaining to the recurrence of endometriosis and its related yet unaddressed issues were identified through MEDLINE. The reported recurrence rates, risk factors for recurrence, the effects of post-operative medication and causes of recurrence were reviewed and synthesized. In addition, several poorly explored issues such as time hazard function and mechanisms of recurrence were reviewed. Approaches to the development of biomarkers for recurrence and future intervention are discussed. RESULTS The reported recurrence rate was high, estimated as 21.5% at 2 years and 40-50% at 5 years. Few risk factors for recurrence have been consistently identified, and the evidence on the efficacy of the post-operative use of medication was scanty. The investigation on the patterns of recurrence may provide us with new insight into the possible mechanisms of recurrence and its control. The attempt to identify biomarkers for recurrence has started only very recently. CONCLUSIONS Much research is needed to better understand the patterns of recurrence and risk factors, and to develop biomarkers. One top priority is to develop biomarkers for recurrence, which may provide much needed clues to the possible mechanisms underlying recurrence and would allow the identification of patients with high recurrence risk, and permit for targeted intervention.
Collapse
Affiliation(s)
- Sun-Wei Guo
- Institute of Obstetric and Gynecologic Research, Shanghai Jiao Tong University School of Medicine, Renji Hospital, 145 Shandong Zhong Road, Shanghai 200001, People's Republic of China.
| |
Collapse
|
47
|
Vercellini P, Crosignani PG, Abbiati A, Somigliana E, Viganò P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Hum Reprod Update 2009; 15:177-88. [PMID: 19136455 DOI: 10.1093/humupd/dmn062] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Surgery is often considered the best treatment option in women with symptomatic endometriosis. However, extent and duration of the therapeutic benefit are still poorly defined. METHODS The best available evidence on surgery for endometriosis-associated pain has been reviewed to estimate the effect size of interventions in the most frequently encountered clinical conditions. RESULTS Methodological drawbacks limit considerably the validity of observational, non-comparative studies on the effect of laparoscopy for stage I-IV disease. As indicated by the results of three RCTs, the absolute benefit increase of destruction of lesions compared with diagnostic only operation in terms of proportion of women reporting pain relief was between 30% and 40% after short follow-up periods. The effect size tended to decrease with time and the re-operation rate, based on long-term follow-up studies, was as high as 50%. In most case series on excisional surgery for rectovaginal endometriosis, substantial short-term pain relief was experienced by approximately 70-80% of the subjects who continued the study. However, at 1 year follow-up, approximately 50% of the women needed analgesics or hormonal treatments. Major complications were observed in 3-10% of the patients. Medium-term recurrence of lesions was observed in approximately 20% of the cases, and around 25% of the women underwent repetitive surgery. CONCLUSIONS Pain recurrence and re-operation rates after conservative surgery for symptomatic endometriosis are high and probably underestimated. Clinicians and patients should be aware that the expected benefit is operator-dependent.
Collapse
Affiliation(s)
- P Vercellini
- Department of Obstetrics and Gynecology, University of Milan, Italy.
| | | | | | | | | | | |
Collapse
|
48
|
Treatment of pelvic pain associated with endometriosis. Fertil Steril 2008; 90:S260-9. [PMID: 19007642 DOI: 10.1016/j.fertnstert.2008.08.057] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 10/21/2022]
Abstract
Pain associated with endometriosis requires careful evaluation to exclude other potential causes and may involve a number of different mechanisms. Both medical and surgical treatments for pain related to endometriosis are effective and choice of treatment must be individualized.
Collapse
|
49
|
Reich H, Wood C, Whittaker M. Laparoscopic anterior resection of the rectum and hysterectomy in a patient with extensive pelvic endometriosis. ACTA ACUST UNITED AC 2008. [DOI: 10.1046/j.1365-2508.1998.00162.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Harry Reich
- Columbia Presbyterian Medical Centre, New York, New York, USA,
| | - Carl Wood
- Monash University, Clayton, Victoria, Australia,
| | | |
Collapse
|
50
|
Pentoxifylline After Conservative Surgery for Endometriosis: A Randomized, Controlled Trial. J Minim Invasive Gynecol 2008; 15:62-6. [DOI: 10.1016/j.jmig.2007.07.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Revised: 07/26/2007] [Accepted: 07/28/2007] [Indexed: 11/22/2022]
|