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Barra F, Ferrero S, Zorzi C, Evangelisti G, Perrone U, Valente I, Capezzuoli T, D'Ancona G, Bogliolo S, Roviglione G, Ceccaroni M. "From the tip to the deep of the iceberg": Parametrial involvement in endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 94:102493. [PMID: 38581882 DOI: 10.1016/j.bpobgyn.2024.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
Deep endometriosis (DE) can be localized in the parametrium, a complex bilateral anatomical structure, sometimes necessitating intricate surgical intervention due to the potential involvement of autonomic nerves, uterine artery, and ureter. If endometriotic ovarian cysts have been considered metaphorically representative of "the tip of the iceberg" concerning concealed DE lesions, it is reasonable to assert that parametrial lesions should be construed as the most profound region of this iceberg. Also, based on a subdual clinical presentation, a comprehensive diagnostic parametrial evaluation becomes imperative to strategize optimal management for patients with suspected DE. Recently, the ULTRAPARAMETRENDO studies aimed to evaluate the role of transvaginal ultrasound for parametrial endometriosis, showing distinctive features, such as a mild hypoechoic appearance, starry morphology, irregular margins, and limited vascularization. The impact of medical therapy on parametrial lesions has not been described in the current literature, primarily due to the lack of adequate detection at imaging. The extension of DE into the parametrium poses significant challenges during the surgical approach, thereby increasing the risk of intra- and postoperative complications, mainly if performed by centers with low expertise and following multiple surgical procedures where parametrial involvement has gone unrecognized. Over time, the principles of nerve-sparing surgery have been incorporated into the surgical DE treatment to minimize iatrogenic damage and potentially reduce the risk of functional complications.
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Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy; Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy.
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Giulio Evangelisti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Unit of Obstetrics and Gynecology, San Paolo Hospital - ASL2, Savona, 17100, Italy
| | - Umberto Perrone
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Irene Valente
- Unit of Radiology, P.O. "Ospedale del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Tommaso Capezzuoli
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Gianmarco D'Ancona
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Stefano Bogliolo
- Unit of Obstetrics and Gynecology, P.O. "Ospedale Del Tigullio"-ASL4, Via Gio Batta Ghio 9, Chiavari, 16043, Genoa, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
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Arena A, Degli Esposti E, Pazzaglia E, Orsini B, Cau I, Govoni F, Raimondo D, Palermo R, Lenzi J, Casadio P, Seracchioli R. Not All Bad Comes to Harm: Enhanced Recovery After Surgery for Rectosigmoid Endometriosis. J Minim Invasive Gynecol 2024; 31:49-56. [PMID: 37839779 DOI: 10.1016/j.jmig.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
STUDY OBJECTIVE To assess the impact of implementing an enhanced recovery after surgery (ERAS) protocol on the length of hospitalization in women undergoing laparoscopy for rectosigmoid deep infiltrating endometriosis (DIE). DESIGN A retrospective cohort study. SETTING An academic referral center for endometriosis and minimally invasive gynecologic surgery. PATIENTS Women aged between 18 and 50 years scheduled for laparoscopic excision (shaving, full-thickness anterior wall resection, segmental resection) of rectosigmoid endometriosis between February 2017 and February 2023. INTERVENTIONS We divided patients into 2 groups (non-ERAS and ERAS) based on the timing of surgery (before or after March 5, 2020). Starting from this day, restrictions were issued to limit the spread of the coronavirus disease 2019 pandemic, inducing our group to implement an ERAS protocol for patients hospitalized after surgery for posterior DIE. MEASUREMENTS AND MAIN RESULTS We included 579 patients in the analysis, 316 (54.6%) in the non-ERAS group and 263 (45.4%) in the ERAS group. In the ERAS group, we observed a shorter length of hospital stay (5.8 ± 3.1 days vs 4.8 ± 2.9 days; p <.001) and lower complications rates (33, 12.5% vs 60, 19.0%; p = .04), despite a decreased frequency of conservative surgical approaches (shaving procedures 121 vs 196; p <.001). Repeated surgery or hospital readmissions owing to postdischarge complications were infrequent, with no significant differences between the 2 groups. The multiple linear regression analysis strengthened our results given the higher prevalence of bowel resection surgeries (both full-thickness anterior wall or segmental), showing that patients managed with a multimodal protocol had an overall reduction of hospital stay by 1.5 days. CONCLUSION The implementation of an ERAS program in patients undergoing laparoscopic surgery for DIE is associated with a significant reduction in hospital stay, without an increase in perioperative or postoperative complication rates.
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Affiliation(s)
- Alessandro Arena
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Eugenia Degli Esposti
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Enrico Pazzaglia
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli).
| | - Benedetta Orsini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Irene Cau
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Francesca Govoni
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli)
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli)
| | - Roberto Palermo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
| | - Jacopo Lenzi
- Department of biomedical and neuromotor sciences, Alma mater Studiorum, University of Bologna, Bologna, Italy (Dr. Lenzi)
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli)
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti, 13, Bologna 40138, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Govoni, Raimondo, Palermo, Casadio, and Seracchioli); Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Arena, Degli Esposti, Pazzaglia, Orsini, Cau, Palermo, Seracchioli)
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Barra F, Zorzi C, Albanese M, Stepniewska A, Deromemaj X, De Mitri P, Roviglione G, Clarizia R, Gustavino C, Ferrero S, Ceccaroni M. Ultrasonographic Findings Indirectly Predicting Parametrial Involvement in Patients with Deep Endometriosis: The ULTRA-PARAMETRENDO I Study. J Minim Invasive Gynecol 2023; 30:61-72. [PMID: 36591808 DOI: 10.1016/j.jmig.2022.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To evaluate ultrasonographic findings as a first-line imaging tool to indirectly predict the presence of parametrial endometriosis (PE) in women with suspected deep endometriosis (DE) undergoing surgery. DESIGN Retrospective analysis of a prospectively collected database (ULTRA-PARAMETRENDO I study; NCT05239871). SETTING Referral center for DE. PATIENTS Consecutive patients undergoing laparoscopic surgery for DE. INTERVENTIONS Preoperative transvaginal ultrasonography was done according to the International Deep Endometriosis Analysis consensus statement. A stepwise forward regression analysis was performed considering the simultaneous presence of DE nodules and the following ultrasonographic indirect signs of DE: diffuse adenomyosis, endometriomas, ovary fixed to the lateral pelvic wall or the uterine wall, absence of anterior/posterior sliding sign, and hydronephrosis. The gold standard for the presence of PE was surgery with histologic confirmation. MEASUREMENTS AND MAIN RESULTS Of 1079 patients, 212 had a surgical diagnosis of PE (left: 18.5%; right: 17.0%; bilateral: 15.9%). The obtained prediction model (χ2 = 222.530; p <.001) for PE included, as independent indirect DE signs presence of hydronephrosis (odds ratio [OR] = 14.5; p = .002), complete absence of posterior sliding sign (OR = 3.3; p <.001), presence of multiple endometriomas per ovary (OR = 3.0; p = .001), and ovary fixation to the uterine wall (OR = 2.4; p <.001); as independent concomitant DE nodules, presence of uterosacral nodules with the largest diameter >10 mm (OR = 3.2; p <.001), presence of rectal endometriosis with the largest diameter >25 mm (OR = 2.3; p = .004), and rectovaginal septum infiltration (OR = 2.3; p = .003). The optimal diagnostic balance was obtained considering at least 2 concomitant DE nodules and at least 1 indirect DE sign (area under the curve 0.75; 95% confidence interval, 0.72-0.79). CONCLUSION Specific indirect ultrasonographic findings should raise suspicion of PE in women undergoing preoperative assessment for DE. The suspicion of parametrial invasion may be critical to address patients to expert leading centers, where proper diagnosis and surgical treatment for PE can be performed.
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Affiliation(s)
- Fabio Barra
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni); Unit of Obstetrics and Gynecology (Drs. Barra and Gustavino), Genoa, Italy
| | - Carlotta Zorzi
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Mara Albanese
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Anna Stepniewska
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Xheni Deromemaj
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Paola De Mitri
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
| | - Claudio Gustavino
- Unit of Obstetrics and Gynecology (Drs. Barra and Gustavino), Genoa, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology (Dr. Ferrero), Genoa, Italy; IRCCS Ospedale Policlinico San Martino, and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa (Dr. Ferrero), Genoa, Italy.
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy (ISSA), IRCCS Ospedale Sacro Cuore - Don Calabria, Negrar, Verona (Drs. Barra, Zorzi, Albanese, Stepniewska, Deromemaj, De Mitri, Roviglione, Clarizia, and Ceccaroni)
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Mittelstadt S, Stäbler A, Kolb M, Krämer B, Horvat H, Reisenauer C, Bachmann C. Acute endometriosis-related sigmoid perforation in pregnancy- case report. BMC Pregnancy Childbirth 2022; 22:647. [PMID: 35978302 PMCID: PMC9386915 DOI: 10.1186/s12884-022-04973-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background An acute abdomen is an emergency that requires accurate diagnosis and prompt treatment. In pregnancy, the process is even more challenging and sometimes the radiological findings are unclear. Moreover, endometriosis- related complications are rare, especially in previously unknown endometriosis. Case presentation We report on a case of acute endometriosis-related sigmoid perforation during pregnancy (34 weeks of gestation) due to a previously unknown deep intestinal infiltrating endometriosis with focal ulceration of the affected colonic mucosa. Conclusions Despite the low relative risk, clinicians should be aware of possible endometriosis-associated complications in pregnancy with potentially life-threatening events, even in previously unknown endometriosis. Further studies should evaluate intestinal complications during pregnancy in relation to previous treatment of intestinal endometriosis (conservative vs. surgical).
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Affiliation(s)
- S Mittelstadt
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - A Stäbler
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, 72076, Tübingen, Germany
| | - M Kolb
- Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - B Krämer
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - H Horvat
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Reisenauer
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Bachmann
- Department of Gynaecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
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Popoutchi P, Marques Junior OW, Averbach P, Cardoso Filho CAM, Averbach M. SURGICAL TECHNIQUES FOR THE TREATMENT OF RECTAL ENDOMETRIOSIS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND OBSERVATIONAL STUDIES. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:548-559. [PMID: 34909864 DOI: 10.1590/s0004-2803.202100000-97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriosis is a common disease in reproductive-age women and it is estimated to occur in up to 50% of those with infertility. Intestinal involvement is reported in up to a third of the cases. This condition is related to chronic pain and loss of quality of life, resulting in emotional, social and economic costs. Treatment consists of hormonal block and surgical resection, with variable side effects and efficacy. The best choice for surgical treatment for rectal endometriosis is a matter of discussion regarding the indication and the best technique to be employed. OBJECTIVE To summarize data on indications, results and complications of surgical techniques for the treatment of rectal endometriosis. METHODS This comprehensive systematic review is a compilation of the available literature and discussion, carried out by a team with experience in the surgical treatment of intestinal endometriosis. Data regarding indications, results and complications of conservative and radical techniques for the surgical treatment of rectal endometriosis was carefully reviewed. Searches of PubMed, EMBASE, and CENTRAL up to May 2021 were performed to identify randomized controlled trials (RCTs) and observational studies that compared at least two of the three surgical techniques of interest (i.e., shaving, discoid resection, segmental resection). RESULTS One RCT and nine case series studies with a total of 3,327 patients met the eligibility criteria. Participants ages ranged from a mean of 30.0 to 37.9 years old. Mean follow-up ranged from 1.2 to 42.76 months. With regards the methodological quality, overall the included studies presented a low risk of bias in the majority of the domains. Surgical treatment of rectal endometriosis is indicated for patients with obstructive symptoms and those with pain scores above 7/10. Patients with disease involving beyond muscularis propria of the rectum, documented in magnetic resonance imaging or transvaginal pelvic ultrasound with intestinal preparation, are candidates for discoid or segmental resection. The presence of multifocal disease, extension greater than 3 cm and infiltration greater than 50% of the loop circumference favor the radical technique. The distance from the lesion to the anal verge, age, symptoms and reproductive desire are other factors that influence the choice of the technique to be employed. The risk of complications and unfavorable functional results seems to be directly related to the complexity of the procedure. CONCLUSION The choice of surgical technique performed for the treatment of rectal endometriosis is a matter of discussion and depends not only on the preoperative staging, but also on the patient's expectations, risks and potential complications, recurrence rates and the expertise of the multidisciplinary team.
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Affiliation(s)
- Pedro Popoutchi
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil
| | - Oswaldo Wiliam Marques Junior
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil.,Fundação Antônio Prudente - A.C.Camargo Hospital, São Paulo, SP, Brasil
| | - Pedro Averbach
- Disciplina de Coloproctologia, Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Celso Augusto Milani Cardoso Filho
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil.,Fundação Antônio Prudente - A.C.Camargo Hospital, São Paulo, SP, Brasil
| | - Marcelo Averbach
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil
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Rotenberg O, Kuo DYS, Goldberg GL. Use of aromatase inhibitors in menopausal deep endometriosis: a case report and literature review. Climacteric 2021; 25:235-239. [PMID: 34694933 DOI: 10.1080/13697137.2021.1990259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report and review the clinical effectiveness of aromatase inhibitors in a patient with refractory, recurrent and infiltrating endometriosis. We demonstrate excellent clinical, radiological and endoscopic responses after failure of multiple other modalities. Our case and the literature show that single-agent letrozole is capable to treat deep infiltrative endometriosis involving the rectum and the urinary tract. The use of aromatase inhibitor treatment of endometriosis in postmenopausal women makes sense, is safe and is well tolerated. Difficult cases of deep infiltrative endometriosis might require use of combined surgical and medical treatment modalities. Multidisciplinary involvement of the gynecologist, bowel surgeon, urologist and invasive radiologist might be needed. Aromatase inhibitors should be considered to be an integral part of the armamentarium in the management of women with endometriosis, especially in refractory cases that have failed conventional therapeutic modalities.
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Affiliation(s)
- O Rotenberg
- Department of Obstetrics & Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - D Y S Kuo
- Department of Obstetrics & Gynecology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - G L Goldberg
- Department of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell and NorthwellHealth, Hempstead, NY, USA
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Sima RM, Pleş L, Socea B, Sklavounos P, Negoi I, Stănescu AD, Iordache II, Hamoud BH, Radosa MP, Juhasz-Boess I, Solomayer EF, Dimitriu MCT, Cîrstoveanu C, Şerban D, Radosa JC. Evaluation of the SF-36 questionnaire for assessment of the quality of life of endometriosis patients undergoing treatment: A systematic review and meta-analysis. Exp Ther Med 2021; 22:1283. [PMID: 34630638 PMCID: PMC8461506 DOI: 10.3892/etm.2021.10718] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022] Open
Abstract
Endometriosis has a negative influence on the physical, psychological, and social aspects of a patient's life; therefore, it affects the health-related quality of life (HRQoL). The current review aimed to investigate the efficiency of a 36-item generic questionnaire survey (SF-36) for patients with endometriosis who were undergoing medical or surgical treatment. A search strategy including the key words ‘endometriosis’, ‘quality of life’ (QOL), and ‘questionnaire SF-36’ was applied using the PubMed/MEDLINE, EMBASE, and Cochrane databases in order to include articles that evaluated the QOL among women with endometriosis using the SF-36. Only articles that included interviews of patients both before and after surgical or medical endometriosis treatment or those articles that compared study groups were considered. The qualitative analysis was based on 37 articles, whereas the quantitative analysis utilized 14 articles. The research participants included 11,101 women, among whom 6,888 patients were diagnosed with endometriosis. The analysis recorded 17 studies dealing with all types of endometriosis, 9 studies dealing with deep infiltrative endometriosis (DIE), and 9 studies dealing with bowel endometriosis or DIE with bowel involvement. QOL was evaluated using only SF-36 in 12 studies that collectively included 1,912 women and using SF-36 in association with other questionnaires in 25 studies that collectively included 8,022 women. For patients with endometriosis, physical functioning [odds ratio (OR), 78.87; 95% confidence interval (CI), 68.97-88.77; I2=98.77%; P≤0.001] was the most affected life parameter. This parameter showed the highest improvement after surgical intervention (OR, 63.39; 95% CI, 48.71-78.07; I2=97.65%; P≤0.001) or hormonal treatment (OR, 38.65; 95% CI, 14.39-62.91; I2=38.65%; P≤0.001). The 36-item survey generic questionnaire seems to be an efficient tool for assessment of the QOL of life of women with endometriosis who are undergoing surgical or medical treatment. It can be applied before and after the procedure, and it can also be used for comparing study groups.
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Affiliation(s)
- Romina-Marina Sima
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Liana Pleş
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Panagiotis Sklavounos
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Ionuţ Negoi
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Anca-Daniela Stănescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Hospital, Bucur Maternity, 040294 Bucharest, Romania
| | - Ioan-Iulian Iordache
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Marc Phillip Radosa
- Department of Gynecology, University Hospital Leipzig, D-04103 Leipzig, Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Erich Franz Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
| | - Mihai C T Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Cătălin Cîrstoveanu
- Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Pediatrics Department, 'Maria Sklodowska Curie' Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Dragoş Şerban
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Julia Caroline Radosa
- Department of Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, D-66421 Homburg, Germany
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8
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Zomer MT, Kondo W, Cavalcanti TCS, Von Linsigen R, Ferreira LRG, Carranco RC, Trippia CH, Kulak J. Assessment of Nerve Fiber Density and Expression of Hormonal Receptors Within Rectosigmoid Endometriosis Nodules. J Minim Invasive Gynecol 2021; 29:265-273. [PMID: 34411730 DOI: 10.1016/j.jmig.2021.08.008] [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: 05/11/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To assess nerve fiber density and expression of hormone receptors in bowel endometriosis. DESIGN Cross-sectional study. SETTING Private hospital. PATIENTS Women with endometriosis undergoing laparoscopic segmental bowel resection (n = 54). INTERVENTIONS Tissue samples were obtained from patients with surgically treated rectosigmoid endometriosis. MEASUREMENTS AND MAIN RESULTS The rectosigmoid specimen containing the endometriosis nodule was manually sectioned and divided into 3 areas: core of the nodule, margin of the nodule, and healthy bowel tissue. The intensity of expression of estrogen and progesterone receptors was evaluated by immunohistochemistry and measured according to the Allred score. Nerve fibers were stained by immunohistochemistry using Protein Gene Product 9.5, and the density of nerve fillets was counted and expressed in number/mm². All glandular and stromal cells stained for estrogen; however, glandular cells stained more strongly than stromal cells (61.1% vs 35.2%; p = .01). Most of glandular and stromal cells stained strongly for progesterone receptors (90.7% vs 98.1%; p = .2). The density of nerve fibers was very high in the margin of the nodule (172.22±45.66/mm²), moderate in healthy bowel tissue (111.48±48.57/mm²), and very low in the core of the nodule (7.31±4.9/mm²); p = .01. CONCLUSION Both glandular and stromal cells within the rectosigmoid endometriosis nodule express estrogen and progesterone receptors. Higher intensity of expression of estrogen receptors occurs in glandular cells. The density of nerve fibers is extremely high at the nodule margin and very low in the center of the nodule.
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Affiliation(s)
- Monica Tessmann Zomer
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil.
| | - William Kondo
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
| | - Teresa Cristina Santos Cavalcanti
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
| | - Renate Von Linsigen
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
| | - Luiz Rodrigo Guimaraes Ferreira
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
| | - Ramiro Cabrera Carranco
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
| | - Carlos Henrique Trippia
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
| | - Jaime Kulak
- Gynecology Department, CEAGIC (Center for Advanced Gynecology Surgery) at Vita Batel Hospital, Rua Angelo Sampaio (Drs. Zomer, Kondo, and Carranco); Neopath, Avenida Vicente Machado (Dr. Cavalcanti); Gynecology Department, Clinics Hospital from the Federal University of Parana, Rua General Carneiro (Drs. Linsigen, Ferreira, and Kulak); Instituto de Roentgen Diagnósticos, Rua Mal. Deodoro (Dr. Trippia), Curitiba, Brazil
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9
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Tanaka K, Ballard E, Petersen D, Amoako AA, Khalil A, Baartz D. Effect of Retaining the Uterus During Anterior Resection for Rectosigmoid Bowel Endometriosis. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keisuke Tanaka
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Damien Petersen
- Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Akwasi A. Amoako
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Akram Khalil
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - David Baartz
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, Australia
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10
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Tschann P, Vitlarov N, Hufschmidt M, Lechner D, Girotti PNC, Offner F, Abendstein B, Königsrainer I. Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome. Eur J Med Res 2021; 26:12. [PMID: 33485396 PMCID: PMC7824935 DOI: 10.1186/s40001-021-00484-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/08/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Endometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis. Methods Twenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome. Results Average follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54). Conclusion Our data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Nikola Vitlarov
- Institute for Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Martin Hufschmidt
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Paolo N C Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Felix Offner
- Institute for Pathology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Burghard Abendstein
- Department of Gynaecology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
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11
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Raimondo D, Mattioli G, Degli Esposti E, Gregori B, Del Forno S, Mastronardi M, Arena A, Borghese G, Ambrosio M, Seracchioli R. Impact of Temporary Protective Ileostomy on Intestinal Function and Quality of Life after a 2-Year Follow-up in Patients Who Underwent Colorectal Segmental Resection for Endometriosis. J Minim Invasive Gynecol 2020; 27:1324-1330. [DOI: 10.1016/j.jmig.2019.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/20/2019] [Accepted: 10/23/2019] [Indexed: 12/11/2022]
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12
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Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb). Arch Gynecol Obstet 2020; 302:983-993. [PMID: 32676859 DOI: 10.1007/s00404-020-05694-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. METHODS All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. RESULTS Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. CONCLUSIONS Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
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13
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Ekin M, Kaya C, Erdoğan ŞV, Bahçeci E, Baghaki S, Yaşar L. The effect of new cross linked hyaluronan gel on quality of life of patients after deep infiltrating endometriosis surgery: a randomized controlled pilot study. J OBSTET GYNAECOL 2020; 41:263-268. [PMID: 32530335 DOI: 10.1080/01443615.2020.1755628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this prospective randomised placebo-controlled study, we aimed to evaluate the effect of New Cross linked Hyaluronan Gel (NCH gel) on the quality of life of patients who underwent laparoscopic surgery due to Deep Infiltrating Endometriosis (DIE). The intervention group received 40 mL of NCH gel, and the control group had a 40 mL sterile saline solution instilled into the peritoneal cavity following standard laparoscopic procedures. The patients were called in the third and sixth postoperative months and requested to fill the Visual Analogue Scale (VAS), Endometriosis Health Profile (EHP-5), and Short Form for Mental and Physical Health (SF-12) questionnaires. There was a significant reduction in dysmenorrhoea, dyschezia, dyspareunia VAS scores at 3rd, and 6th-month visits in NCH gel group. The postoperative 6th-month EHP-5 scores were significantly lower (1.16 ± 1.51, p-value: .02) in NCH gel group. Besides, NCH gel group had higher SF-12 mental and SF-12 physical scores. Clinical Trials registration number: NCT04023383IMPACT STATEMENTWhat is already known on this subject? Application of solid or liquid physical barriers is believed to be a promising strategy to reduce adhesions after laparoscopic endometriosis surgery. However, comparable data regarding the effects of adhesion barriers are still lacking.What the results of this study add? We revealed that there was a significantly higher decrease in VAS and EHP-5 scores and an increase in SF-12 physical-mental ratings after surgery in NCH gel group.What are the implications of these findings for clinical practice and/or further research? Using NHC gel in addition to standard surgical procedure improves postoperative VAS scores, and provides better quality of life scores.
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Affiliation(s)
- Murat Ekin
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Cihan Kaya
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Şakir Volkan Erdoğan
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Ece Bahçeci
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Sema Baghaki
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Levent Yaşar
- Department of Obstetric and Gynaecology, University of Health Sciences Turkey, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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14
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Mabrouk M, Borghese G, Esposti ED, Raimondo D, Remorgida V, Arena A, Zupi E, Mattioli G, Ambrosio M, Seracchioli R. Acute abdominal pain in non-pregnant endometriotic patients: not just dysmenorrhoea. A systematic review. J OBSTET GYNAECOL 2020; 41:7-20. [PMID: 32312121 DOI: 10.1080/01443615.2019.1700946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis, defined as the presence of functional endometrial tissue outside the uterine cavity, presents mainly with pelvic pain and infertility. Acute abdominal pain in non-pregnant patients with endometriosis might be minimised as a typical feature of the disease, while endometriosis is rarely considered in the differential diagnosis of acute abdominal pain. Our objective was to conduct a systematic review of the current literature of cases of acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. We performed a PubMed/MEDLINE search of studies published from January 1990 to December 2018, selecting English language reports and series of non-pregnant patients with acute abdomen and histological confirmation of endometriosis. The studies were revised by two independent authors. Data were abstracted and compiled for analysis. Fifty articles reporting 62 patients were identified. The complications were classified according to anatomical sites in bowel, urinary tract, and genital organs emergencies. Rarely was the first diagnostic hypothesis endometriosis, misdiagnosis was frequent. The time frame from symptoms onset to management was often long. This is the first systematic review evaluating acute abdomen/acute abdominal pain in non-pregnant endometriotic patients. These conditions are rare but possibly life-threating and require prompt diagnosis and emergent medical or surgical treatment.
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Affiliation(s)
- Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cambridge Clinical School, Cambridge, UK
| | - Giulia Borghese
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Eugenia Degli Esposti
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentino Remorgida
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Academic Unit of Obstetrics and Gynaecology, University of Genova, Genova, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Errico Zupi
- Obstetrics and Gynaecology Clinic, Department of Biomedicine and Prevention, University of Roma "Tor Vergata", Roma, Italy
| | - Giulia Mattioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Marco Ambrosio
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy
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15
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Raimondo D, Mattioli G, Casadio P, Borghese G, Ambrosio M, Arena A, Paradisi R, Del Forno S, Coppola F, Valerio D, Garattoni M, Golfieri R, Seracchioli R. Frequency and clinical impact of Dolichocolon in women submitted to surgery for rectosigmoid endometriosis. J Gynecol Obstet Hum Reprod 2020; 49:101697. [PMID: 32018043 DOI: 10.1016/j.jogoh.2020.101697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/25/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Rectosigmoid endometriosis and Dolichocolon can both present with a triad of chronic abdominal pain, constipation and bloating. The relationship between these two pathologies is unknown. The present study aims to determine the frequency of DC in women with rectosigmoid endometriosis and its possible impact on pre- and post-operative symptoms. MATERIAL AND METHODS We conducted a retrospective cohort study on 113 consecutive patients submitted to magnetic resonance imaging enema and subsequent complete surgical removal for symptomatic rectosigmoid endometriosis between June 2015 to June 2018. Dolichocolon is an anatomic variant characterized by redundancies and lengthening of the colon. We divided our study population according to its presence or absence. The two groups were compared in terms of demographic data, surgical findings and pre- and post-operative clinical variables. Pain symptoms were assessed through numerical rating scale from 0 to 10. Bowel complaints included constipation, bloating and diarrhea. RESULTS Thirty-five patients (31 %) presented a dolichocolon at magnetic resonance imaging enema. The two groups were comparable in terms of demographic data, pre-operative clinical variables and surgical findings. At 6-month follow-up, there was a significant improvement of symptoms, except for constipation and bloating in dolichocolon group. In particular, we observed with a statistical difference (p < .05) the persistence of constipation and bloating in dolichocolon group compared to non-dolichocolon group. CONCLUSIONS Dolichocolon was observed in one third patients with rectosigmoid endometriosis and could influence surgical outcomes for rectosigmoid endometriosis in terms of relief of bowel symptoms.
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Affiliation(s)
- Diego Raimondo
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Giulia Mattioli
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy.
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Marco Ambrosio
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Roberto Paradisi
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Simona Del Forno
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
| | - Francesca Coppola
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Domenico Valerio
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Monica Garattoni
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Digestive Disease and Internal Medicine, DIMES, S. Orsola Hospital, University of Bologna, Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy
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16
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Bendifallah S, Vesale E, Daraï E, Thomassin-Naggara I, Bazot M, Tuech JJ, Abo C, Roman H. Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:441-451.e2. [DOI: 10.1016/j.jmig.2019.09.791] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/27/2023]
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Habib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, Zupi E, Afors K. Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. Int J Womens Health 2020; 12:35-47. [PMID: 32099483 PMCID: PMC6996110 DOI: 10.2147/ijwh.s190326] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is a chronic condition primarily affecting young women of reproductive age. Although some women with bowel endometriosis may be asymptomatic patients typically report a myriad of symptoms such as alteration in bowel habits (constipation/diarrhoea) dyschezia, dysmenorrhoea and dyspareunia in addition to infertility. To date, there are no clear guidelines on the evaluation of patients with suspected bowel endometriosis. Several techniques have been proposed including transvaginal and/or transrectal ultrasonography, magnetic resonance imaging, and double-contrast barium enema. These different imaging modalities provide greater information regarding presence, location and extent of endometriosis ensuring patients are adequately informed whilst also optimizing preoperative planning. In cases where surgical management is indicated, surgery should be performed by experienced surgeons, in centres with access to multidisciplinary care. Treatment should be tailored according to patient symptoms and wishes with a view to excising as much disease as possible, whilst at the same time preserving organ function. In this review article current perspectives on diagnosis and management of bowel endometriosis are discussed.
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Affiliation(s)
- Nassir Habib
- Department of Obstetrics and Gynaecology, Beaujon Hospital-University of Paris, Clichy Cedex 92110, France
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, University of Siena, Ospedale Santa Maria alle Scotte, Siena 53100, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, University of Siena, Ospedale Santa Maria alle Scotte, Siena 53100, Italy
| | - Nicola Amoruso
- Department of Molecular and Developmental Medicine, University of Siena, Ospedale Santa Maria alle Scotte, Siena 53100, Italy
| | - Lionel El Khoury
- Department of Colorectal Surgery-Delafontaine Hospital, Saint Denis 93200, France
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, University of Siena, Ospedale Santa Maria alle Scotte, Siena 53100, Italy
| | - Karolina Afors
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, UK
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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.
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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
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19
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Mabrouk M, Raimondo D, Altieri M, Arena A, Del Forno S, Moro E, Mattioli G, Iodice R, Seracchioli R. Surgical, Clinical, and Functional Outcomes in Patients with Rectosigmoid Endometriosis in the Gray Zone: 13-Year Long-Term Follow-up. J Minim Invasive Gynecol 2019; 26:1110-1116. [DOI: 10.1016/j.jmig.2018.08.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/27/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023]
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20
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Parametrial Endometriosis: The Occult Condition that Makes the Hard Harder. J Minim Invasive Gynecol 2019; 26:871-876. [DOI: 10.1016/j.jmig.2018.08.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023]
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21
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Mabrouk M, Raimondo D, Mastronardi M, Raimondo I, Del Forno S, Arena A, Sutherland N, Borgia A, Mattioli G, Terzano P, Seracchioli R. Endometriosis of the Appendix: When to Predict and How to Manage-A Multivariate Analysis of 1935 Endometriosis Cases. J Minim Invasive Gynecol 2019; 27:100-106. [PMID: 30849476 DOI: 10.1016/j.jmig.2019.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE To evaluate appendiceal endometriosis (AE) prevalence and risk factors in endometriotic patients submitted to surgery. DESIGN A retrospective cohort study. SETTING A tertiary level referral center, university hospital. PATIENTS One thousand nine hundred thirty-five consecutive patients who underwent surgical removal for symptomatic endometriosis. INTERVENTIONS Electronic medical records of patients submitted to surgery over a 12-year period were reviewed. We assessed any correlation between demographic, clinical, and surgical variables and AE. In our center, appendectomy was performed using a selective approach. Appendix removal was performed in case of gross abnormalities of the organ, such as enlargement, dilation, tortuosity, or discoloration of the organ or the presence of suspected endometriotic implants. MEASUREMENTS AND MAIN RESULTS AE prevalence was 2.6% (50/1935), with only 1 false-positive case at gross intraoperative evaluation. In multivariate analysis using a stepwise logistic regression model, independent risk factors for AE were adenomyosis (adjusted odds ratio [aOR] = 2.48; 95% confidence interval [CI], 1.32-4.68), right endometrioma (aOR = 8.03; 95% CI, 4.08-15.80), right endometrioma ≥5 cm (aOR = 13.90; 95% CI, 6.63-29.15), bladder endometriosis (aOR = 2.05; 95% CI, 1.05-3.99), deep posterior pelvic endometriosis (aOR = 5.79; 95% CI, 2.82-11.90), left deep lateral pelvic endometriosis (aOR = 2.11; 95% CI, 1.10-4.02), and ileocecal involvement (aOR = 12.51; 95% CI, 2.07-75.75). CONCLUSION Among patients with endometriosis submitted to surgery, AE was observed in 2.6%, and it was associated with adenomyosis, large right endometrioma, bladder endometriosis, deep posterior pelvic endometriosis, left deep lateral pelvic endometriosis, and ileocecal involvement.
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Affiliation(s)
- Mohamed Mabrouk
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli); Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandra, Egypt (Dr. Mabrouk)
| | - Diego Raimondo
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli).
| | - Manuela Mastronardi
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
| | - Ivano Raimondo
- Department of Obstetrics and Gynecology, University of Sassari, Sassari, Italy (Dr. Raimondo)
| | - Simona Del Forno
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
| | - Neveta Sutherland
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli); Department of Obstetrics and Gynecology, Victoria Jubilee Hospital, University of the West Indies, Mona, Jamaica (Dr. Sutherland)
| | - Alessandra Borgia
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
| | - Giulia Mattioli
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
| | - Patrizia Terzano
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli)
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22
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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23
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Arcoverde FVL, Andres MDP, Borrelli GM, Barbosa PDA, Abrão MS, Kho RM. Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2018; 26:266-278. [PMID: 30244153 DOI: 10.1016/j.jmig.2018.09.774] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 11/27/2022]
Abstract
Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, was conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: all types endometriosis, deep infiltrative endometriosis (DIE), and bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean differences between the 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (.21; 95% confidence interval [CI], .04-.38); significant improvement after surgical treatment for DIE in Vitality (.67; 95% CI, .41-.94), Social Functioning (.59; 95% CI, .18-.99), Role Emotional .49; 95% CI, .02-.97), Mental Health (.39; 95% CI, .03-.74), Physical Functioning (.93; 95% CI, .49-1.38), Bodily Pain (1.23; 95% CI, .47-1.99), General Health (.57; 95% CI, .02-1.12), MCS (.55; 95% CI, .10-1.00), and Physical Component Score (PCS; .73; 95% CI, .27-1.18); and significant improvement after surgery for bowel endometriosis for all 8 domains (Vitality [1.00; 95% CI, .56-1.43], Social Functioning [.97; 95% CI, .57-1.37], Role Emotional [1.17; 95% CI, .7-1.63], Mental Health [.94; 95% CI, .5-1.38], Physical Functioning [.74; 95% CI, .3-1.18], Role Physical [1.25; 95% CI, .75-1.76], Bodily Pain [1.39; 95% CI, .79-1.98], General Health [.84; 95% CI, 1.46-1.22]), MCS (.93; 95% CI, .47-1.40), PCS (.82; 95% CI, .40-1.23), and total score (1.15; 95% CI, .48-1.83). Only 1 study assessed patients with minimal disease and showed significant improvement in PCS (p = .002) and MCS (p <.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in most health domains of health-related QOL, with the greatest improvement found in the Bodily Pain domain.
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Affiliation(s)
- Fernanda Vieira Lins Arcoverde
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina de Paula Andres
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Giuliano Moysés Borrelli
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila de Almeida Barbosa
- Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Mauricio Simões Abrão
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and.
| | - Rosanne Marie Kho
- Benign Gynecology Surgery Section (Dr. Kho), Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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24
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Seracchioli R, Raimondo D, Del Forno S, Leonardi D, De Meis L, Martelli V, Arena A, Paradisi R, Mabrouk M. Transvaginal and transperineal ultrasound follow-up after laparoscopic correction of uterine retrodisplacement in women with posterior deep infiltrating endometriosis. Aust N Z J Obstet Gynaecol 2018; 59:288-293. [PMID: 30136296 DOI: 10.1111/ajo.12882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Retrodisplacement of the uterus (retroflexion and/or retroversion) may be associated with pelvic pain symptoms and posterior deep infiltrating endometriosis (DIE). Previous studies in symptomatic women with retrodisplacement of the uterus showed the efficacy of hysteropexy in terms of pain symptoms improvement. AIM To evaluate sonographic, clinical and surgical outcomes of a hysteropexy technique MATERIALS AND METHODS: Laparoscopic round ligament plication and tilting of the uterine fundus in women with uterine retrodisplacement and posterior deep infiltrating endometriosis was performed. Forty-two symptomatic women were enrolled and the sonographic data of each (angle of uterine version and uterine flexion, uterine mobility) was assessed before and after surgery with transvaginal and transperineal approaches. Women were also evaluated at 1, 6 and 12 months after surgery for pain symptoms with a numerical rating scale (dysmenorrhoea, dyspareunia and chronic pelvic pain), intraoperative data and surgical complications. RESULTS The additional mean operative time of hysteropexy procedure was 8 ± 3 min. At early follow-up both the uterine angles were significantly (P < 0.001) reduced. At 12-month follow-up, seven patients (16.7%) presented a retroverted uterus, while 12 (28.6%) presented a retroflexed uterus; the sliding sign remained negative in four patients (9.5%). A significant improvement of symptoms (P < 0.001) was observed during the follow-up. CONCLUSION Laparoscopic hysteropexy appears as an effective additional surgical procedure, which can temporarily correct the uterine position in order to reduce the risk of postoperative adhesions.
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Affiliation(s)
- Renato Seracchioli
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Deborah Leonardi
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Lucia De Meis
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Valentina Martelli
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Roberto Paradisi
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Mohamed Mabrouk
- Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.,Department of Obstetrics and Gynecology, El Shatby University Hospital for Children, University of Alexandria, Alexandria, Egypt
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25
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Ianieri MM, Mautone D, Ceccaroni M. Recurrence in Deep Infiltrating Endometriosis: A Systematic Review of the Literature. J Minim Invasive Gynecol 2018; 25:786-793. [DOI: 10.1016/j.jmig.2017.12.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/27/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
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26
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Wollenschlaeger M, Carlan SJ, McWhorter J, Kuffskie M, Madruga M. Spontaneous Sigmoid Colon Rupture Secondary to Endometriosis in the Third Trimester of Pregnancy. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Steve J. Carlan
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL
| | - Jeannie McWhorter
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL
| | - Martha Kuffskie
- Department of Obstetrics and Gynecology, Orlando Regional Healthcare, Orlando, FL
| | - Mario Madruga
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL
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27
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Badescu A, Roman H, Barsan I, Soldea V, Nastasia S, Aziz M, Puscasiu L, Stolnicu S. Patterns of Bowel Invisible Microscopic Endometriosis Reveal the Goal of Surgery: Removal of Visual Lesions Only. J Minim Invasive Gynecol 2017; 25:522-527.e9. [PMID: 29097234 DOI: 10.1016/j.jmig.2017.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVE To document the presence of bowel invisible microscopic endometriosis implants and their relationship with deep endometriosis macronodule infiltrating the bowel. DESIGN A series of consecutive patients with deep endometriosis infiltrating the rectum and/or sigmoid colon (Canadian Task Force classification II-2). SETTINGS A university referral center. PATIENTS Ten patients managed by colorectal resection. INTERVENTIONS A microscopic study of endometriotic foci of the bowel involving 3272 microsection slides was established using a unique method of step serial sections using combined transverse and longitudinal macrosection. Two-dimensional reconstruction based on slide scanning highlighted the presence and localization of the deep endometriosis macronodule in contrast with bowel invisible microscopic endometriosis microimplants. MEASUREMENTS AND MAIN RESULTS The distance separating the microimplants and the nodule and their histologic characteristics. The mean length of the colorectal specimens was 91 ± 19 mm. The maximum distance between the farthest microimplants was 7.2 cm. The maximum distance from the macroscopic nodule limit to the farthest microimplant was 31 mm. Bowel invisible microscopic endometriosis microimplants presented with similar features independently of the type of spread. They had an active appearance including stroma and glands, were sometimes decidualized, and were free of fibrosis. They were found on the distal/rectal limit of the specimen in 3 patients and on both limits (distal/rectal and proximal/sigmoid colon) in 1 patient. CONCLUSION Invisible microscopic endometriosis implants surround the bowel macroscopic endometriosis nodule at variable distances, suggesting that complete surgical microscopic removal may be a challenging goal. These results may help to reconsider the principles and feasibility of the surgical management of bowel endometriosis.
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Affiliation(s)
- Alexandra Badescu
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen France; Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen France; Research Group 4308 "Spermatogenesis and Gamete Quality," IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen France.
| | - Iulia Barsan
- Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Valentin Soldea
- Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania; Department of Thoracic Surgery, Rouen University Hospital, Rouen France
| | - Serban Nastasia
- Department of Obstetrics and Gynecology, Cantacuzino Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Moutaz Aziz
- Department of Pathology, Rouen University Hospital, Rouen France
| | - Lucian Puscasiu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Simona Stolnicu
- Department of Pathology, University of Medicine and Pharmacy, Targu Mures, Romania
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Ofkeli O, Ulas M, Oter V, Aksoy E, Zengin N, Ozer I, Bostanci EB. Colorectal endometriosis: Five years’ experience in this enigmatic problem. SURGICAL PRACTICE 2017. [DOI: 10.1111/1744-1633.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ozcem Ofkeli
- Department of Gastroenterological Surgery; Gazi Yaşargil Educational and Research Hospital; Diyarbakir Turkey
| | - Murat Ulas
- Department of Gastroenterological Surgery; Yüksek İhtisas Educational and Research Hospital; Ankara Turkey
| | - Volkan Oter
- Department of Gastroenterological Surgery; Şanlıurfa Mehmet Akif İnan Educational and Research Hospital; Sanliurfa Turkey
| | - Erol Aksoy
- Department of Gastroenterological Surgery; Yüksek İhtisas Educational and Research Hospital; Ankara Turkey
| | - Neslihan Zengin
- Department of Pathology; Yüksek İhtisas Educational and Research Hospital; Ankara Turkey
| | - Ilter Ozer
- Department of Gastroenterological Surgery; Yüksek İhtisas Educational and Research Hospital; Ankara Turkey
| | - Erdal Birol Bostanci
- Department of Gastroenterological Surgery; Yüksek İhtisas Educational and Research Hospital; Ankara Turkey
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Comparison of transvaginal sonography and computed tomography–colonography with contrast media and urographic phase for diagnosing deep infiltrating endometriosis of the posterior compartment of the pelvis: a pilot study. Jpn J Radiol 2017; 35:546-554. [DOI: 10.1007/s11604-017-0665-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 06/25/2017] [Indexed: 12/11/2022]
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Piccinni G, De Luca GM, Lafranceschina S, Biondi A, Marzullo A, Gurrado A, Testini M. Laparoscopic Treatment of a Retroduodenopancreatic Endometriotic Cyst Observed Postpartum. J Laparoendosc Adv Surg Tech A 2016:lap.2016.0319. [PMID: 27513589 DOI: 10.1089/lap.2016.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Endometriosis occurs in 5%-10% of fertile women, usually in the pelvic region, such as the ovaries, uterine ligaments, pelvic peritoneum, and rectovaginal septum. A mesenteric endometriotic cyst is an exceptional observation and difficult to diagnose preoperatively. We report a case of a large mesenteric endometriotic cyst treated by laparoscopy. A 21-year-old Caucasian woman was admitted as an emergency to our Academic Hospital on the 30th day postpartum for abdominal pain and a palpable epigastric mass. A CT scan revealed a mass measuring 7.5 × 5.5 cm showing a fluid content, located below the pancreas. A preoperative diagnosis of mesenteric cyst was made and confirmed by MRI. A dissection of the mass from the inferior vena cava, pancreas, and duodenum was achieved by a laparoscopic approach. During the blunt dissection, avoiding any spillage, the cyst was aspirated to preserve a safe cleavage plane with the lower third of the duodenum showing tenacious adhesions to the mass. Histology revealed an endometriotic cyst of the mesenterium. To our knowledge, this is the first case reported in the literature of laparoscopic treatment of a retroduodenopancreatic endometriotic cyst observed postpartum. In dedicated centers, laparoscopic management could be the gold standard.
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Affiliation(s)
- Giuseppe Piccinni
- 1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari , Bari, Italy
| | - Giuseppe Massimiliano De Luca
- 1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari , Bari, Italy
| | - Stefano Lafranceschina
- 1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari , Bari, Italy
| | - Antonio Biondi
- 2 Unit of General Surgery, Department of General Surgery, University Medical School of Catania , Catania, Italy
| | - Andrea Marzullo
- 3 Unit of Anatomic Pathology, Department of Emergency and Organ Transplantation, University Medical School of Bari , Bari, Italy
| | - Angela Gurrado
- 1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari , Bari, Italy
| | - Mario Testini
- 1 Unit of Endocrine, Digestive and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, University Medical School of Bari , Bari, Italy
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Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3617179. [PMID: 27579309 PMCID: PMC4989089 DOI: 10.1155/2016/3617179] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/08/2016] [Accepted: 07/18/2016] [Indexed: 01/16/2023]
Abstract
Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.
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Rossini R, Monsellato D, Bertolaccini L, Pesci A, Zamboni G, Ceccaroni M, Ruffo G. Lymph Node Involvement in Deep Infiltrating Intestinal Endometriosis: Does It Really Mean Anything? J Minim Invasive Gynecol 2016; 23:787-92. [DOI: 10.1016/j.jmig.2016.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
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Double Circular Stapler (DCS) or Laparoscopic Double Discoid Resection with a Circular Stapler? Standardization of the Procedure's Nomenclature. J Minim Invasive Gynecol 2016; 23:844-5. [PMID: 26899717 DOI: 10.1016/j.jmig.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/21/2022]
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Roman H, Hennetier C, Darwish B, Badescu A, Csanyi M, Aziz M, Tuech JJ, Abo C. Bowel occult microscopic endometriosis in resection margins in deep colorectal endometriosis specimens has no impact on short-term postoperative outcomes. Fertil Steril 2016; 105:423-9.e7. [DOI: 10.1016/j.fertnstert.2015.09.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/14/2015] [Accepted: 09/20/2015] [Indexed: 02/03/2023]
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35
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Badescu A, Roman H, Aziz M, Puscasiu L, Molnar C, Huet E, Sabourin JC, Stolnicu S. Mapping of bowel occult microscopic endometriosis implants surrounding deep endometriosis nodules infiltrating the bowel. Fertil Steril 2016; 105:430-4.e26. [DOI: 10.1016/j.fertnstert.2015.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, Viganò P, Candiani M. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2015; 22:70-103. [PMID: 26450609 DOI: 10.1093/humupd/dmv045] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/14/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of endometriotic tissue but also to different metabolic, hormonal, immune and angiogenesis changes related to pregnancy. However, a growing literature is emerging on the role of endometriosis in affecting the development of pregnancy and its outcomes and also on the impact of pregnancy on endometriosis. The present article aims to underline the difficulty in diagnosing endometriotic lesions during pregnancy and discuss the options for the treatment of decidualized endometriosis in relation to imaging and symptomatology; to describe all the possible acute complications of pregnancy caused by pre-existing endometriosis and evaluate potential treatments of these complications; to assess whether endometriosis affects pregnancy outcome and hypothesize mechanisms to explain the underlying relationships. METHODS This systematic review is based on material searched and obtained via Pubmed and Medline between January 1950 and March 2015. Peer-reviewed, English-language journal articles examining the impact of endometriosis on pregnancy and vice versa were included in this article. RESULTS Changes of the endometriotic lesions may occur during pregnancy caused by the modifications of the hormonal milieu, posing a clinical dilemma due to their atypical appearance. The management of these events is actually challenging as only few cases have been described and the review of available literature evidenced a lack of formal estimates of their incidence. Acute complications of endometriosis during pregnancy, such as spontaneous hemoperitoneum, bowel and ovarian complications, represent rare but life-threatening conditions that require, in most of the cases, surgical operations to be managed. Due to the unpredictability of these complications, no specific recommendation for additional interventions to the routinely monitoring of pregnancy of women with known history of endometriosis is advisable. Even if the results of the published studies are controversial, some evidence is suggestive of an association of endometriosis with spontaneous miscarriage, preterm birth and small for gestational age babies. A correlation of endometriosis with placenta previa (odds ratio from 1.67 to 15.1 according to various studies) has been demonstrated, possibly linked to the abnormal frequency and amplitude of uterine contractions observed in women affected. Finally, there is no evidence that prophylactic surgery would prevent the negative impact of endometriosis itself on pregnancy outcome. CONCLUSIONS Complications of endometriosis during pregnancy are rare and there is no evidence that the disease has a major detrimental effect on pregnancy outcome. Therefore, pregnant women with endometriosis can be reassured on the course of their pregnancies although the physicians should be aware of the potential increased risk of placenta previa. Current evidence does not support any modification of conventional monitoring of pregnancy in patients with endometriosis.
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Affiliation(s)
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Annalisa Inversetti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Veronica Giorgione
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milano, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Via Olgettina 58, 20132 Milano, Italy
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Baden DN, van de Ven A, Verbeek PCM. Endometriosis with an acute colon obstruction: a case report. J Med Case Rep 2015; 9:150. [PMID: 26112271 PMCID: PMC4517405 DOI: 10.1186/s13256-015-0609-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/28/2015] [Indexed: 01/12/2023] Open
Abstract
Introduction The presentation of an acute bowel obstruction caused by endometriosis in an emergency department setting is rare, as it usually presents through years of complaints in the absence of a distinct acute onset. In this report, we present a case of a patient who was familiar with abdominal complaints and eventually required emergency surgery to treat an acute bowel obstruction caused by endometriosis. Endometrioses present infrequently in the acute phase, and only a few cases in which emergency surgery was required have been described in the literature. Case presentation A 31-year-old Caucasian woman presented to the emergency room of our hospital with a distended abdomen, pain and nausea accompanied by a history of 14 years of chronic abdominal pain and constipation. An abdominal X-ray and subsequent computed tomographic scan showed a severely distended cecum of 9cm with stenosis in the sigmoid. Cecal blow-out was considered highly likely, and, during an emergency laparotomy, an obstructing process was found in the sigmoid. An oncologic resection of the sigmoid was performed with a primary anastomosis and loop ileostomy. A pathological examination revealed a tumor of 4cm in the sigmoid, which contained a tubelike structure with cytogenic stroma and the remains of focal bleeding. These are typical aspects of endometriosis. Conclusions Infiltrating endometriosis is an invalidating disease that can be misdiagnosed for a wide range of other diseases. Emergency room physicians and surgeons should be aware that it can present as an acute obstruction and should be considered in diagnosing women of childbearing age. After initial colonoscopy, emergency surgery is the best therapeutic approach if there is a complete obstruction.
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Affiliation(s)
- David N Baden
- Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.
| | - Anthony van de Ven
- Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.
| | - Paul C M Verbeek
- Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.
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Daraï C, Deboute O, Zacharopoulou C, Laas E, Canlorbe G, Belghiti J, Zilberman S, Ballester M, Daraï E. Impact of osteopathic manipulative therapy on quality of life of patients with deep infiltrating endometriosis with colorectal involvement: results of a pilot study. Eur J Obstet Gynecol Reprod Biol 2015; 188:70-3. [DOI: 10.1016/j.ejogrb.2015.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 02/21/2015] [Accepted: 03/02/2015] [Indexed: 11/29/2022]
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Abstract
Clear cell thymic carcinoma is a rare and invasive tumor of the mediastinum for which there are no uniform treatment guidelines. The combination of carboplatin plus paclitaxel seems to be the most effective regimen for this disease. We report a case of locally advanced clear cell thymic carcinoma treated with this schedule, in which we observed a relevant and rapid tumor shrinkage.
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Evaluation of pre- and post-operative symptoms in patients submitted to linear stapler nodulectomy due to anterior rectal wall endometriosis. Surg Endosc 2014; 29:2389-93. [PMID: 25380710 DOI: 10.1007/s00464-014-3945-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 10/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the feasibility and safety of a more versatile rectosigmoid nodulectomy technique using a linear stapler. METHODS Case series. SETTING tertiary care (reference center for endometriosis surgery). PATIENTS Sixty-one consecutive patients who were operated on between January 2006 and February 2013. INTERVENTION anterior rectal wall nodulectomy technique using sequential bites of the linear stapler. MEASUREMENTS Perioperative complications were recorded, and a condition-specific bowel dysfunction quality of life questionnaire (Rome III--Constipation) was applied pre-operatively and post-operatively during the first week of April 2013. DESIGN CLASSIFICATION Canadian Task Force III RESULTS: A total of 61 patients were submitted to the intervention. After a mean follow-up period of 1.83 years (.25-7.1 ± 1.97), no post-operative fistula or leakage was observed. In addition, no cases of rectal stenosis or bowel obstruction were recorded, and two patients were excluded for not answering the post-operative questionnaire. According to the Rome III questionnaire, constipation symptoms improved significantly in 12 out of 17 questions. No patient reported worsening of symptoms in question. CONCLUSIONS Linear stapler resection is a safe alternative to segmentar resection for endometriotic nodules on the anterior rectal wall.
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Spagnolo E, Zannoni L, Raimondo D, Ferrini G, Mabrouk M, Benfenati A, Villa G, Bertoldo V, Seracchioli R. Urodynamic Evaluation and Anorectal Manometry Pre- and Post-operative Bowel Shaving Surgical Procedure for Posterior Deep Infiltrating Endometriosis: A Pilot Study. J Minim Invasive Gynecol 2014; 21:1080-5. [DOI: 10.1016/j.jmig.2014.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 05/24/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
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Nirgianakis K, McKinnon B, Imboden S, Knabben L, Gloor B, Mueller MD. Laparoscopic management of bowel endometriosis: resection margins as a predictor of recurrence. Acta Obstet Gynecol Scand 2014; 93:1262-7. [DOI: 10.1111/aogs.12490] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Brett McKinnon
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
| | - Laura Knabben
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
| | - Beat Gloor
- Department of Visceral Surgery and Medicine; University of Berne; Berne Switzerland
| | - Michael D. Mueller
- Department of Obstetrics and Gynecology; University of Berne; Berne Switzerland
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Afors K, Murtada R, Centini G, Fernandes R, Meza C, Castellano J, Wattiez A. Employing Laparoscopic Surgery for Endometriosis. WOMENS HEALTH 2014; 10:431-43. [DOI: 10.2217/whe.14.28] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endometriosis is a chronic, multifactorial disease, which can impact significantly on a women's quality of life. It is associated with pelvic pain, dyspareunia and intestinal disorders, and can lead to infertility. The use of laparoscopic surgery in the management of endometriosis is well documented; however, the optimal management of women with deep infiltrating disease remains controversial. This review describes the different surgical strategies for the treatment of endometriosis.
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Affiliation(s)
- Karolina Afors
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Rouba Murtada
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Gabriele Centini
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Rodrigo Fernandes
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Carolina Meza
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Jesus Castellano
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
| | - Arnaud Wattiez
- IRCAD, Hopitaux Universitaires, 1 Place de l'Hopital, 67091 Strasbourg, France
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Silveira da Cunha Araújo R, Abdalla Ayroza Ribeiro HS, Sekula VG, da Costa Porto BT, Ayroza Galvão Ribeiro PA. Long-Term Outcomes on Quality of Life in Women Submitted to Laparoscopic Treatment for Bowel Endometriosis. J Minim Invasive Gynecol 2014; 21:682-8. [DOI: 10.1016/j.jmig.2014.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 02/01/2023]
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Multidisciplinary laparoscopic treatment for bowel endometriosis. Best Pract Res Clin Gastroenterol 2014; 28:53-67. [PMID: 24485255 DOI: 10.1016/j.bpg.2013.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/02/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%.
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Reply: Poor results after surgery for rectovaginal endometriosis can be related to uterine adenomyosis. Hum Reprod 2012. [DOI: 10.1093/humrep/des277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jia SZ, Leng JH, Shi JH, Sun PR, Lang JH. Health-related quality of life in women with endometriosis: a systematic review. J Ovarian Res 2012; 5:29. [PMID: 23078813 PMCID: PMC3507705 DOI: 10.1186/1757-2215-5-29] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/01/2012] [Indexed: 12/24/2022] Open
Abstract
Endometriosis has critical implications for women's quality of life. However, an overview of the current knowledge of this issue is limited. The objective of this systematic review was to determine the extent of endometriosis and its treatment upon women's health-related quality of life (HRQoL). PubMed, Embase, PsycoINFO, CINAHL and the Cochrane Clinical Trials were searched up to May 2012, and only studies using standardized instruments to evaluate HRQoL in women with endometriosis were selected. Our electronic searches identified 591 citations, of which 39 studies satisfied the inclusion criteria including nine qualitative studies and 30 treatment-related studies. Findings showed that endometriosis impaired women's HRQoL. Pain was strongly related to a poor HRQoL, and medical or surgical treatment could partially restore this impairment. No conclusive evidence was available on whether endometriosis imposed an additional impairment in HRQoL per se, apart from the decrease caused by chronic pelvic pain, or on the superiority of various hormonal suppression agents. The impacts of disease extent, duration and fertility status upon HRQoL were inconsistent. In summary, HRQoL was impaired in women with endometriosis, and medical or surgical treatment to alleviate pain could partially restore this impairment.
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Affiliation(s)
- Shuang-Zheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking, Union Medical College, P, R, China.
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Poor results after surgery for rectovaginal endometriosis can be related to uterine adenomyosis. Hum Reprod 2012; 27:3360-1; author reply 3361. [DOI: 10.1093/humrep/des276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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