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Etrusco A, Chiantera V, Serra P, Stabile G, Margioula-Siarkou C, Della Corte L, Giampaolino P, Török P, Baldini GM, Ghezzi F, D'Amato A, Laganà AS. Impact of surgery on reproductive outcomes in women with deep endometriosis and proven presurgical infertility: Facts and controversies. Best Pract Res Clin Obstet Gynaecol 2024:102524. [PMID: 38910100 DOI: 10.1016/j.bpobgyn.2024.102524] [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: 01/20/2024] [Revised: 02/09/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024]
Abstract
In women with proven infertility and deep endometriosis (DE), optimal management is controversial. To date, there is no clear evidence on the association between infertility and different stages of rASRM, nor is there clear guidance from leading scientific societies for surgical treatment of DE patients. A comprehensive literature search was conducted on the main databases for English-language trials describing the effectiveness of surgery for DE in patients with proven infertility; 16 studies were deemed eligible for inclusion in this systematic review (CRD42024498888). Quantitative analysis was not possible because of the heterogeneity of the data. A descriptive summary of the results according to location of pathology, surgical technique used, and whether assisted reproductive technology (ART) was needed or not was provided. A total of 947 infertile women were identified, 486 of whom became pregnant, with an average pregnancy rate of 51.3%. Our review suggests that surgery can be of valuable help in improving reproductive outcomes by improving the results of ART. It has not been possible to reach robust conclusions on the outcomes of surgery based on the location of DE because of the heterogeneity of evidence available to date. Overall, although some data encourage first-line surgical management, further investigation is needed to determine its effective application before or after ART failure.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy.
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy; Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", 80131, Naples, Italy.
| | - Pietro Serra
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy.
| | - Guglielmo Stabile
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71122, Foggia, Italy.
| | - Chrysoula Margioula-Siarkou
- 2(nd)Academic Department of Obstetrics and Gynecology, Hippokration General Hospital, Aristotle University of Thessaloniki, 54643, Thessaloníki, Greece.
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80126, Naples, Italy.
| | - Pierluigi Giampaolino
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80126, Naples, Italy.
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032, Debrecen, Hungary.
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, 21100, Varese, Italy.
| | - Antonio D'Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, 90127, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127, Palermo, Italy.
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Crestani A, Dabi Y, Bendifallah S, Kolanska K, Buffet NC, Thomassin-Naggara I, Darai E, Touboul C. ENDOGRADE: A four level classification to rate surgical complexity in endometriosis. J Gynecol Obstet Hum Reprod 2023; 52:102632. [PMID: 37473962 DOI: 10.1016/j.jogoh.2023.102632] [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: 04/25/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES We studied a post operative classification of surgical complexity in endometriosis. STUDY DESIGN Retrospective monocentric observational study was conducted between January 2001 to December 2019 and included 764 women with DE that underwent surgery. We retrospectively graded surgical complexity through operative reports according to the ENDOGRADE classification, that grades the surgical complexity of DE in four progressive levels. RESULTS Operating time was longer for patients rated ENDOGRADE 3 (228±93 min) compared to patients rated ENDOGRADE 2 (120± 51 min) (p<10-3) and for patients rated ENDOGRADE 4 (301±99 min) compared to patients rated ENDOGRADE 3 (228±93 min), (p<10-3). Eighty percent (20/25) of peroperative complications were rated ENDOGRADE 3 or 4, 20% (5/25) were rated ENDOGRADE 1 or 2 (p = 0.01). Patients rated ENDOGRADE 2, 3 and 4 were 10.3 times (95CI=2.4-44.9, p = 2.10-3), 12.2 times (95CI=2.9-50.2, p = 5.10-4) and 38.3 times (95CI=9.1-162, p = 7.10-7) more likely to experience postoperative complications than those rated ENDOGRADE 1. According to multivariate analysis, only patients rated ENDOGRADE 2, 3, and 4 had a significantly higher risk of postoperative complications with an OR=16.0 (95CI=2.0-127.4, p = 9.10-3), OR=16.2 (95CI=1.6-159.7, p = 0.02) and OR=104.2 (95CI=24.6-440.5, p = 4.10-3), respectively. CONCLUSION ENDOGRADE classification of surgical complexity in DE is correlated to operating time, per- and post-operative complications.
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Affiliation(s)
- Adrien Crestani
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris 75012, France.
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; Université de Médecine Paris Est Créteil (UPEC), Centre Hospitalier intercommunal de Créteil Service de Gynécologie Obstétrique
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; Groupe de recherche clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, hôpital Tenon, Sorbonne Université, Paris 75020, France
| | - Kamila Kolanska
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris 75012, France
| | - Nathalie Chabbert Buffet
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris 75012, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris 75012, France; Groupe de recherche clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, hôpital Tenon, Sorbonne Université, Paris 75020, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris 75020, France; UMRS 938, Centre de recherche Saint Antoine, Faculté de Médecine Sorbonne Université, Paris 75012, France; Groupe de recherche clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance publique des hôpitaux de Paris, hôpital Tenon, Sorbonne Université, Paris 75020, France
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Fertility Outcomes after Surgical Management of Colorectal Endometriosis: A Single-center Retrospective Study. J Minim Invasive Gynecol 2023; 30:230-239. [PMID: 36509394 DOI: 10.1016/j.jmig.2022.12.005] [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: 10/05/2022] [Revised: 11/26/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To assess the pregnancy rate after surgery for colorectal endometriosis. DESIGN A retrospective, single-center study performed from January 2014 to December 2019. SETTING A university tertiary referral center. PATIENTS Patients with the intention to get pregnant younger than the age of 43 years, with or without a history of infertility and who were surgically managed for colorectal endometriosis. INTERVENTIONS Complete excision of deeply infiltrating endometriosis. MEASUREMENTS AND MAIN RESULTS The postoperative pregnancy rate was assessed. Seventy-seven patients had surgery; their mean age was 32.5 ± 4.4 years. Preoperative documented infertility was present in 77.9% of patients (n = 60). The mean length of history of infertility was 36.2 ± 24.9 months. The procedure was performed by laparoscopic surgery in 92.2% of patients (n = 71). Nonconservative, conservative, and mixed treatment were performed in 66.2% (n = 51), 29.9% (n = 23), and 3.9% of patients (n = 3), respectively. According to the Clavien-Dindo classification, the 3B complication rate was 6.5% (n = 5). The mean follow-up was 46.7 ± 20.6 months. Clinical pregnancies were defined by the presence of intrauterine pregnancy with an embryo with cardiac activity. The postoperative pregnancy rate was 62.3% (n = 48), and 54.2% (n = 26) were spontaneous. The mean number of pregnancies was 1.2 ± 0.4 per patient. In addition, 18.7% of patients (n = 9) got pregnant twice. The mean time from surgery to pregnancy was 13.8 ± 13.1 months. The live birth rate was 89.1% (n = 41). There were no significant differences concerning the prognostic criteria reported in the literature (antimüllerian hormone level, age, presence of adenomyosis). There were no predictive criteria for live births. CONCLUSION According to this study, surgery for colorectal endometriosis results in a high postoperative pregnancy rate. Studies with a high level of evidence are needed to determine good candidates for this type of surgery.
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Daniilidis A, Angioni S, Di Michele S, Dinas K, Gkrozou F, D’Alterio MN. Deep Endometriosis and Infertility: What Is the Impact of Surgery? J Clin Med 2022; 11:jcm11226727. [PMID: 36431203 PMCID: PMC9693611 DOI: 10.3390/jcm11226727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
In women with deep endometriosis, the spontaneous fertility rate might range from 2 to 10%. The optimal management of these women is still an area of debate. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior infertility. A total of 392 articles were identified through database searching. Twenty-three studies were eligible to be included in the review. A total of 1548 women were identified, 814 of whom became pregnant, with a mean pregnancy rate of 52.6% (95% CI 49.7-63%). Our review suggests that surgery may improve fertility outcomes. Due to the variability in the studies, it is impossible to stratify fertility outcomes of surgery by the localization of deep endometriosis. More investigations are needed to determine whether surgical management should be first-intention or limited to the failure of medically assisted reproduction treatment.
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Affiliation(s)
- Angelos Daniilidis
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
| | - Stefano Angioni
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Stefano Di Michele
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Konstantinos Dinas
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
| | - Fani Gkrozou
- University Clinic in Obstetrics and Gynecology, University of Ioannina, 451 10 Ioannina, Greece
| | - Maurizio Nicola D’Alterio
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
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Parra RS, Valério FP, Zanardi JVC, Feitosa MR, Camargo HP, Féres O. Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1040-1046. [PMID: 36138537 PMCID: PMC9800063 DOI: 10.1055/s-0042-1756212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose was to assess the rates of postoperative complications and the need of temporary stoma of laparoscopic surgical treatment for bowel endometriosis in a referral center. METHODS The surgical indication, type of operation, operative time, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, postoperative complications were evaluated. RESULTS One-hundred and fifty patients were included. The average duration of surgery was significantly longer for segmental resection (151 minutes) than for disc excision (111.5 minutes, p < 0.001) and shaving (96.8 minutes, p < 0.001). Patients with segmental resection had longer postoperative lengths of hospital stay (1.87 days) compared with patients with disc excision (1.43 days, p < 0.001) and shaving (1.03 days, p < 0.001). A temporary stoma was performed in 2.7% of patients. Grade II and III postoperative complications occurred in 6.7% and 4.7% patients, respectively. CONCLUSION Laparoscopic intestinal resection has an acceptable postoperative complication rate and a low need for a temporary stoma.
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Affiliation(s)
- Rogério Serafim Parra
- School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil,Address for correspondence Rogério Serafim Parra, MD, PhD Av. Bandeirantes, 3900, 14048-900, Ribeirão Preto, SPBrazil
| | | | | | - Marley Ribeiro Feitosa
- School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Hugo Parra Camargo
- School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Xu P, Wang J, Zhang Y, Zhu L, Zhang X. Factors Affecting the Postoperative Bowel Function and Recurrence of Surgery for Intestinal Deep Endometriosis. Front Surg 2022; 9:914661. [PMID: 35774384 PMCID: PMC9239406 DOI: 10.3389/fsurg.2022.914661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to evaluate the factors associated with complications and long-term results in the surgical treatment of intestinal deep endometriosis and to figure out the optimized treatment measures for bowel endometriosis.MethodsA retrospective study was performed in a single center in China. Medical charts were reviewed from 61 women undergoing surgical treatment for bowel endometriosis between January 2013 and August 2019 in the Department of General Gynecology, Women’s Hospital School of Medicine Zhejiang University. Multivariate regression analysis was utilized to investigate the impact of the stages of endometriosis and surgical steps (independent risk factors) on complications (and postoperative bowel dysfunction). The clinical characters, surgical procedures, postoperative treatment, complications, and recurrence rate were summarized and analyzed by using Lasso regression.ResultsSurgery type was the most important independent risk factor related to postoperative abnormal defecation in intestinal deep endometriosis patients (P < 0.05, OR = 34.133). Infection is the most important independent risk factor related to both postoperative complications (OR = 96.931) and recurrences after conservative surgery (OR = 4.667). Surgery type and age were significantly related to recurrences after conservative surgery.ConclusionsWe recommended conservative operation especially full-thickness disc excision to improve the quality of life of intestinal deep endometriosis patients. In addition, prevention of infection is very important to reduce the postoperative complications rate and the recurrence rate.
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Mathilde L, Mary P, Emilie F, Massimo L, Françoise F, Lise L, Arnaud W, Cherif A. Impact of surgery for colorectal endometriosis on postoperative fertility and pregnancy outcomes. J Gynecol Obstet Hum Reprod 2022; 51:102348. [DOI: 10.1016/j.jogoh.2022.102348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 01/04/2022] [Accepted: 02/24/2022] [Indexed: 10/19/2022]
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Vermel M, Lecointre L, Jochum F, Schwaab T, Futcher F, Faller É, Boisramé T, Baldauf JJ, Akladios C. Bowel resection performed by gynecologists - Outcomes and learning curves. Activity profile in a Gynecology Department: 7-year observational cohort. Eur J Obstet Gynecol Reprod Biol 2021; 267:142-149. [PMID: 34773876 DOI: 10.1016/j.ejogrb.2021.09.024] [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: 06/04/2021] [Revised: 08/31/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Bowel resection is frequently used when performing oncological surgery to obtain complete cytoreduction or to remove endometriosis in case of intestinal invasion. Acquiring the surgical skills to perform this kind of procedure is crucial to offer to our patients an optimal management. The aim of this study is to describe a 7-years surgical experience in bowel resections of a gynecologic surgeon and to determine his learning curves. STUDY DESIGN This is a monocentric retrospective cohort study reporting digestive resection performed between January 2013 and April 2020 in the Gynecology Department of Strasbourg University Hospital. Ninety-one consecutive patients were assigned in two groups: gynecological cancer (n = 44) and deep infiltrating endometriosis (DIE) (n = 47). The main outcome measure was the postoperative complications rate at 30 days, based on the modified Clavien-Dindo severity system. Learning curves were evaluated using cumulative sum (CUSUM) analysis of operative time and risk-adjusted cumulative sum (RA-CUSUM) analysis of severe perioperative complications. Identification of predictive factors for operation duration and severe perioperative complication occurrence was conducted using multivariate analysis. RESULTS Minor complications were found in 25% of cases. Major complication rate (Clavien-Dindo ≥ IIIa) was 14% in total and only involved patients operated for cancer. The CUSUM curve for operative time peaked at the 35th case and showed a downward slope after the 45th case. Significant predictive factors of operating time were cytoreductive tumoral surgery, size of the bowel resection and laparoscopic surgery, while learning phase 3 significantly decreased it. The RA-CUSUM curve for severe perioperative complications (Clavien-Dindo ≥ IIIa) showed a progressive decrease in the complication rate as the number of interventions increases without showing clear inflection points. Only cardiopulmonary pathologies were found as significant predictive factor of severe complications. CONCLUSION Proficiency in performing highly complex surgery was achieved after approximately 45 cases, cancer and DIE all together. Acceptable rates of severe perioperative complications were observed even during the initial learning period and are comparable with those found in the literature concerning bowel resection performed by gynecologic oncologists but also by general and digestive surgeons.
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Affiliation(s)
- Muriel Vermel
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Lise Lecointre
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France; I-Cube UMR 7357, laboratoire des Sciences de l'ingénieur, de l'informatique et de l'imagerie, Strasbourg University, Pôle API - Parc d'innovation, 300 boulevard Sébastien Brant - BP 10413, 67412 Illkirch Cedex, France
| | - Floriane Jochum
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Thomas Schwaab
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Françoise Futcher
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Émilie Faller
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Thomas Boisramé
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Jean-Jacques Baldauf
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France
| | - Chérif Akladios
- Gynecology Department, Strasbourg University Hospital, Avenue Molière, 67200 Strasbourg, France.
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Fan J, McDonnell R, Jacques A, Fender L, Lo G. MRI sliding sign: Using MRI to assess rectouterine mobility in pelvic endometriosis. J Med Imaging Radiat Oncol 2021; 66:54-59. [PMID: 34241976 DOI: 10.1111/1754-9485.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgical excision of deep infiltrating endometriosis (DIE) is complex and associated with morbidity. Diagnostic imaging plays an important role in the preoperative workup. We sought to determine the utility of single sagittal T2-weighted MRI motion sequence in the preoperative assessment of pelvic mobility in patients with endometriosis. METHODS An observational study at a single tertiary public referral centre in Australia. Eighty-one MRI studies from 1 May 2019 to 3 December 2019, were enrolled. Studies were included if they were performed to stage endometriosis, including a T2-weighted motion series, adequately covering a uterus, cervix and rectum. Fifty-seven studies met inclusion criteria. The reference standard was a contemporaneous transvaginal ultrasound (TVUS) reporting on pelvic organ mobility. Three subspecialist radiologists were then blindly asked to identify, on the cine loop: rectouterine immobility, superficial endometriosis (pelvic bowel adhesions), rectosigmoid Deep Infiltrating Endometriosis (DIE). Fleiss' Kappa assessed interobserver agreement. Consensus MRI sensitivity and specificity were estimated against the reference standard (TVUS). RESULTS Median age was 35 years (range 19-51). Forty-three cases had a contemporaneous TVUS; 14 reporting a sliding sign, 29 with fixed pelves. Interobserver agreement was 'substantial' (k = 0.79) for absent MRI sliding sign and 'almost perfect' (k = 0.90) for absence of DIE. Consensus MRI had 90% sensitivity (95% CI 73-98%) for pelvic immobility at TVUS (absent sliding sign). Interobserver agreement and consensus MRI sensitivity were higher for adhesions and immobility than normal findings. CONCLUSION An MRI motion sequence can identify patients with pelvic adhesions and immobility, helping determine surgical difficulty when TVUS is not diagnostic.
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Affiliation(s)
- Jim Fan
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Rose McDonnell
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Laura Fender
- King Edward Memorial Hospital, Perth, Western Australia, Australia.,Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Glen Lo
- King Edward Memorial Hospital, Perth, Western Australia, Australia.,Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia.,Curtin University, Perth, Western Australia, Australia
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D'Alterio MN, Saponara S, D'Ancona G, Russo M, Laganà AS, Sorrentino F, Nappi L, Angioni S. Role of surgical treatment in endometriosis. Minerva Obstet Gynecol 2021; 73:317-332. [PMID: 34008386 DOI: 10.23736/s2724-606x.21.04737-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endometriosis can take one of three forms depending on its clinical presentation and management: endometriotic ovarian cyst (ovarian endometrioma), superficial or peritoneal endometriosis and deep infiltrating endometriosis (DIE).1Among them, DIE is considered the most aggressive, and the patient is often affected by more than one type together. The therapeutic methodology should not be influenced by a combination of different types of endometriotic lesion. According to the clinical context and the patient's needs, the treatment of this pathology can be medical or surgical. Although medical therapy could improve endometriosis-associated symptoms, it never offers a definite treatment for symptomatic patients, who often require surgical treatment. The rationale behind endometriosis surgical treatment is to achieve the complete removal of all lesions through a one-step surgical procedure; to obtain promising long-term results for pelvic pain, recurrence rate, and fertility; and to protect the functionality of the involved organs. Achieving these results depends on the total removal of the pathology from the pelvis, in an attempt to preserve, as much as possible, the healthy tissues surrounding the site of the disease. The choice of a surgical approach rather than medical therapy is subject to the patient's expectations, such as pregnancy desire, the effectiveness of treatment compared to possible complications, the type of pain and its intensity, and the location and severity of the disease. In this context, surgical management using a multidisciplinary endometriosis team is an important factor for achieving good outcomes.
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Affiliation(s)
- Maurizio N D'Alterio
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy -
| | - Stefania Saponara
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gianmarco D'Ancona
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Margherita Russo
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Stefano Angioni
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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D'Alterio MN, D'Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S. Management Challenges of Deep Infiltrating Endometriosis. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:88-94. [PMID: 33687160 PMCID: PMC8052801 DOI: 10.22074/ijfs.2020.134689] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Deep infiltrating endometriosis (DIE) is the most aggressive of the three phenotypes that constitute endometriosis. It can affect the whole pelvis, subverting the anatomy and functionality of vital organs, with an important negative impact on the patient's quality of life. The diagnosis of DIE is based on clinical and physical examination, instrumental examination, and, if surgery is needed, the identification and biopsy of lesions. The choice of the best therapeutic approach for women with DIE is often challenging. Therapeutic options include medical and surgical treatment, and the decision should be dictated by the patient's medical history, disease stage, symptom severity, and personal choice. Medical therapy can control the symptoms and stop the development of pathology, keeping in mind the side effects derived from a long-term treatment and the risk of recurrence once suspended. Surgical treatment should be proposed only when it is strictly necessary (failed hormone therapy, contraindications to hormone treatment, severity of symptoms, infertility), preferring, whenever possible, a conservative approach performed by a multidisciplinary team. All therapeutic possibilities have to be explained by the physicians in order to help the patients to make the right choice and minimize the impact of the disease on their lives.
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Affiliation(s)
| | - Gianmarco D'Ancona
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Mohamed Raslan
- Department of Obstetrics and Gynaecology, Tanta University, Tanta, Egypt
| | - Raffaele Tinelli
- Department of Obstetrics and Gynaecology, 'Valle d'Itria' Hospital, Martina Franca, Taranto, Italy
| | - Angelos Daniilidis
- Department of Obstetrics and Gynaecology, 2nd University Clinic of Obstetrics and Gynaecology, Aristotele University of Thessaloniki, Thessaloniki, Greece
| | - Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
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Barra F, Mikhail E, Villegas-Echeverri JD, Ferrero S. Infertility in patients with bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2021; 71:161-171. [DOI: 10.1016/j.bpobgyn.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
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13
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Hirata T, Koga K, Kai K, Katabuchi H, Kitade M, Kitawaki J, Kurihara M, Takazawa N, Tanaka T, Taniguchi F, Nakajima J, Narahara H, Harada T, Horie S, Honda R, Murono K, Yoshimura K, Osuga Y. Clinical practice guidelines for the treatment of extragenital endometriosis in Japan, 2018. J Obstet Gynaecol Res 2020; 46:2474-2487. [PMID: 33078482 PMCID: PMC7756675 DOI: 10.1111/jog.14522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/28/2020] [Indexed: 01/31/2023]
Abstract
The aim of this publication is to disseminate the clinical practice guidelines for the treatment of intestinal, bladder/ureteral, thoracic and umbilical endometriosis, already published in Japanese, to non-Japanese speakers. For developing the original Japanese guidelines, the clinical practice guideline committee was formed by the research team for extragenital endometriosis, which is part of the research program of intractable disease of the Japanese Ministry of Health, Labor and Welfare. The clinical practice guideline committee formulated eight clinical questions for the treatment of extragenital endometriosis, which were intestinal, bladder/ureteral, thoracic and umbilical endometriosis. The committee performed a systematic review of the literature to provide responses to clinical questions and developed clinical guidelines for extragenital endometriosis, according to the process proposed by the Medical Information Network Distribution Service. The recommendation level was determined using modified Delphi methods. The clinical practice guidelines were officially approved by the Japan Society of Obstetrics and Gynecology and the Japan Society of Endometriosis. This English version was translated from the Japanese version.
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Affiliation(s)
- Tetsuya Hirata
- Department of Obstetrics and GynecologyDoai Kinen HospitalTokyoJapan
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kaori Koga
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
| | - Kentaro Kai
- Department of Obstetrics and GynecologyOita UniversityOitaJapan
| | | | - Mari Kitade
- Department of Obstetrics and GynecologyJuntendo UniversityTokyoJapan
| | - Jo Kitawaki
- Department of Obstetrics and GynecologyKyoto Prefectural UniversityKyotoJapan
| | - Masatoshi Kurihara
- Pneumothorax Research Center and Division of Thoracic SurgeryNissan Tamagawa HospitalTokyoJapan
| | | | - Toshiaki Tanaka
- Department of Surgical OncologyUniversity of TokyoTokyoJapan
- Department of SurgeryInternational Catholic HospitalTokyoJapan
| | | | - Jun Nakajima
- Department of Thoracic SurgeryUniversity of TokyoTokyoJapan
| | | | - Tasuku Harada
- Department of Obstetrics and GynecologyTottori UniversityTottoriJapan
| | - Shigeo Horie
- Department of UrologyJuntendo UniversityTokyoJapan
| | - Ritsuo Honda
- Department of Obstetrics and GynecologyKumamoto UniversityKumamotoJapan
| | - Koji Murono
- Department of Surgical OncologyUniversity of TokyoTokyoJapan
| | - Kotaro Yoshimura
- Department of Plastic SurgeryJichi Medical UniversityShimotsukeJapan
| | - Yutaka Osuga
- Department of Obstetrics and GynecologyUniversity of TokyoTokyoJapan
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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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15
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Understanding pre-operative staging and surgical practice in advanced endometriosis: A survey of Canadian gynaecologists. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520924500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Study objective: To determine the pre-operative evaluation, surgical management and referral practices in patients with advanced stage endometriosis by Canadian gynaecologists. Design: A survey of obstetricians and gynaecologists. Setting: The survey was initiated and piloted at an academic centre by general gynaecologists and endometriosis specialists. Intervention: Electronically distributed to 733 individuals by the Society of Obstetricians and Gynaecologists of Canada. This included all members, irrespective of subspecialty and practice patterns. Measurement: Responses were collected using a web-based survey tool and analysed using Excel. Results: The response rate was 15.7% (115 respondents). Pre-operatively, 62.2% of respondents perform a transvaginal ultrasound on all of their patients, while magnetic resonance imaging is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis, bowel, bladder or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect pre-operatively <10% of the time. Although 40% of respondents would refer their patients in whom they suspected deep infiltrating endometriosis, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, 54.4% would never refer without previously confirming the diagnosis at laparoscopy. In contrast, only 15% felt comfortable treating advanced endometriosis completely at time of laparoscopy (including deep infiltrating endometriosis, bladder and bowel disease). Post-operatively, 67.8% of respondents refer patients to an endometriosis specialist only if their disease was not appropriately treated surgically, while 23.3% do not refer any of their patients. Conclusion: Our study identified significant variability in the management of advanced endometriosis in Canada. Understanding these patterns will help us formulate a more universal investigation and management plan, which may improve the identification of patients pre-operatively with advanced stage endometriosis that could benefit from treatment by an endometriosis specialist.
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Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC WOMENS HEALTH 2020; 20:111. [PMID: 32434535 PMCID: PMC7240912 DOI: 10.1186/s12905-020-00974-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Background To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
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Affiliation(s)
- Hungling Kwok
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Tian Li
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People's Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hui Fei
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Cheng
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuqin Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
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Hini JD, Ferrier C, Owen C, Arfi A, Touboul C, Bendifallah S, Darai E. [Interposing lateral pelvic peritoneum between the vaginal and digestive scares during a surgical colorectal resection for endometriosis, without associated hysterectomy]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:457-459. [PMID: 32156667 DOI: 10.1016/j.gofs.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 06/10/2023]
Affiliation(s)
- J-D Hini
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France.
| | - C Ferrier
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France
| | - C Owen
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France
| | - A Arfi
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France
| | - C Touboul
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France
| | - S Bendifallah
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France
| | - E Darai
- Service de chirurgie gynécologique, hôpital Tenon, 4, rue de la Chine, 75012 Paris, France
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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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Nicolaus K, Zschauer S, Bräuer D, Jimenez-Cruz J, Lehmann T, Rengsberger M, Diebolder H, Runnebaum IB. Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 2020; 301:699-706. [PMID: 31989287 DOI: 10.1007/s00404-019-05425-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to assess post-operative complications based on the Clavien-Dindo classification system following routine laparoscopic treatment of all stages of endometriosis. METHODS A retrospective cohort study was carried out to identify women who underwent laparoscopic complete resection of newly diagnosed endometriosis between 2013 and 2016. 401 patients were identified using hospital database search software, and electronic files were reviewed. The stages of endometriosis had been classified according to the revised score of the American Society of Reproductive Medicine (rASRM) and the Enzian classification in cases of deep infiltrating endometriosis. Post-operative complications were recorded based on the Clavien-Dindo classification. Multivariate regression analysis was used to investigate the impact of the stages of endometriosis and surgical steps on complications. RESULTS Grade III complications requiring surgical, endoscopic, or radiological intervention occurred in only 1.7% of patients and were significantly associated with rASRM stage IV (OR 1.8). Grade II complications (blood transfusion, total parenteral nutrition) occurred in 18.7% of patients. rASRM stage IV (OR 2.0), hysterectomy (OR 3.2), conversion to laparotomy (OR 11.1), and bowel resection (OR 27.6) were significantly associated with increased risk of grade II complications. rASRM stages I-III did not show an effect on post-operative complications or hospital stay. CONCLUSIONS Clavien-Dindo complication grading was readily applicable to laparoscopic removal of endometriosis of all stages. Higher Clavien-Dindo grades correctly reflected clinically relevant complications and were associated with deep infiltrating endometriosis, stage IV endometriosis, bowel surgery, or hysterectomy. Clavien-Dindo classification can be recommended for evaluation of laparoscopic endometriosis surgery outcome.
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Affiliation(s)
- Kristin Nicolaus
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Stefan Zschauer
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Dominik Bräuer
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Jorge Jimenez-Cruz
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
- Department of Obstetrics and Prenatal Medicine, University Women's Hospital Bonn, Bonn, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Rengsberger
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Herbert Diebolder
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany.
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Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol 2019; 239:21-29. [PMID: 31163353 DOI: 10.1016/j.ejogrb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/20/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
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Affiliation(s)
- Johannes Lermann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
| | - Nalan Topal
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany; Department of Obstetrics and Gynecology, Klinikverbund Südwest, Klinikum Sindelfingen-Böblingen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefanie Burghaus
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Felix Heindl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
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Rocha AM, Albuquerque MMD, Schmidt EM, Freitas CD, Farias JP, Bedin F. LATE IMPACT OF THE LAPAROSCOPIC TREATMENT OF DEEP INFILTRATING ENDOMETRIOSIS WITH SEGMENTAL COLORECTAL RESECTION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 31:e1406. [PMID: 30539981 PMCID: PMC6284382 DOI: 10.1590/0102-672020180001e1406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Deep infiltrating colorectal endometriosis may severely affect the quality of life and fertility of patients. Although segmental resection is a therapeutic option that provides positive outcomes in the management of symptoms, its functional effects are still unproven. AIM Assess the late impact of the laparoscopic approach in treating deep infiltrating endometriosis with segmental colorectal resection. METHODS Prospective case series of 46 patients submitted to laparoscopic treatment of deep infiltrating endometriosis with segmental colorectal resection between 2013 and 2016. Fertility, gynecological and bowel symptoms were assessed at the preoperative period and at three and 12 months (or more) after the procedure. RESULTS Preoperative interview assessed the prevalence of infertility (45.6%), gynecological (87%) and intestinal (80.4%) symptoms. At the third month after the procedure a significant reduction in the prevalence of gynecological symptoms (p<0,001), tenesmus (p=0,001) and dysquesia (p=0,002) was observed. After a period of 12 months or more following the procedure a significant reduction in the prevalence persisted for dysmenorrhea (p=0,001), deep dyspareunia (p=0,041), chronic pelvic pain (p=0,011) and dysquesia (p=0,001), as compared to the preoperative period. Total pregnancy rate was 57.1% and spontaneous pregnancy 47.6%. CONCLUSION The treatment of deep infiltrating endometriosis using segmental colorectal resection has provided early and late relief of gynecological and bowel symptoms. The outcomes also indicate a positive impact on the fertility of infertile patients.
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Affiliation(s)
| | | | | | | | | | - Fernanda Bedin
- Medical School, University of Southern Santa Catarina, Palhoça
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22
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Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018; 33:835-847. [PMID: 29744578 DOI: 10.1007/s00384-018-3082-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE "Endometriosis" is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5 mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis. METHODS We performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: "rectal resection" AND "endometriosis" and "rectosigmoid resection" AND "endometriosis." The search revealed 380 papers of which 78 were fully analyzed. RESULTS Thirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 ± 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 ± 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 ± 3.71 days. CONCLUSIONS Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - José D Subiela
- Department of Urology, Fundació Puigvert, Carrer de Cartegena 340, Universidad Autónoma de Barcelona, 08025, Barcelona, Spain
| | - Mostafa Shalaby
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Giuseppe Petrella
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
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Functional Outcomes After Rectal Resection for Deep Infiltrating Pelvic Endometriosis: Long-term Results. Dis Colon Rectum 2018; 61:733-742. [PMID: 29664797 DOI: 10.1097/dcr.0000000000001047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Curative management of deep infiltrating endometriosis requires complete removal of all endometriotic implants. Surgical approach to rectal involvement has become a topic of debate given potential postoperative bowel dysfunction and complications. OBJECTIVE This study aims to assess long-term postoperative evacuation and incontinence outcomes after laparoscopic segmental rectal resection for deep infiltrating endometriosis involving the rectal wall. DESIGN This is a retrospective study of prospectively collected data. SETTINGS This single-center study was conducted at the University Hospital of Bern, Switzerland. PATIENTS Patients with deep infiltrating endometriosis involving the rectum undergoing rectal resection from June 2002 to May 2011 with at least 24 months follow-up were included. MAIN OUTCOME MEASURES Aside from endometriosis-related symptoms, detailed symptoms on evacuation (points: 0 (best) to 21 (worst)) and incontinence (0-24) were evaluated by using a standardized questionnaire before and at least 24 months after surgery. RESULTS Of 66 women who underwent rectal resection, 51 were available for analyses with a median follow-up period of 86 months (range: 26-168). Forty-eight patients (94%) underwent laparoscopic resection (4% converted, 2% primary open), with end-to-end anastomosis in 41 patients (82%). Two patients (4%) had an anastomotic insufficiency; 1 case was complicated by rectovaginal fistula. Dysmenorrhea, nonmenstrual pain, and dyspareunia substantially improved (p < 0.001 for all comparisons). Overall evacuation score increased from a median of 0 (range: 0-11) to 2 points (0-15), p = 0.002. Overall incontinence also increased from 0 (range: 0-9) to 2 points (0-9), p = 0.003. LIMITATIONS This study was limited by its retrospective nature and moderate number of patients. CONCLUSIONS Laparoscopic segmental rectal resection for the treatment of deep infiltrating endometriosis including the rectal wall is associated with good results in endometriotic-related symptoms, although patients should be informed about possible postoperative impairments in evacuation and incontinence. However, its clinical impact does not outweigh the benefit that can be achieved through this approach. See Video Abstract at http://links.lww.com/DCR/A547.
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Mathieu d'Argent E, Cohen J, Chauffour C, Pouly JL, Boujenah J, Poncelet C, Decanter C, Santulli P. [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:357-367. [PMID: 29544710 DOI: 10.1016/j.gofs.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 01/27/2023]
Abstract
Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.
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Affiliation(s)
- E Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - J Cohen
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Chauffour
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J L Pouly
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Boujenah
- Service de gynécologie obstétrique, CHU de Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - C Poncelet
- Service de gynécologie obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; UFR SMBH, université Paris 13, Sorbonne Paris-Cité, 93022 Bobigny, France
| | - C Decanter
- EA 4308 Gamétogenèse et qualité du gamète, service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU de Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris-Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
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Ballester M, Roman H. [Surgical management of deep endometriosis with colorectal involvement: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29534879 DOI: 10.1016/j.gofs.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Deep endometriosis with colorectal involvement is considered one of the most severe forms of the disease due to its impact on patients' quality of life and fertility but also by the difficulties encountered by the clinicians when proposing a therapeutic strategy. Although the literature is very rich, evidence based medicine remains poor explaining the great heterogeneity concerning the management of such patients. Surgery therefore remains a therapeutic option. It improves the intensity of gynecological, digestive and general symptoms and the quality of life. Concerning the surgical approach, it appears that laparoscopy should be the first option; the laparoscopic robot-assisted route can also be proposed. The techniques of rectal shaving, discoid resection and segmental resection are the three techniques used for surgical excision of colorectal endometriosis. The parameters taken into account for the use of either technique are: the surgeon's experience, the depth of infiltration of the lesion within the rectosigmoid wall, the lesion size and circumference, multifocality and the distance of the lesion from the anal margin. In the case of deep endometriosis with colorectal involvement, performing an incomplete surgery increases the rate of pain recurrence and decreases postoperative fertility. In case of surgery for colorectal endometriosis, pregnancy rates are similar to those obtained after ART in non-operated patients. Existing data are insufficient to formally recommend first line surgery or ART in infertile patients with colorectal endometriosis. The surgery for colorectal endometriosis exposes to a risk of postoperative complications and recurrence of which the patients should be informed preoperatively.
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Affiliation(s)
- M Ballester
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
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Vercellini P, Buggio L, Borghi A, Monti E, Gattei U, Frattaruolo MP. Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review. Acta Obstet Gynecol Scand 2018; 97:942-955. [DOI: 10.1111/aogs.13328] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Paolo Vercellini
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
- IRCCS Ca ‘Granda Foundation - Maggiore Policlinico Hospital; Milan Italy
| | - Laura Buggio
- IRCCS Ca ‘Granda Foundation - Maggiore Policlinico Hospital; Milan Italy
| | - Alessandra Borghi
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Ermelinda Monti
- IRCCS Ca ‘Granda Foundation - Maggiore Policlinico Hospital; Milan Italy
| | - Umberto Gattei
- IRCCS Ca ‘Granda Foundation - Maggiore Policlinico Hospital; Milan Italy
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Zheng Y, Zhang N, Lu W, Zhang L, Gu S, Zhang Y, Yi X, Hua K. Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter? J Int Med Res 2018; 46:852-864. [PMID: 29132241 PMCID: PMC5971512 DOI: 10.1177/0300060517728208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/03/2017] [Indexed: 12/28/2022] Open
Abstract
Objective This study was performed to identify risk factors for postoperative rectovaginal fistula (PRF) in patients with deep infiltrating endometriosis (DIE). Methods Data were retrospectively obtained from the medical records of 104 patients with DIE, and statistical analysis was used to detect risk factors for PRF. Results Five of 104 (4.8%) patients developed PRF from 5 to 16 days postoperatively. The operative procedures included 84 (80.8%) superficial excisions, 6 (5.8%) full-thickness disc excisions, and 14 (13.5%) bowel resections. Most lesions were located in the cul-de-sac, and the mean lesion size was 2.6 cm (range, 0.5-7.0 cm). The univariate analysis showed that lesion location, larger lesion size, and surgical technique were statistically significant risk factors for PRF. Conclusion Surgical procedures should be very carefully executed in patients with DIE lesions of ≥4 cm.
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Affiliation(s)
- Yunxi Zheng
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, PR China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, PR China
| | - Ning Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Liang Zhang
- Department of Urinary Surgery, Xinhua Hospital, Jiaotong University, Shanghai, PR China
| | - Shouxin Gu
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Ying Zhang
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
| | - Xiaofang Yi
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, PR China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, PR China
| | - Keqin Hua
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai, PR China
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, PR China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, PR China
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Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril 2017; 108:913-930. [DOI: 10.1016/j.fertnstert.2017.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
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Saavalainen L, Tikka T, But A, Gissler M, Haukka J, Tiitinen A, Härkki P, Heikinheimo O. Trends in the incidence rate, type and treatment of surgically verified endometriosis - a nationwide cohort study. Acta Obstet Gynecol Scand 2017; 97:59-67. [PMID: 29028285 DOI: 10.1111/aogs.13244] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/08/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION To study the trends in incidence rate, type and surgical treatment, and patient characteristics of surgically verified endometriosis during 1987-2012. MATERIAL AND METHODS This is a register-based cohort study. We identified women receiving their first diagnosis of endometriosis in surgery from the Finnish Hospital Discharge Register (FHDR). Quality of the FHDR records was assessed bidirectionally. The age-standardized incidence rates of the first surgically verified endometriosis was assessed by calendar year. RESULTS The cohort comprises 49 956 women. The quality assessment suggested the FHDR data to be of good quality. The most common diagnosis, ovarian endometriosis (46%), was associated with highest median age 38.5 years (interquartile range 31.0-44.8) and the second most common diagnosis, peritoneal endometriosis (40%), with median age 34.9 years (28.6-41.7). Between 1987 and 2012, a decrease was observed in the median age, from 38.8 (32.3-43.6) to 34.0 (28.9-41.0) years, and in the age-standardized incidence rate from 116 [95% confidence interval (CI) 112-121] to 45 (42-48) per 100 000 women. The proportion of hysterectomy as a first surgical treatment decreased from 38 to 19%, whereas that of laparoscopy increased from 42 to 73% when comparing 1987-1995 with 1996-2012. CONCLUSIONS This nationwide cohort of surgically verified endometriosis showed a decrease in the incidence rate and in the patient age at the time of first diagnosis, even though the proportion of laparoscopy has increased. The number of hysterectomies has decreased. These changes are likely to reflect the evolving diagnostics, increasing awareness of endometriosis, and effective use of medical treatment before surgery.
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Affiliation(s)
- Liisu Saavalainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuulia Tikka
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna But
- Department of Public Health Clinicum, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jari Haukka
- Department of Public Health Clinicum, University of Helsinki, Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Härkki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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From Endometriosis to Pregnancy: Which is the “Road-Map”? JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last decade, pregnancy was considered as a therapeutic period for patients affected by endometriosis and painful symptoms. However, several studies have taken into consideration how endometriosis affects pregnancy achievement and pregnancy development, including obstetric complications. The adverse effects of endometriosis on the development of pregnancy include miscarriage, hypertensive disorders and pre-eclampsia, placenta previa, obstetric hemorrhages, preterm birth, small for gestational age, and adverse neonatal outcomes. The aim of this review is to analyze the current literature regarding the relationship between different forms of endometriosis (endometrioma, peritoneal endometriosis, deep endometriosis) and infertility, and the impact of endometriosis on pregnancy outcomes.
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Renner SP, Kessler H, Topal N, Proske K, Adler W, Burghaus S, Haupt W, Beckmann MW, Lermann J. Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 2017; 295:1277-1285. [DOI: 10.1007/s00404-017-4360-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 11/24/2022]
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Daraï E, Cohen J, Ballester M. Colorectal endometriosis and fertility. Eur J Obstet Gynecol Reprod Biol 2017; 209:86-94. [DOI: 10.1016/j.ejogrb.2016.05.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 02/08/2023]
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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: 108] [Impact Index Per Article: 13.5] [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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Rates, trends, and short-term outcomes of colorectal resections for endometriosis: An ACS-NSQIP review. Int J Surg 2016; 31:5-9. [DOI: 10.1016/j.ijsu.2016.05.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 04/26/2016] [Accepted: 05/09/2016] [Indexed: 11/23/2022]
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Saavalainen L, Heikinheimo O, Tiitinen A, Härkki P. Deep infiltrating endometriosis affecting the urinary tract-surgical treatment and fertility outcomes in 2004-2013. ACTA ACUST UNITED AC 2016; 13:435-444. [PMID: 28003801 PMCID: PMC5133280 DOI: 10.1007/s10397-016-0958-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/18/2016] [Indexed: 11/25/2022]
Abstract
Urinary tract endometriosis (UTE) is a rare form of deep infiltrating endometriosis. We studied the operative treatment of UTE and evaluated postoperative recurrences and fertility outcomes. This is a retrospective cohort study of 53 women who underwent operative treatment for UTE in 2004–2013 at Helsinki University Hospital, and were followed-up until the end of 2014. The data were gathered from the hospital’s electronic database. The main outcome measures were complications, reoperations, postoperative pregnancies, and deliveries. Preoperative diagnosis was accurate in 72 % with bladder endometriosis and in 93 % with ureteral disease. Thirty-one (58 %) of the 53 operations were performed via laparoscopy. Postoperative complications requiring re-intervention occurred in five cases (9 %). Five reoperations were performed in four cases due to endometriosis recurrence, only two due to recurrence of UTE (4 %). Twenty-eight women wished for pregnancy; 18 (64 %) of them conceived. Infertility treatment was needed in 20 (71 %) cases. Twelve (75 %) women delivered via cesarean section; intraoperative difficulties occurred in ten (83 %). The complication rate with UTE operations is acceptable and recurrences are rare. Infertility is common, but 57 % of those who wished for a child succeeded. A majority of the deliveries involved unplanned and complicated cesarean section.
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Affiliation(s)
- Liisu Saavalainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Sofianlehdonkatu 5, PO Box 610, FI-00029 HUS Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Sofianlehdonkatu 5, PO Box 610, FI-00029 HUS Helsinki, Finland
| | - Aila Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Sofianlehdonkatu 5, PO Box 610, FI-00029 HUS Helsinki, Finland
| | - Päivi Härkki
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Sofianlehdonkatu 5, PO Box 610, FI-00029 HUS Helsinki, Finland
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Somigliana E, Busnelli A, Benaglia L, Viganò P, Leonardi M, Paffoni A, Vercellini P. Postoperative hormonal therapy after surgical excision of deep endometriosis. Eur J Obstet Gynecol Reprod Biol 2016; 209:77-80. [PMID: 27067871 DOI: 10.1016/j.ejogrb.2016.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/24/2016] [Indexed: 12/16/2022]
Abstract
The clinical management of women with deep peritoneal endometriosis remains controversial. The debate focuses mainly on the precise role of hormonal medical treatment and surgery and on the most suitable surgical technique to be used. In particular, considering the risks of second-line surgery, prevention of recurrences after first-line surgery is a priority in this context. Post-surgical medical therapy has been advocated to improve the effectiveness of surgery and prevent recurrences. However, adjuvant therapy, i.e. a short course of 3-6 months of hormonal therapy after surgery, has been proven to be of limited or no benefit for endometriosis in general and for deep peritoneal endometriosis in particular. On the other hand, two cohort studies suggest a beneficial effect of prolonged hormonal therapy after surgery for deep endometriosis. Even if this evidence is too weak to confidently advocate systematic administration of prolonged medical therapy after surgery, we argue in favour of this approach because of the strong association of deep endometriosis with other disease forms. In fact, women operated on for deep endometriosis may also face recurrences of endometriomas, superficial peritoneal lesions and pelvic pain in general. The demonstrated high effectiveness of prolonged postoperative therapy for the prevention of endometriomas' formation and dysmenorrhea recurrence should thus receive utmost consideration in the decision-making process.
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Affiliation(s)
- Edgardo Somigliana
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Andrea Busnelli
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | - Laura Benaglia
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Viganò
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, Milan, Italy
| | - Marta Leonardi
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Paffoni
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Obstet-Gynecol Dept, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Università degli Studi di Milano, Milan, Italy
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Martínez-Serrano MJ, Martínez-Román S, Pahisa J, Balasch J, Carmona F. Intestinal surgery performed by gynecologists. Acta Obstet Gynecol Scand 2015; 94:954-9. [DOI: 10.1111/aogs.12698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 06/08/2015] [Indexed: 01/15/2023]
Affiliation(s)
- María José Martínez-Serrano
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Sergio Martínez-Román
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Jaume Pahisa
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Joan Balasch
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
| | - Francisco Carmona
- Clinical Institute of Gynecology, Obstetrics and Neonatology; Faculty of Medicine; Hospital Clinic and August Pi I Sunyer Biomedical Investigation Institute (IDIBAPS); University of Barcelona; Barcelona Spain
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