Surgical Management of Deep Infiltrating Endometriosis and Impact on Quality of Life (original) (raw)
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Case Based Discussion of Surgical Approach to Deep Infiltrating Endometriosis
Iris Publishers LLC, 2019
Endometriosis presents a diagnostic challenge as clinical symptoms do not correlate well with the extent of disease [1]. Cramer, et al. [2] found that menstrual cycle length shorter than 27 days, menses longer than 7 days and severe cramping dysmenorrhea were predictive of endometriosis with relative risks of 2.1 (95%CI 1.5-2.9), 2.4 (95%CI 1.4-4.0) and 6.7(95%CI 4.4-10.2) respectively. The study compared 268 women with infertility and laparoscopically confirmed endometriosis with 3794 women admitted for delivery (controls) using a retrospective questionnaire. The study was limited by recall bias and the criteria for laparoscopic diagnosis were not clearly defined. No significant correlation was found with chronic pelvic pain. The issue has been studied prospectively [3,4] in 134 women scheduled for laparoscopy for chronic pelvic pain (CPP). Dyschezia, dyspareunia, and non-menstrual pain were all identified as predictors of deep infiltrating endometriosis (DIE) with odds ratios of 3.9 (95%CI 1.7-8.9), 4.6 (95%CI 1.5-14.2) and 2.5 (95%CI 1.1-5.6) respectively. Mrs. SF presented with all of these symptoms to a greater or lesser extent. One criticism of Chapron’s study is that the diagnosis was made on laparoscopic appearance without histological confirmation. Visualization alone has been shown to have a positive predictive value (PPV) for endometriosis of 45% and up to 36% of lesions were down staged on histology
Outcome of conservative surgical treatment of deep infiltrating endometriosis
Gynecological Surgery, 2013
Deep infiltrating endometriosis, which is frequently associated with pain, is diagnosed at clinical examination and with indirect imaging techniques like ultrasound and MRI. The aim of this study was to evaluate complications and recurrence rate after laparoscopic resection of deep infiltrating endometriosis by shaving technique. Between January 2004 and December 2010, 74 procedures for deep infiltrating endometriosis were performed in patients with pain and/or infertility. The endometriotic plaques were resected laparoscopically using scissors and bipolar and/or unipolar current. If rectosigmoidal invasion was present, a shaving was performed. Mean age was 31.7 years (SD ± 4.4). The vaginal nodule was a solitary lesion in 4 % of the patients without involvement of the ovaries, rectum or bladder. In 86 % of the cases, the rectosigmoid was involved as well. Mean follow-up was 776 days (SD0 465). One patient developed postoperatively a severe complication with intestinal perforation secondary to thermal necrosis (1.4 %). In four patients recurrence of symptoms was noted (8 %). Conservative surgery for deep infiltrating endometriosis resulted in the relief of pain, with a low postoperative complication rate (1.4 %). This shaving technique also resulted in a limited risk of recurrence of the symptoms (8 %).
The Journal of the American Association of Gynecologic Laparoscopists, 2004
Study Objective. To determine the efficacy of gonadotropinreleasing hormone (GnRH) analogs plus add-back therapy compared with GnRH analogs alone and estroprogestin in patients with relapse of endometriosis-associated pain. Methods. One hundred thirty-three women with relapse of endometriosis-related pain after previous endometriosis surgery were enrolled. Forty-six women were treated with GnRH analog plus add-back therapy, 44 women were given GnRH analog alone, and 43 women received estroprogestin, for 12 months. Pain evaluation by a visual analog scale, quality of life in treated patients using the SF-36 questionnaire, and occurrence of adverse effects including bone mass density loss, at pretreatment, after 6 months of treatment, at the end of treatment, and 6 months after discontinuation of treatment were evaluated. Measurements and Main Results. Patients treated either
Surgical treatment of deeply infiltrating endometriosis
1995
background: Treatment of colorectal endometriosis is difficult and challenging. We reviewed the clinical outcome of surgical treatment of deeply infiltrating endometriosis (DIE) with colorectal involvement. methods: Review was based upon a literature search using following search terms: (1) 'surgery' and 'colorectal endometriosis', (2) 'bowel' and 'endometriosis' and 'surgery'. Inclusion criteria: clear explanation of surgical technique and follow-up data on at least one of the following items: complications, pain, quality of life (QOL), fertility and recurrence. results: Most of the 49 studies included complications (94%) and pain (67%); few studies reported recurrence (41%), fertility (37%) and QOL (10%); only 29% reported (loss of) follow-up. Out of 3894 patients, 71% received bowel resection anastomosis, 10% received fullthickness disc excision and 17% were treated with superficial surgery. Comparison of clinical outcome between different surgical techniques was not possible. Post-operative complications were present in 0-3% of the patients. Although pain improvement was reported in most studies, pain evaluation was patient-based in ,50% (Visual Analogue Scale in only 18%). While QOL was improved in most studies, prospective data were only available for 149 patients. Pregnancy rates were 23-57% with a cumulative pregnancy rate of 58-70% within 4 years. The overall endometriosis recurrence rate in studies (.2 years follow-up) was 5-25% with most of the studies reporting 10%. Owing to highly variable study design and data collection, a CONSORT-inspired checklist was developed for future studies. conclusions: Prospective studies reporting standardized and well-defined clinical outcome after surgical treatment of DIE with colorectal involvement with long-term follow-up are needed.
Gineco.eu, 2016
Endometriosis is a benign disease with highly variable symptoms. The adequate treatment for symptomatic disease requires complete resection of all lesions. In advanced stages, bowel involvement is common. However, indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The aim of this study was to assess the feasibility of complete laparoscopic management of symptomatic deep pelvic endometriosis in a new multidisciplinary center in Romania. We included and retrospectively evaluated 74 patients treated for symptomatic deep infiltrating endometriosis in our institution between 2014 and 2015. In the majority of patients (97.3%), radical resection was achieved entirely using a minimally invasive surgical technique. Complications occurred in only 2 cases with anastomotic leakage in 1 patient and a rectovaginal fistula in another patient. A well-trained interdisciplinary team can perform the laparoscopic treatment of deep infiltrating endometriosis with low incidence of major complications and good clinical outcome.
Health and Quality of Life Outcomes, 2011
Deep infiltrating endometriosis (DIE) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface. It is a chronic disease which can impair women's sexual function. There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE. Aims. The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives (COC) administration on sexual function in patients with DIE and to compare sexual function outcomes of women submitted to intestinal resection and nodule excision. Methods. It is a prospective cohort study in a tertiary care university hospital on 106 sexually active women, with histologically confirmed DIE, managed by laparoscopy and subsequent COC therapy for 6 months. Patients filled preoperatively and 6-month postoperatively a quality of sexual life questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) and they ranked their symptom intensity using a 10-point visual analogue scale (VAS). Main Outcome Measures. Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores. Intraoperative details, type of intervention and perioperative complications were noted. Results. Six months after surgery and postoperative COC treatment, a significant improvement was observed in the SHOW-Q domains of pelvic problem interference, sexual satisfaction and desire (P < 0.05). Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning (P = 0.7). No significant difference was found in SHOW-Q scores between patients submitted to intestinal resection and patients submitted to intestinal nodule excision (P > 0.05). Conclusions. Sexual desire, satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy. No difference in sexual outcomes was detected between patients submitted to intestinal resection and nodule excision. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med 2012;9:770-778.
Deep Infiltrative Endometriosis: A Review of Surgical Treatment Options
2020
Deep infiltrative endometriosis (DIE) is defined as the presence of ectopic endometrial mucosa that infiltrates more than 5 mm of the peritoneum, in most cases accompanied by pain. Surgery is the treatment of choice in most cases. The aim of this review is to present the variety of surgical approaches to DIE. We performed a thorough MEDLINE search using the terms “(surgery OR surgical treatment OR surgical procedures OR surgical approach OR surgical technique) AND (deeply infiltra* endometriosis OR deep endometriosis OR infiltrative endometriosis). A total of 17 articles were included in the present study. Depending on the site of the lesion, different surgical techniques can be used. Laparoscopy is the most used approach for different lesion sites. It can be combined with open surgery if needed. Another promising alternative to laparoscopy is robotic surgery. For lesions that are not very extensive ablation and shaving techniques can be performed.
The diagnosis and treatment of deep infiltrating endometriosis
Deutsches Ärzteblatt international, 2010
Endometriosis and adenomyosis uteri are the most common benign disorders affecting girls and women after uterine myomas (fibroids), with a prevalence of roughly 5% to 15%. There have been many advances in diagnostic assessment and in our understanding of the disease over the past decade. Steady improvements in treatment have been accompanied by heightened consciousness of the diagnosis among the affected women and the doctors who care for them. A selective literature search was carried out in the Cochrane and PubMed databases using the key words "endometriosis," "deep infiltrating endometriosis," "endometriosis AND diagnostics," "endometriosis AND surgical therapy," "endometriosis AND endocrine treatment," and others. The AWMF and ESHRE guidelines were also taken in account. The main manifestations are primary or secondary dysmenorrhea, bleeding disturbances, infertility, dysuria, pain on defecation (dyschezia), cycle-dependent or (l...
Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE)
Jurnalul de Chirurgie, 2015
Endometriosis is categorized as one of the chronic benign gynecologic diseases, which causes pelvic pain and infertility, affecting almost 10% of reproductive-age women. Deeply infiltrating endometriosis (DIE) is a specific entity of endometriosis, responsible for painful symptoms, which are related to the anatomic location of the lesions. In this paper, we aim to review the current literature regarding the post-surgery quality of life improvement for DIE. Irrespective of its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should be emphasized as a basic diagnostic tool in detecting endometriosis. This will help in planning further DIE related therapeutic interventions. Out of several, transvaginal ultrasound (TVUS) has been reported as one of the widely used and excellent tools to diagnose DIE lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid and vesical wall).