Deep Infiltrative Endometriosis: A Review of Surgical Treatment Options (original) (raw)
Related papers
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 %).
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.
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
Surgical Management of Deep Infiltrating Endometriosis and Impact on Quality of Life
Objective: The purpose of this retrospective review study was to assess the impact of surgery and quality of life for patients presenting painful deep infiltrating endometriosis (DIE). Patients and methods All patients with histological proved infiltrating endometriosis who had surgery from 1.01.2006 to 31.12.2010 at the Department of Obstetrics and Gynecology I , Targu-Mures and the Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, Rouen, France were included in the study. Surgical exeresis of endometriosis for patients with deep infiltrating endometriosis with GnRha (Gonadotrophin-releasing hormone) analogues treatment before and after the surgery. Results: One hundred fourteen subjects underwent operative laparoscopy for deep infiltrating endometriosis. Involvement of urinary tract was confirmed in thirty patients and the colorectal localization in eighty-four patients. Intra-operative finding according to American Fertility Society reviewed-clas...
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.
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.
BACKGROUND: Deeply in®ltrating endometriosis (DIE) is recognized as a speci®c entity responsible for pain. The distribution of locations and their contribution to surgical management has not been previously studied. METHODS: Medical, operative and pathological reports of 241 consecutive patients with histologically proven DIE were analysed. DIE lesions were classi®ed as: (i) bladder, de®ned as in®ltration of the muscularis propria; (ii) uterosacral ligaments (USL), as DIE of the USL alone; (iii) vagina, as DIE of the anterior rectovaginal pouch, the posterior vaginal fornix and the retroperitoneal area in between, and (iv) intestine, as DIE of the muscularis propria. RESULTS: A total of 241 patients presented 344 DIE lesions: USL (69.2%; 238); vaginal (14.5%; 50); bladder (6.4%; 22); intestinal (9.9%; 34). The proportion of isolated lesions differed signi®cantly according to the DIE location: 83.2% (198) for USL DIE; 56.0% (28) for vaginal DIE; 59.0% (13) for bladder DIE; 29.4% (10) for intestinal DIE (P < 0.0001). The total number of DIE lesions varied signi®cantly according to the location (P < 0.0001). In 39.1% of cases (9/23) intestinal lesions were multifocal. Only 20.6% (seven cases) of intestinal DIE were isolated and unifocal. CONCLUSIONS: Multifocality must be considered during the pre-operative work-up and surgical treatment of DIE. We propose a surgical classi®cation based on the locations of DIE. Operative laparoscopy is ef®cient for bladder, USL and vaginal DIE. However, indications for laparotomy still exist, notably for bowel lesions.
Management Challenges of Deep Infiltrating Endometriosis
2021
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, instrumen- tal 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, ...
Diagnosis and treatment of deep infiltrating endometriosis with bowel involvement: A case report
Srpski arhiv za celokupno lekarstvo, 2011
Introduction Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis. Case Outline We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel. Conclusion Transvaginal sonography has an important role in detecting deep endometriosis of the pelvis. Fertility sparing surgery is the treatment of choice in symptomatic women wishing to retain fertility, since drugs used for endometriosis interfere with ovulation. The success of the surgery depends on the accuracy of the preoperative diagnosis. A multidisciplinary approach in managing deep endometriosis is mandatory in order to offer patients the best possible treatment using the combined skills of the colorectal and gynaecologic surgical teams. The presented case exhibits the feasibility of laparoscopic approach to severe pelvic endometriosis with bowel involvement.