Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis (original) (raw)
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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...
Total or Subtotal Hysterectomy for the Treatment of Endometriosis: A Review
Journal of Clinical Medicine
Objective: The purpose of the review was to evaluate and compare outcomes after total or subtotal hysterectomy in women with endometriosis or adenomyosis. Methods: We searched four electronic databases: Medline (PubMed), Scopus, Embase, and Web of Science (WoS). The first aim of the study was to compare outcomes after total and subtotal hysterectomy in women with endometriosis, and the second aim was to compare the two procedures in women with adenomyosis. Publications that reported short- and long-term outcomes after total and subtotal hysterectomy were included in the review. The search was not subject to any limitation in terms of time or method. Results: After screening 4948 records, we included 35 studies published from 1988 to 2021; the studies were based on various methodologies. With regard to the first aim of the review, we found 32 eligible studies and divided these into the following four categories: postoperative short- and long-term outcomes, recurrence of endometriosis...
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 %).
Radical resection of invasive endometriosis with bowel or bladder involvement—Long-term results
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2005
Objective: With the present study we wanted to evaluate the effect of a radical resection of bowel and bladder endometriosis with respect to relief of pain symptoms and long-term effects. Study design: Retrospectively we analyzed 23 patients undergoing bowel or bladder resection for infiltrating endometriosis between 1995 and 2004. Chart review was performed and data were analyzed with respect to pain symptoms, fertility, type of surgery, operative morbidity and mortality. At 1, 3 and 5 years of follow-up patients were asked to evaluate their symptoms based on a visual analogue pain scale (0: no pain, 10: most severe pain). Results were compared using the Student's t-test. Results: Leading symptoms were chronic pelvic pain (17/23, 73.9%), dysmenorrhea (11/23, 47.8%), dyspareunia (6/23, 26.1%), infertility (4/23, 17.4%) and dyschezia (4/23, 17.4%). Three patients (13%) had abdominal hysterectomy, 5 (21.7%) LSO (n = 2) or BSO (n = 3), 18 (78.3%) anterior rectal resection, 4 (17.4%) sigmoid resection, 2 (8.6%) segmental bladder resection and one patient (4.3%) cecal resection. Major complications requiring re-operation occurred in three patients (2Â postoperative bleeding, 1Â anastomosis break-down). During follow-up (mean 40.5 months) 21 of the 23 patients (91.3%) had a persistent improvement of symptoms, 8 of the 23 (34.8%) had recurrent symptoms with a mean symptom-free interval of 40.4 months after surgery (24-60 months). No patient developed dyspareunia or dyschezia during follow-up. Overall cure rate was 73.9%. Four patients became pregnant (23%). Average pain scores increased during follow-up period but still remained significantly below the initial score ( p < 0.001). Conclusion: Radical surgery for deep endometriosis with bowel or bladder involvement leads to a reliable and persistent relief of pain symptoms. Especially deep dyspareunia and dyschezia might be eliminated by this procedure. #
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
Recurrence of endometriosis after hysterectomy
Facts, views & vision in ObGyn, 2014
Persistent or recurrent pain after hysterectomy is one of the most frustrating clinical scenarios in benign gynaecology. We attempt to review the current evidence regarding the recurrence of pelvic pain after hysterectomy for endometriosis. The impact of ovarian conservation, type of hysterectomy and the extent of surgical excision were analysed. Peer reviewed published manuscripts in the English language in the period between 1980 and 2014 were reviewed using Pubmed and science direct regarding the incidence, causes and recurrence of endometriosis. Sixty-seven articles were identified. Incomplete excision of endometriosis is the most predominant reason in the literature for the recurrence of endometriosis, and the type of Hysterectomy affects the recurrent symptoms mainly by impacting the extent of excision of the lesion. Ovarian cyst drainage is associated with the highest rate of ovarian cyst reformation within three to six months after surgery. The use of hormone replacement the...
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
Facts, Views and Vision in ObGyn
Background: Deep endometriosis (DE) usually creates a distortion of the retroperitoneal anatomy and may infiltrate the parametria with an oncomimetic pathway similar to cervical cancer. The condition represents a severe manifestation of endometriosis that may result in a functional impairment of the inferior hypogastric plexus. An extensive surgical resection may be required with an associated risk of increased neurogenic postoperative pelvic organ dysfunction. Objectives: To evaluate the post-operative function and complications following hysterectomy with posterolateral parametrial resection for DE. Materials and Methods: In total, 23 patients underwent radical hysterectomy for DE with the parametria involved. The severity of pain was assessed by the Visual Analogue Scale (VAS) score. The KESS, GQLI, BFLUTS and FSFI were used to examine the gastrointestinal, urinary and sexual functions respectively. Intra and post-operative complications were recorded. Main outcome measures: The ...
Multidisciplinary Treatment of Severe Deep Endometriosis
2020
Introduction: Endometriosis is a clinical entity characterized by the presence of endometrial tissue outside the endometrium, being the most aggressive rectocolonic condition. Design: Descriptive, retrospective case series study. Objective: Evaluate the feasibility of colorectal resections in this complex pathology that must be approached in a multidisciplinary way and report the results obtained from more than 10 years of work. Material and methods: In the period between 2005 and early 2017, 29 patients were evaluated in a multidisciplinary way. Results: One hundred and seventy-one patients were operated on for deep endometriosis, mean age 34 years. Twentynine patients required colon resection, 27 anterior resection and 2 sigmoidectomies. Seventeen end-to-end and 12 endtoside stapled anastomoses were performed. Twenty-eight anastomoses were performed between 7 and 5 cm from the anal margin and one at 4 cm. In the latter, a protective transverse colostomy was made. The mean operativ...