1
|
Robot-assisted laparoscopy for deep infiltrating endometriosis: a retrospective French multicentric study (2008-2019) using the Society of European Robotic Gynecological Surgery endometriosis database. Arch Gynecol Obstet 2022; 305:1105-1113. [PMID: 35113234 DOI: 10.1007/s00404-022-06414-6] [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: 03/21/2021] [Accepted: 01/04/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aimed at assessing perioperative results of robot-assisted laparoscopy (RAL) in the context of deep infiltrating endometriosis (DIE). METHODS This retrospective French multicentric study included all patients with DIE who underwent surgical treatment managed by RAL (Da Vinci® System). From November 2008 to June 2019, patients were included in a single European database, in Robotic Assisted Laparoscopic Gynecologic Surgery, with Society of European Robotic Gynecological Surgery collaboration. Patients had different DIE sites as follows: gynecological, urological, or digestive, or combinations of these. Surgical procedures and perioperative complications were evaluated. To assess complications, patients were divided into the following four groups according to surgical procedure and DIE site: gynecological only; gynecological and urological; gynecological and digestive; and gynecological, urological, and digestive. RESULTS A total of 460 patients treated at one of eight health-care facilities from November 2008 to June 2019 were included. Median operative time was 245 min (IQR 186-320), surgeon console time was 138 ± 75 min and estimated blood loss was 70.0 mL ± 107 mL. Among this patient sample, 42.1% had a multidisciplinary surgical approach with a digestive or urology surgeon in addition to gynecology surgeon (25.5% and 16.6% of cases, respectively). Among those with intraoperative complications (n = 25, 5.4%) were primarily conversion to laparotomy (n = 6, 2.0%), transfusion (n = 2, 0.6%), and organ wounds (n = 8, 1.7%). Overall, 5.6% had severe postoperative complications (Clavien-Dindo classification ≥ Grade 3). CONCLUSION This is among the largest published series addressing RAL for DIE. Interest in this procedure appears promising, with no observed increases in blood loss or in peri- or post-operative complications. DIE laparoscopic surgery can require complex surgical procedures performed by multidisciplinary surgical teams. Thus, it may be one of the best candidates for RAL within gynecology surgery.
Collapse
|
2
|
Scattarelli A. [Anatomic reports of vegetative nerves within para rectal fossa, to the rectal endometriosis surgery application]. ACTA ACUST UNITED AC 2020; 48:649-656. [PMID: 32283208 DOI: 10.1016/j.gofs.2020.04.002] [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: 06/29/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of the study was to describe the inferior hypogastric plexus and nerves constituting the para-rectal fossa in order to study the importance of anatomical knowledge in rectal endometriosis surgery. METHODS In order to discover the complete anatomy of the study area, we carried out a review of the literature and relied on dissection of a female cadaver and operative dissections in patients treated for rectal endometriosis. RESULTS The inferior hypogastric plexus, the hypogastric nerve and the pelvic splanchnic nerves are the nervous elements component the para-rectal fossa. These nerves were important urinary, digestive and sexual functions. The dissection of the Okabayashi and the Latzko spaces within the para-rectal fossa and sparing nerve within this zone is more important for the prevention of traumatic nervous sequelae during rectal endometriosis surgery. The pelvic anatomy can be by attraction and sheathing nerve structures by endometriosis lesions which can complicate preservation techniques. CONCLUSION Lesions of pelvic vegetative nerves running through the para-rectal fossa can be responsible for urinary, digestive and sexual disorders that can affect patients quality of life. There is currently only one standardized "nerve sparing" technique in pelvic endometriosis surgery. Knowledge of the anatomy of the nerves making up the para-rectal fossa helps to orient the operative dissection and prevent postoperative nerve complications after surgery for rectal endometriosis.
Collapse
Affiliation(s)
- A Scattarelli
- Département de chirurgie gynécologique, CHU Rouen, 37, boulevard Gambetta, Rouen, France.
| |
Collapse
|
3
|
Ledu N, Rubod C, Piessen G, Roman H, Collinet P. Management of deep infiltrating endometriosis of the rectum: Is a systematic temporary stoma relevant? J Gynecol Obstet Hum Reprod 2017; 47:1-7. [PMID: 29097291 DOI: 10.1016/j.jogoh.2017.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE To assess the value of performing a protective stoma in patients operated for rectal endometriosis. MATERIAL AND METHODS From June 2009 to December 2011, 47 patients were operated for rectal endometriosis by segmental or discoid resection in 4 different centers. Two groups were formed: one with protective stoma (group S), n=33 and one without protective stoma (group NS), n=14. Data were collected from the CIRENDO database. MEASUREMENTS AND MAIN RESULTS Postoperative complication rate of group NS was 57% against 48% in group S (P=0.75). There was an increasing trend of the rate of anastomotic leakage in group S as compared to group NS: 21% against 3% (P=0.073). All 3 patients of group NS with an anastomotic leakage were reoperated and the group S patient had medical treatment. In a center, digestive operative time was not necessarily performed in association with a gastrointestinal surgeon. All patients in group S had a restoration of continuity in about 3 months. Two of them had dilation of anastomotic stricture and 3 others showed a transient postoperative ileus during this recovery. Quality of life was assessed by the MOS SF-36 and significantly improved in both groups thanks to the intervention. CONCLUSION Temporary digestive stoma in patients operated for rectal endometriosis has to be considered because in our study, it seems reducing complications such as anastomotic leakage. This must be confirmed with studies with larger numbers.
Collapse
Affiliation(s)
- N Ledu
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| | - C Rubod
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - G Piessen
- Service de chirurgie digestive et générale du Pr Mariette, hôpital Huriez, CHRU Lille, place de Verdun, 59037 Lille, France
| | - H Roman
- Clinique gynécologique et obstétricale, centre hospitalier universitaire Charles-Nicolle, 76031 Rouen, France
| | - P Collinet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, université Lille-Nord-de-France, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| |
Collapse
|
4
|
Ureterovesical reimplantation for ureteral deep infiltrating endometriosis: A retrospective study. J Gynecol Obstet Hum Reprod 2017; 46:229-233. [DOI: 10.1016/j.jogoh.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 11/24/2022]
|
5
|
Roman H. A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: A multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod 2017; 46:159-165. [DOI: 10.1016/j.jogoh.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/03/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022]
|
6
|
Selvi Dogan F, Cottenet J, Douvier S, Sagot P. [Quality of life after deep pelvic endometriosis surgery: Evaluation of a French version of the EHP-30]. ACTA ACUST UNITED AC 2015; 45:249-56. [PMID: 26142209 DOI: 10.1016/j.jgyn.2015.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/28/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the changes in the quality of life of patients after deep pelvic endometriosis surgery, with a French version of EHP-30 questionnaire, and the capacity of the EHP-30 to carry out this measurement. MATERIAL AND METHODS Study prospective monocentric, conducted in the obstetrics and gynecology department of the CHU Dijon during the period of October 2012 from October 2013. A EHP-30 questionnaire was given to patients before surgery. The same questionnaire was sent to their homes, away from surgery (3-6 months) to inform about their postoperative quality of life. The difference in preoperative and postoperative scores was tested using the test Wilcoxon signed ranks. A difference was considered significant if the p-value was less than or equal to 0.05. Sensitivity to change was calculated by the method of effect size (ES). The size of the effect is defined as the difference in mean preoperative and postoperative scores divided by the standard deviation of preoperative scores. A size effet of 0.20 indicates less change scores, of 0.50 a moderate change and of 0.80 a material change. RESULTS We included 22 patients in total in the prospective analysis. The majority of patients had gynecological symptoms of dysmenorrhea with 69.7%, 75.7% and 75.7% dyspareunia chronic pelvic pain. Nineteen patients (57.6%) had gastro-intestinal symptoms. Urinary symptoms were less frequent. The results of the EHP-30 showed a significant improvement for the items "pain" (P=0.01), "control and powerlessness" (P=0.02), "emotional well-being" (P<0,01) "social relations" (P<0.01), "sexual intercourse" (P=0.03) and "relationship with the medical world" (P=0.05). We observed a non-significant improvement for the items "self-image" (P=0.44), "work" (P=0.48) and "relationships with children" (P=0.50). The size of the effect (ES) was low to high for all dimensions of the questionnaire, ranging from 0.1 to 0.6 for the entire group. A significant sensitivity to change was found for the items "pain" (ES=0.60), "control and powerlessness" (ES=0.62), "social relations" (ES=0.57). A moderate sensitivity to change was found for the items "emotional well-being" (ES=0.29), "relationship with the medical world" (ES=0.26). A low sensitivity to change was found for the items "relationships with children" (ES=0.06), "self-image" (ES=0.16), "work" (ES=0.18), "sexual intercourse" (ES=0.20). A size that is important to moderate effect corresponded to a statistically significant improvement of the score EHP-30. CONCLUSION This study showed that the EHP-30 is a sensitive tool to change the health status and an appropriate instrument for the assessment of treatment effects in patients with deep pelvic endometriosis.
Collapse
Affiliation(s)
- F Selvi Dogan
- Service de gynécologie-obstétrique, CHU de Dijon, 5, rue Edgar-Quinet, 21000 Dijon, France.
| | - J Cottenet
- Équipe d'accueil E7 41S4 : épidémiologie des populations, université de Bourgogne, 21000 Dijon, France
| | - S Douvier
- Service de gynécologie-obstétrique, CHU de Dijon, 5, rue Edgar-Quinet, 21000 Dijon, France; Faculté de médecine, université de Bourgogne, 21000 Dijon, France
| | - P Sagot
- Service de gynécologie-obstétrique, CHU de Dijon, 5, rue Edgar-Quinet, 21000 Dijon, France; Faculté de médecine, université de Bourgogne, 21000 Dijon, France
| |
Collapse
|
7
|
[Urinary functional disorders bound to deep endometriosis and to its treatment: review of the literature]. ACTA ACUST UNITED AC 2014; 43:431-42. [PMID: 24831568 DOI: 10.1016/j.jgyn.2014.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 11/22/2022]
Abstract
Lower urinary tract disorders in case of deep endometriosis are common (up to 50% of patients), although often masked by pelvic pain. They result from damage to the pelvic autonomic nervous system by direct infiltration of these structures by endometriotic lesions or surgical trauma (especially in resection of the uterosacral ligaments, rectum or vagina). These are mainly sensory disturbances and bladder voiding dysfunction. They impact quality of life and could be responsible for long-term complications (recurrent urinary tract infections on a persistent residual urine or pelvic floor disorders due to chronic thrusting). It is therefore important to diagnose and treat early these troubles by well-conducted interviews or standardized questionnaires. Different drug treatments have been proposed, such as cholinergics or prokinetics, but their effectiveness has not been demonstrated yet. Neuromodulation of the superior hypogastric plexus for treatment of refractory atonic bladder with persistent urinary retention after surgery seems promising but should be confirmed by further studies. To date, standard treatment of urinary retention after surgery remains self-catheterization. In terms of prevention, surgical nerve sparing techniques have been developed in order to minimize intraoperative injury of pelvic nerve plexus and reduce postoperative morbidity.
Collapse
|
8
|
Évolution des symptômes et de la qualité de vie des patientes après chirurgie de l’endométriose digestive. ACTA ACUST UNITED AC 2013; 41:627-34. [DOI: 10.1016/j.gyobfe.2013.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Indexed: 11/22/2022]
|
9
|
Serati M, Cattoni E, Braga A, Uccella S, Cromi A, Ghezzi F. Deep endometriosis and bladder and detrusor functions in women without urinary symptoms: a pilot study through an unexplored world. Fertil Steril 2013; 100:1332-6. [PMID: 23891020 DOI: 10.1016/j.fertnstert.2013.06.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/23/2013] [Accepted: 06/25/2013] [Indexed: 11/17/2022]
|
10
|
Hématome infecté du cul-de-sac de Douglas : une complication spécifique de la chirurgie de l’endométriose profonde postérieure du fond vaginal. ACTA ACUST UNITED AC 2013; 41:149-55. [DOI: 10.1016/j.gyobfe.2013.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 11/21/2012] [Indexed: 11/20/2022]
|
11
|
The Value of Pelvic MRI in the Diagnosis of Posterior Cul-De-Sac Obliteration in Cases of Deep Pelvic Endometriosis. AJR Am J Roentgenol 2012; 199:1410-5. [DOI: 10.2214/ajr.11.7898] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
12
|
Boileau L, Borie F, Laporte S, Tailland ML, Mares P, de Tayrac R. Pelviperitonitis by colorectal perforation in the third trimester of pregnancy after surgery for deep pelvic endometriosis. Fertil Steril 2011; 96:e42-4. [DOI: 10.1016/j.fertnstert.2011.04.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 04/18/2011] [Accepted: 04/19/2011] [Indexed: 10/18/2022]
|
13
|
Do patients manage to achieve pregnancy after a major complication of deeply infiltrating endometriosis resection? Eur J Obstet Gynecol Reprod Biol 2011; 154:196-9. [DOI: 10.1016/j.ejogrb.2010.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/18/2010] [Accepted: 09/26/2010] [Indexed: 11/23/2022]
|
14
|
Kondo W, Bourdel N, Tamburro S, Cavoli D, Jardon K, Rabischong B, Botchorishvili R, Pouly J, Mage G, Canis M. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG 2010; 118:292-8. [PMID: 21083863 DOI: 10.1111/j.1471-0528.2010.02774.x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to evaluate the complications after surgery for deep endometriosis. DESIGN retrospective study. SETTING data from the CHU Estaing database and patients' charts between January 1987 and December 2007. SAMPLE all women given surgical treatment for deep endometriosis. METHODS women who underwent surgery for deep endometriosis were reviewed for intra- and postoperative complications. MAIN OUTCOME MEASURES primary outcomes were rates of intra- and postoperative complications. Complications were compared according to the procedure performed. RESULTS a total of 568 women were included in the study, with a mean age of 32.4 years. The mean estimated diameter of the nodule felt by vaginal examination was 1.8 cm (ranging from 0.5 to 7 cm). Laparoscopic surgery was performed in 560 women (98.6%), and conversion was required in 2.3%. The mean operative time was 155 minutes. Intraoperative complications occurred in 12 women (2.1%), including six minor (1.05%) and six major (1.05%) complications. Postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3% (21 out of 226), compared with only 1.5% for the other women (five out of 342) (P < .01). Shaving presented less major postoperative complications compared with segmental resection (24 versus 6.7%; P = 0.004). CONCLUSIONS surgery for deep endometriosis is feasible, but it is associated with major complications, especially when any type of rectal surgery must be performed.
Collapse
Affiliation(s)
- W Kondo
- Department of Gynaecologic Surgery, CHU Estaing, Clermont-Ferrand, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Daraï E, Ballester M, Chereau E, Coutant C, Rouzier R, Wafo E. Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis. Surg Endosc 2010; 24:3060-7. [DOI: 10.1007/s00464-010-1089-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
|
16
|
94 months follow-up after laparoscopic assisted vaginal resection of septum rectovaginale and rectosigmoid in women with deep infiltrating endometriosis. Arch Gynecol Obstet 2010; 283:1059-64. [PMID: 20458487 DOI: 10.1007/s00404-010-1499-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Endometriosis with bowel involvement is the most invasive form and can cause infertility, chronic pelvic pain and bowel symptoms. Effective surgical treatment of endometriosis requires complete excision of endometriosis and in same case may require segmental rectosigmoid resection. METHODS Between December 1997 and October 2003, 55 patients with rectovaginal endometriosis underwent a combined laparoscopic vaginal technique. 30 patients were found at a follow-up and underwent a telephone interview. The questionnaire covered questions about symptoms related to recurrences of intestinal endometriosis, dyspareunia, dysmenorrhea and pregnancy. RESULTS Twenty-seven of 30 (90%) women have no clinical symptoms of reported recurrence of endometriosis. Two patients (6.6%) had evidence of recurrence of bowel endometriosis. Dysmenorrhoea disappeared in 28 (93.3%), dyspareunia in 26 (86.7%) and pelvic pain in 27 (90%) patients. 17 patients (31%) tried to become pregnant and 11 of these patients (65%) became pregnant: 9 patients delivered healthy newborns, 18 pregnancies occurred and 19 healthy children were born. CONCLUSIONS Despite the small number of follow-up patients, our 94-month follow-up data demonstrated that endometriosis with bowel involvement and radical resection was associated with significant reductions in painful and dysfunctional symptoms, a low recurrence rate (6.6%) and high pregnancy rate (36.6%).
Collapse
|
17
|
Roman H, Bourdel N. Contre la résection segmentaire systématique dans les endométrioses colorectales. Ne remplaçons pas les douleurs par des symptômes digestifs désagréables ! ACTA ACUST UNITED AC 2009; 37:358-62. [DOI: 10.1016/j.gyobfe.2009.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
|
19
|
Benbara A, Fortin A, Martin B, Palazzo L, Le Tohic A, Madelenat P, Yazbeck C. [Surgical and functional results of rectosigmoidal resection for severe endometriosis]. ACTA ACUST UNITED AC 2008; 36:1191-201. [PMID: 19019719 DOI: 10.1016/j.gyobfe.2008.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 09/24/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Indications of colorectal resection for endometriosis are controversial because of the risk of major complications. This study aims to evaluate the value of different diagnostic tests in decision-making, and to evaluate the surgical results and complications, as well as long-term functional results after surgery. PATIENTS AND METHODS In the set of a retrospective case series, 50 patients who have been admitted for a colorectal resection because of deep endometriosis were included. Most of them have had an MRI and an endorectal ultrasonography. Specific questionnaires have been proposed in order to evaluate symptoms, sexuality (BISF-W) and quality of life (EHP-30). RESULTS For the diagnosis of rectal involvement, the sensitivity of MRI and endorectal ultrasonography were 55 and 100%, respectively. Forty-one colorectal amputations and nine partial colorectal resections have been done by 24 laparotomies, two laparoscopies and 24 laparoconversions. Major complications included six (12.5%) digestive fistulas, three (6%) anastomotic strictures, one ureterovaginal fistula and one ureteral stricture. Risk factors associated with digestive fistulas were the association of a vaginal opening (p=0.002) and an additional ileocaecal resection (p=0.007). The mean follow-up period was of 42 months. A significant improvement of dysmenorrhea (p<10(-4)), dyschesia (p<10(-4)), chronic pelvic pain (p<10(-4)), and of some digestive symptoms such as catamenial epreintes (p=0.002) and catamenial diarrheas (p=0.006), was noted. We noted postoperative 14 dysurias, six constipations and 12 rectal polykynesias. Four patients have had deep recurrent lesions. Twenty patients had a desire of pregnancy after the operation, 17 pregnancies were obtained (eight spontaneous and nine by ART) giving birth to 14 living children. Sexuality evaluation was below normal range. The quality of life was improved for most of the items. The global satisfaction was good (91%). DISCUSSION AND CONCLUSION Colorectal resection for deep endometriosis improve significantly most of the pain symptoms, but the women should have detailed counselling about the risks of major complications and recurrence.
Collapse
Affiliation(s)
- A Benbara
- Service de gynécologie-obstétrique, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | | | | | | | | | | | | |
Collapse
|
20
|
de Lapasse C, Renouvel F, Chis C, Grosdemouge I, Panel P. [Urinary functional and urodynamic preoperative evaluation of patients with deep pelvic surgical endometriosis: about 12 cases]. ACTA ACUST UNITED AC 2008; 36:272-7. [PMID: 18494148 DOI: 10.1016/j.gyobfe.2007.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Laparoscopic surgery of deep endometriosis, including uterosacral ligament and rectal localisation, generally induces postoperative urinary disorders, caused by sacral plexus nerve lesions. However, during presurgical consultation, patients with these symptoms frequently present some urinary disorders. Our objective was to prospectively evaluate the reality of pre-existant urinary disorders by performing urodynamic tests. PATIENTS AND METHODS This study is a prospective, descriptive and non-comparative study about 12 consecutive patients consulting for a surgical assumption of deep endometriosis, including clinical and radiological lesions on the uterosacral ligaments, on the uterine torus and/or on the rectum. RESULTS A total of 12 patients whose ages ranged from 24 to 42 (mean age 34.6 +/-5.3 years). The mean parity was 0.5+/- 0.8 children (0-2). A clinical examination and multiple preoperative imaging techniques (abdominopelvic ultrasonography [US] and Magnetic Resonance Imaging [MRI]) were used to diagnose a deep endometriosis. During consultation, four patients presented no urinary dysfunction (33%). The eight other patients presented at least one of the following symptoms: increased daytime frequency, urinary incontinence, straining, increased night time frequency, urgency, mictional burns, bladder cramps, reduction in the bladder sensation. Any urinary infection was systematically eliminated. Multiple imaging techniques allowed to diagnose: an adnexal lesion in three cases (25%), adenomyosis in three cases (25%). Endometriosis was detected on the rectum in eight cases (66.7%), on the uterine torus in nine cases (75%) and on the uterosacral ligaments in 10 cases (83.3%). No vesical localisation was found. The urodynamic tests performed before surgery were totally normal in only two cases (16.7%). Three patients had a true postmictional residue (25%), but only one was pathological (more than 100 mL). The mean urethral fence pressure was 87.8 +/- 33.5 cm H20 (38-150). Four patients had a urethral hypertonia (30%), three patients a urethral instability (25%), three patients a dysuria (25%), two patients a hypersensitive bladder (16.7%), two patients had an insufficiency of the urethral sphincter (16.7%), one patient a big hypoesthetic bladder (8.3%) and one patient a small bladder capacity. DISCUSSION AND CONCLUSION Patients with deep endometriosis on the uterosacral ligaments and/or on the former face of the rectum frequently have urinary disorders. Consulting such patients is fundamental since it allows to diagnose them but it is not sufficient. Performing urodynamic tests can precisely determine and quantify real disorders. These disorders are neurological, probably related to lesions of the inferior hypogastric plexus and not to a lesion of the bladder. In this prospective study, there is no correlation between the preoperative disorders and the localisation of the lesions. A further study on a greater number of patients is necessary to define possible improvements and complications related to the surgery.
Collapse
Affiliation(s)
- C de Lapasse
- Service de gynécologie-obstétrique, hôpital André-Mignot, centre hospitalier de Versailles, 177 rue de Versailles, Le Chesnay cedex, France.
| | | | | | | | | |
Collapse
|
21
|
Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G. Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol 2007; 19:308-13. [PMID: 17625410 DOI: 10.1097/gco.0b013e328216f6bc] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Endometriosis is a frequent gynaecological disorder in young women. Colorectal endometriosis accounts for about 90% of all intestinal locations. The effectiveness of medical therapies is poor, and surgery, including colorectal resection, is therefore often required. Since the first description of laparoscopic colorectal resection by Redwine and Sharp, the feasibility of this approach has been confirmed by several teams but remains a matter of debate. RECENT FINDINGS A review of the literature showed that conversion to laparotomy was necessary in 7.8% of cases. Segmental colorectal resection appears to be the best option, owing to the risk of incomplete resection in the case of full-thickness disc or superficial-thickness excision. However, complications are more frequent with segmental resection than with other procedures, and include de-novo urinary disorders. Laparoscopic colorectal resection for endometriosis is associated with symptom relief and a significant improvement in quality of life. In addition, 44.6% of women wishing to conceive were able to do so. SUMMARY Laparoscopic colorectal resection for endometriosis appears to be an adequate alternative to laparotomy. Further studies are required to identify objective criteria with which to select women most likely to benefit from this surgery, which must be performed in special units.
Collapse
Affiliation(s)
- Emile Daraï
- Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
| | | | | | | | | |
Collapse
|
22
|
Ball E, Byrne H, Davis C. The value of two-step operative laparoscopy with interval pituitary suppression in the treatment of infertility caused by severe endometriosis. Curr Opin Obstet Gynecol 2007; 19:303-7. [PMID: 17625409 DOI: 10.1097/gco.0b013e328216f642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To appraise a new approach to laparoscopic surgery for infertility caused by advanced endometriosis. RECENT FINDINGS Endometriosis is a common systemic and local disease with altered peritoneal function, which requires both systemic and local treatment. Medication alone cannot improve infertility, and laparoscopic treatment, particularly in severe endometriosis, has a high recurrence rate and is often limited by technical difficulties. Novel treatment strategies have therefore to be sought, especially in women who do not want in-vitro fertilization as a first option, either because they suffer from pain in addition to infertility or want to enhance their fertility over many cycles. SUMMARY Two-step operative laparoscopy with interval pituitary suppression by means of gonadotrophin-releasing hormone analogues reduces the extent of endometriosis, as classified by the American Fertility Association, and appears to be a promising method of achieving optimal cytoreduction and facilitating complicated surgery in severe endometriosis, while protecting the ovary from unnecessary trauma. A large-scale well-designed study is needed to confirm that this treatment leads to improved pregnancy rates.
Collapse
Affiliation(s)
- Elizabeth Ball
- The Centre for Reproductive Medicine and Surgery, Kenton and Lucas Wing, St Bartholomew's Hospital, London, UK
| | | | | |
Collapse
|
23
|
Vidart A, Mozer P, Chartier-Kastler E, Ruffion A. Chapitre G - Les conséquences neuro-urologiques de la chirurgie gynécologique (endométriose, hystérectomie simple, colpo-hystérectomie élargie), de la chirurgie colo-rectale et de la radiothérapie pelvienne. Prog Urol 2007; 17:381-4. [PMID: 17622063 DOI: 10.1016/s1166-7087(07)92334-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Apart from damage to bladder innervation, a number of local diseases and treatments such as radiotherapy can induce lower urinary tract functional disorders. Some of these disorders can be treated according to the principles used in the management of neurogenic bladder The purpose of this review is to report the functional consequences of pelvic endometriosis, radiotherapy, colorectal surgery and urinary incontinence surgery with particular emphasis on situations in which a neurogenic mechanism is suspected.
Collapse
Affiliation(s)
- A Vidart
- Service d'urologie, GH Pitié Salpétrière, Paris VI, France.
| | | | | | | |
Collapse
|
24
|
|