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Vesale E, Roman H, Moawad G, Benoit L, Touboul C, Darai E, Bendifallah S. Voiding Dysfunction after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1490-1502.e3. [PMID: 32730989 DOI: 10.1016/j.jmig.2020.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Surgical management of deep endometriosis is associated with a high incidence of lower urinary tract dysfunction. The aim of the current systematic review and meta-analysis was to assess the rates of voiding dysfunction according to colorectal shaving, discoid excision, and segmental resection for deep endometriosis. DATA SOURCES We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. Medical Subject Headings terms for colorectal endometriosis and voiding dysfunction were combined and restricted to the French and English languages. The final search was performed on August 28, 2019. The outcome measured was the occurrence of postoperative voiding dysfunction. METHODS OF STUDY SELECTION Study Quality Assessment Tools were used to assess the quality of included studies. Studies rated as good and fair were included. Two reviewers independently assessed the quality of each included study, discrepancies were discussed; if consensus was not reached, a third reviewer was consulted. TABULATION, INTEGRATION AND RESULTS Out of 201 relevant published reports, 51 studies were ultimately reviewed systematically and 13 were included in the meta-analysis. Rectal shaving was statistically less associated with postoperative voiding dysfunction than segmental colorectal resection (Odds ratio [OR] 0.34; 95% confidence intervals [CI], 0.18-0.63; I2 = 0%; p <.001) or discoid excision (OR 0.22; 95% CI, 0.09-0.51; I2 = 0%; p <.001). No significant difference was noted when comparing discoid excision and segmental colorectal resection (OR 0.74; 95% CI, 0.32-1.69; I2 = 29%; p = .47). Similarly, rectal shaving was associated with a lower risk of self-catheterization >1 month than segmental colorectal resection (OR 0.3; 95% CI, 0.14-0.66; I2 = 0%; p = .003). This outcome was no longer significant when comparing discoid excision and segmental colorectal resection (OR 0.72; 95% CI, 0.4-1.31; I2 = 63%; p = .28). CONCLUSION Colorectal surgery for endometriosis has a significant impact on urinary function regardless of the technique. However, rectal shaving causes less postoperative voiding dysfunction than discoid excision or segmental resection.
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Affiliation(s)
- Elie Vesale
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); Department of Gynecology and Obstetrics, Medical Center of the Sud-Francilien, (Dr Vesale), Corbeil-Essonne, France
| | - Horace Roman
- Clinique Tivoli-Ducos, Bordeaux (Dr. Roman), France
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, (Dr. Moawad), Washington, District of Columbia
| | - Louise Benoit
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris.
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
| | - Emile Darai
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
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Li X, Zhang W, Chao X, Dai Y, Shi J, Jia S, Chen S, Wu Y, Gu Z, Leng J. Clinical characteristics difference between early and late recurrence of ovarian endometriosis after laparoscopic cystectomy. Arch Gynecol Obstet 2020; 302:905-913. [PMID: 32583208 DOI: 10.1007/s00404-020-05657-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ovarian endometriosis is the most frequent type of endometriosis. Despite the use of surgery and medication, many patients suffer from recurrence within near future. Currently, there are no effective clinical characteristics available to predict the time to recurrence in ovarian endometriosis patients. PURPOSE To identify the effective clinical indicators for early and late endometrioma recurrence, we compared the clinical characteristics of early and late recurrence after treatment. METHODS We collected 358 patients with ovarian endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing a laparoscopic excision of ovarian endometrioma performed at Peking Union Medical College Hospital from January 2009 to April 2013. RESULTS A total of 358 patients were recruited in the validation set, with a median follow-up time of 83 months (60-120 months). Till the last follow-up, 68 patients exhibited recurrence. Three-year and 5-year recurrence rates were 9.2% and 15.4%, respectively. Univariate analysis in our study showed that patient with endometrioma surgery history had higher incidence of recurrence in 3 years after re-surgery (OR: 5.594, P = 0.029). Univariate and multivariate analyses using the logistic regression showed that the presence of tenesmus before surgery affected the incidence of early recurrence with a ratio of 57.9% (11/19) and 89.5% (17/19) in 3 years and 5 years after surgery, respectively. CONCLUSIONS Presence of tenesmus before surgery may be linked to the early recurrence of endometrioma.
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Affiliation(s)
- Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Wen Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
| | - Xiaopei Chao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yi Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinghua Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Shuangzheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Sikai Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yushi Wu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Zhiyue Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jinhua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
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Seth J, Kiosoglous A, Pakzad M, Hamid R, Shah J, Ockrim J, Greenwell T. Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center. Int J Urol 2019; 26:717-723. [PMID: 31206870 DOI: 10.1111/iju.13965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. METHODS We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. RESULTS Overall, 116 patients (median age 49 years, range 23-88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post-radiotherapy vesicovaginal fistula, and the remainder were post-surgical. Three patients with post-radiotherapy vesicovaginal fistula proceeded to primary diversion. CONCLUSIONS Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.
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Affiliation(s)
- Jai Seth
- Department of Urology, University College London Hospital, London, UK
| | | | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, London, UK
| | - Julian Shah
- Department of Urology, University College London Hospital, London, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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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: 9] [Impact Index Per Article: 1.3] [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.
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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
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Roman H, Darwish B, Bridoux V, Chati R, Kermiche S, Coget J, Huet E, Tuech JJ. Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients. Fertil Steril 2017; 107:977-986.e2. [DOI: 10.1016/j.fertnstert.2016.12.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/01/2016] [Accepted: 12/25/2016] [Indexed: 01/28/2023]
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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]
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Darwish B, Roman H. Surgical treatment of deep infiltrating rectal endometriosis: in favor of less aggressive surgery. Am J Obstet Gynecol 2016; 215:195-200. [PMID: 26851598 DOI: 10.1016/j.ajog.2016.01.189] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/17/2016] [Accepted: 01/28/2016] [Indexed: 02/08/2023]
Abstract
Deep infiltrating endometriosis of the rectum is a severe disease concerning young women of reproductive age. Because it is a benign condition, aggressive surgical treatment and subsequent complications are not always accepted by young patients. Two surgical approaches exist: the radical approach, employing colorectal resection; and the conservative approach, based on rectal shaving or full-thickness disc excision. At present, the majority of patients with rectal endometriosis worldwide are managed by the radical approach. Conversely, as high as 66% of patients with colorectal endometriosis can be managed by either rectal shaving or full-thickness disc excision. Most arguments that used to support the large use of the radical approach may now be disputed. The presumed higher risk of recurrence related to conservative surgery can be balanced by a supposed higher risk of postoperative bowel dysfunction related to the radical approach. Bowel occult microscopic endometriosis renders debatable the hypothesis that more aggressive surgery can definitively cure endometriosis. Although most surgeons consider that radical surgery is unavoidable in patients with rectal nodules responsible for digestive stenosis, conservative surgery can be successfully performed in a majority of cases. In multifocal bowel endometriosis, multiple conservative procedures may be proposed, provided that the nodules are separated by segments of healthy bowel of longer than 5 cm. Attempting conservation of a maximum length of rectum may reduce the risk of postoperative anterior rectal resection syndrome and subsequent debilitating bowel dysfunction and impaired quality of life. Promotion of less aggressive surgery with an aim to better spare organ function has become a general tendency in both oncologic and benign pathologies; thus the management of deep colorectal endometriosis should logically be concerned, too.
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Doh K, Thiam I, Ka S, Dial C, Woto-Gaye G. [Rectal endometriosis: An exceptional etiology of acute intestinal occlusion]. Ann Pathol 2016; 36:412-414. [PMID: 27079729 DOI: 10.1016/j.annpat.2015.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 08/05/2015] [Accepted: 11/12/2015] [Indexed: 11/25/2022]
Abstract
The intestinal occlusion acute is an emergency and therapeutic diagnostic. A rectal tumor is rarely the cause in a young adult. We are carrying the case of a patient of 43years old, received at emergency on a board of intestinal occlusion acute due to a rectal tumor of a fortuitous discovery during the operation. The final diagnosis after a histopathologic examination was for the less unexpected. It was rectal endometriosis in its tumor-like. A complementary medical care obtains satisfactory results.
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Affiliation(s)
- Kwame Doh
- Laboratoire d'anatomie et cytologie pathologiques, hôpital Aristide le Dantec, pavillon Bichat, BP 3001, avenue Pasteur, Dakar, Sénégal.
| | - Ibou Thiam
- Laboratoire d'anatomie et cytologie pathologiques, hôpital Aristide le Dantec, pavillon Bichat, BP 3001, avenue Pasteur, Dakar, Sénégal.
| | - Sidy Ka
- Service des urgences chirurgicales, hôpital régional de Thiès, Thiès, Sénégal.
| | - Cherif Dial
- Laboratoire d'anatomie et cytologie pathologiques, hôpital Aristide le Dantec, pavillon Bichat, BP 3001, avenue Pasteur, Dakar, Sénégal.
| | - Gisèle Woto-Gaye
- Laboratoire d'anatomie et cytologie pathologiques, hôpital Aristide le Dantec, pavillon Bichat, BP 3001, avenue Pasteur, Dakar, Sénégal
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Rectal Endometriosis: An Exceptional Cause of Large-Bowel Obstruction. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2015. [DOI: 10.5301/je.5000223] [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
Acute large-bowel obstruction (LBO) is an emergency condition that requires early identification and intervention. A rectal tumor is rarely the cause in a young adult. We report the case of a 43-year-old patient who received emergency surgery for an LBO. A rectal tumor was fortuitously discovered during the operation. However, histopathologic examination revealed that the tumor-like mass was in fact rectal endometriosis. Appropriate medical care was established and obtained satisfactory results.
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Roman H, Saint Ghislain M, Milles M, Marty N, Hennetier C, Moatassim S, Desnyder E, Abo C. Improvement of digestive complaints in women with severe colorectal endometriosis benefiting from continuous amenorrhoea triggered by triptorelin. A prospective pilot study. ACTA ACUST UNITED AC 2015; 43:575-81. [DOI: 10.1016/j.gyobfe.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
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Nyangoh Timoh K, Canlorbe G, Verollet D, Peyrat L, Ballester M, Amarenco G, Darai E. Contribution of sacral neuromodulation to manage persistent voiding dysfunction after surgery for deep infiltrating endometriosis with colorectal involvement: preliminary results. Eur J Obstet Gynecol Reprod Biol 2015; 190:31-5. [PMID: 25966436 DOI: 10.1016/j.ejogrb.2015.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Around 5% of women experience persistent voiding dysfunction after surgery for deep infiltrating endometriosis (DIE) with colorectal involvement. The gold standard to manage persistent voiding dysfunction is intermittent self-catherization, but this treatment may reduce quality of life of the patients due to care constraints. The objective of our study was to assess the contribution of sacral neuromodulation (SNM) in the management of persistent voiding dysfunction secondary to surgery for DIE with colorectal resection. STUDY DESIGN Five patients referred for persistent voiding dysfunction after surgery for DIE with colorectal resection were included and fitted with a temporary SNM system to test for feasibility. This consisted of placing an electrode unilaterally next to the S3 sacral nerve root and connecting it to an external pacemaker. The patients wore the electrode and the external neurostimulator for 21 days and kept a voiding diary. The SNM test was considered positive when a 50% decrease in self-catheterization was achieved after removal of the electrode. The system was implanted permanently in patients with a positive SNM test. Urodynamic tests were performed before and after the SNM test. RESULTS Two of the five patients had a positive SNM test and were implanted permanently. At 40 months the first patient had completely stopped self-catheterization and the second patient was performing self-catheterization twice a day with a post voiding residue volume of less than 100ml at 52 months. CONCLUSION SNM could be a curative technique in some patients with persistent voiding dysfunction after surgery for DIE. Further studies are required to better select patients who might benefit from SNM testing and subsequent device implantation.
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Affiliation(s)
- Krystel Nyangoh Timoh
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Geoffroy Canlorbe
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France.
| | - Delphine Verollet
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Laurence Peyrat
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France; Department of Urology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Gérard Amarenco
- Department of Neuro-urology and Electrophysiological Explorations, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), GRC01 GREEN Sorbonnes Universités, University Pierre and Marie Curie, Paris 6, France
| | - Emile Darai
- Department of Obstetrics and Gynaecology, GRC-6 UPMC, Centre Expert en Endométriose (C3E), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, France; Saint Antoine Research Center, UMRS-938, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Abstract
Clear cell thymic carcinoma is a rare and invasive tumor of the mediastinum for which there are no uniform treatment guidelines. The combination of carboplatin plus paclitaxel seems to be the most effective regimen for this disease. We report a case of locally advanced clear cell thymic carcinoma treated with this schedule, in which we observed a relevant and rapid tumor shrinkage.
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Abrao MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21:329-39. [DOI: 10.1093/humupd/dmv003] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/06/2015] [Indexed: 12/15/2022] Open
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[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.
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Roman H, Bridoux V, Tuech JJ, Marpeau L, da Costa C, Savoye G, Puscasiu L. Bowel dysfunction before and after surgery for endometriosis. Am J Obstet Gynecol 2013; 209:524-30. [PMID: 23583209 DOI: 10.1016/j.ajog.2013.04.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/25/2013] [Accepted: 04/04/2013] [Indexed: 01/28/2023]
Abstract
The relationship between deep fibrotic endometriosis of the rectum and digestive symptoms as well as the impact of surgical treatment on digestive complaints appears increasingly complex. With the exception of cases in which the disease leads to rectal stenosis, it seems likely that certain digestive symptoms are a result of cyclic inflammatory phenomena leading to irritation of the digestive tract and not necessarily the result of actual involvement of the rectum by the disease itself because they frequently occur in women free of rectal nodules. Functional or inflammatory bowel diseases and rectal hypersensitivity may be associated with pelvic endometriosis and consequently joepardize the hypothetical causal relationship between the presence of a rectal nodule and digestive complaints. Women treated surgically for rectal endometriosis may continue to experience postoperative digestive complaints, such as constipation. Despite successful surgery free of intra- and postoperative complications and significant improvement in well-being and pelvic pain, several unpleasant digestive symptoms may be incompletely cured by the surgery. Furthermore, de novo postoperative digestive complaints may occur after rectal surgery. Retrospective data suggest that performing colorectal resection is related to less favorable digestive functional outcomes than the use of conservative procedures such as shaving or full-thickness disc excision. These hypotheses need to be confirmed by prospective randomized trials comparing rectal radical and conservative approaches. Bearing in mind the complex relationship between rectal nodules, digestive symptoms and rectal surgery, particular care must be taken in the preoperative assessment of digestive function and in choosing the most suitable surgical procedure.
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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]
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Zilberman S, Ballester M, Touboul C, Chéreau E, Sèbe P, Bazot M, Daraï E. Partial Colpectomy is a Risk Factor for Urologic Complications of Colorectal Resection for Endometriosis. J Minim Invasive Gynecol 2013; 20:49-55. [DOI: 10.1016/j.jmig.2012.08.775] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/18/2012] [Accepted: 08/23/2012] [Indexed: 11/17/2022]
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Dell’oro M, Collinet P, Robin G, Rubod C. Réunion de concertation pluridisciplinaire de l’endométriose pelvienne profonde : intérêts et modalités de fonctionnement. ACTA ACUST UNITED AC 2013; 41:58-64. [DOI: 10.1016/j.gyobfe.2012.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 11/30/2012] [Indexed: 11/30/2022]
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Abet E, Lehur PA, Wong M, Rigaud J, Darnis E, Meurette G. Sexual function and laparoscopic ventral rectopexy for complex rectocoele. Colorectal Dis 2012; 14:e721-6. [PMID: 22651543 DOI: 10.1111/j.1463-1318.2012.03113.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM Laparoscopic ventral rectopexy (LVR) has recently been shown to be feasible, safe and efficient in restoring anatomy and improving rectal emptying in female patients presenting with a posterior pelvic floor prolapse. However, little is known about the sexual function of these patients. This study aimed to assess sexual activity in a group of patients referred for complex rectocoele and the consequences on sexual comfort of their treatment after LVR. METHOD We prospectively assessed 41 consecutive patients who underwent LVR (either laparoscopic or robotic-assisted) for symptomatic complex rectocoele from January 2009 to January 2010. We first identified sexually active patients in the cohort using a nonvalidated simplified questionnaire. The Brief Index Sexual Functioning for Women (BISF-W) questionnaire was used postoperatively to assess the impact of LVR on sexual function. Acceptability of the assessment of sexuality was also tested. The postoperative outcome of the sexually active patients was compared with data obtained from the French general population. RESULTS Among 38 patients in whom a successful LVR had been performed (three conversions), 22 (57.9%) were sexually active preoperatively and 18 (47.4%) were sexually active postoperatively at a mean of 7±4.2months of follow-up (P=0.44). No de novo dyspareunia was reported. At baseline, 13 patients experienced dyspareunia compared with six after LVR (P=0.02). A significant improvement in dyspareunia was observed (seven patients vs two patients; P=0.03). 19 (86%) of the 22 patients responded to the BISF-W questionnaire. The mean composite score was 26.7±8.2, with 63.2% of patients estimating sexual activity as important or very important. Compared with a reference population, sexual comfort was similar in LVR patients (32.2±12.6 vs 26.7±8.2; P=0.14). CONCLUSION Assessment of sexual function is accepted by the majority of patients suffering from pelvic floor disorders. In addition to the benefit on anatomical restoration and bowel function, LVR improves sexual function and dyspareunia in patients operated on for complex rectocoele.
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Affiliation(s)
- E Abet
- Clinique de Chirurgie Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes - Hôtel Dieu, Nantes, France
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Abstract
PURPOSE OF REVIEW Rectal endometriosis is a very indolent disease whose treatment has been debated by a range of competing schools. Meanwhile, not all audiences in the scientific community are entirely familiar with the full aspects of the disease. Hence, the purpose of this review is to outline the basic as well as the recent literature pertaining to the disease, thus offering a broader view to the interested reader. RECENT FINDINGS Laparoscopic shaving or disc excision for rectal endometriotic nodules may be simple, safe options of controlling the disease. On the contrary, laparoscopic rectal resections, originally reserved for more extensive disease, are now more skillfully mastered by surgeons and gynecologists. Meta-analyses, retrospective, and prospective studies are being published frequently supporting one form of therapy at a time and discrediting another at other times. SUMMARY Laparoscopic shaving or disc excisions for rectal endometriotic foci or rectal resections are feasible and efficient methods for treating rectal endometriosis. More complex surgery to the bowel means more risk for complications. With the rising learning curve of the operators, laparoscopic rectal resections have become a safe option that should be offered to patients. The patient's preference to a particular treatment option should be central to the type of surgery to be elected.
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Bridoux V, Roman H, Kianifard B, Vassilieff M, Marpeau L, Michot F, Tuech JJ. Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum. Hum Reprod 2011; 27:418-26. [DOI: 10.1093/humrep/der422] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Boileau L, Laporte S, Bourgaux JF, Rouanet JP, Filleron T, Mares P, de Tayrac R. [Laparoscopic colorectal resection for deep pelvic endometriosis: Evaluation of post-operative outcome]. ACTA ACUST UNITED AC 2011; 41:128-35. [PMID: 22071018 DOI: 10.1016/j.jgyn.2011.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 06/21/2011] [Accepted: 06/24/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluation of mid-term functional results and the quality of life after laparoscopic colorectal resection. PATIENTS AND METHODS Twenty-three consecutive patients were included in a retrospective monocentric study. Postoperative functional outcomes and quality of life were analyzed. RESULTS The median follow-up after colorectal resection was of 24±15.7 months (6-72). Major complications occurred in three cases (12,9%) including one anastomotic stenosis, one digestive and one bladder fistula. A significant improvement in pelvic pain symptoms was observed. De novo constipation and pain on defecation occurred in respectively 23% and 42% of the cases. Transient de novo dysuria occurred in 18% of the cases. The quality of life has been significantly improved. CONCLUSION Laparoscopic colorectal resection is associated with unfavourable postoperative digestive and urological outcomes, such as bladder and rectal dysfunction. Radical treatment should be limited to selected patients.
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Affiliation(s)
- L Boileau
- Service de gynécologie et d'obstétrique, CHU de Nîmes, place du Pr R.-Debré, 30029 Nîmes, France.
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Bassi MA, Podgaec S, Dias JA, D'Amico Filho N, Petta CA, Abrao MS. Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement. J Minim Invasive Gynecol 2011; 18:730-3. [PMID: 21930435 DOI: 10.1016/j.jmig.2011.07.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/23/2011] [Accepted: 07/28/2011] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To estimate the quality of life of patients undergoing laparoscopic resection of a segment of the rectosigmoid for the treatment of deep infiltrating endometriosis with bowel involvement. DESIGN Prospective application of the SF-36 Health Status Questionnaire to 151 women before and 1 year after surgical intervention (Canadian Task Force Design Classification II). SETTING Department of Obstetrics and Gynecology, University of São Paulo Medical School, and Samaritano Hospital, São Paulo, Brazil. PATIENTS A total of 151 women (mean age 34.05 ± 5.65 years) with deep infiltrating endometriosis underwent resection of a segment of the rectosigmoid by laparoscopy between 2002 to 2009. INTERVENTIONS All the patients had historical data collected and underwent clinical examination and transvaginal ultrasonography with prior bowel preparation for resection of a segment of the rectosigmoid by laparoscopy indicated for patients with symptoms (pelvic pain) with 1 or more lesions of more than 3 cm in length or multifocal lesions. MEASUREMENTS AND MAIN RESULTS Wilcoxon signed rank test verified differences between the degrees of the symptoms and the SF-36 scores before and 1 year after laparoscopic treatment. There was a significant improvement (p < .001) in all pain-related symptoms, as well as a significant increase (p < .001) in scores in all the SF-36 domains and in the sum of the components comprising both physical and mental health. CONCLUSION Laparoscopic segmental resection of the rectosigmoid fulfills its essential objective of treating endometriosis with bowel involvement and improving patients' QoL to a significant extent.
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Affiliation(s)
- Marco Antonio Bassi
- Department of Obstetrics and Gynecology, University of São Paulo Medical School, São Paulo, Brazil.
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Fourquet J, Báez L, Figueroa M, Iriarte RI, Flores I. Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity. Fertil Steril 2011. [DOI: 78495111110.1016/j.fertnstert.2011.04.095' target='_blank'>'"<>78495111110.1016/j.fertnstert.2011.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1016/j.fertnstert.2011.04.095','', '10.1016/j.gyobfe.2008.09.016')">Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
78495111110.1016/j.fertnstert.2011.04.095" />
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Armengol-Debeir L, Savoye G, Leroi AM, Gourcerol G, Savoye-Collet C, Tuech JJ, Vassilieff M, Roman H. Pathophysiological approach to bowel dysfunction after segmental colorectal resection for deep endometriosis infiltrating the rectum: a preliminary study. Hum Reprod 2011; 26:2330-5. [PMID: 21705371 DOI: 10.1093/humrep/der190] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Colorectal segmental resection is performed worldwide in a majority of women presenting with symptomatic deep endometriosis infiltrating the rectum. The aim of the present study was to investigate the pathophysiological mechanisms involved in post-operative digestive dysfunction. METHODS We selected patients managed by colorectal resection for rectal endometriosis, who had developed post-operative severe constipation and whose follow up was superior to 24 months. To assess the mechanisms involved in the pathogenesis of this complaint, we performed a step-by-step work up including: low digestive tract endoscopy, colonic transit time measurement and when appropriate anorectal manometry, electromyography and defecographic evaluation. RESULTS Five out of 25 (20%) patients, whose age ranged from 27 to 41 years, were investigated for severe post-operative terminal constipation. Four different mechanisms responsible for terminal constipation were identified: tight stenosis of the colorectal anastomosis, post-operative neurological sequelae, colonic intussusception through the colorectal anastomosis and transit constipation that developed post surgery. CONCLUSIONS Post-operative constipation is a frequent complaint in women managed by colorectal resection for rectal endometriosis. A multidisciplinary approach is mandatory as pathophysiologic mechanisms may vary and prove difficult to understand. The risk of post-operative bowel dysfunction following colorectal endometriosis must be taken into account whenever this technique is proposed in young women presenting with a benign disease such as deep endometriosis.
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Vassilieff M, Suaud O, Collet-Savoye C, Da Costa C, Marouteau-Pasquier N, Belhiba H, Tuech JJ, Marpeau L, Roman H. Coloscanner à l’air avec coloscopie virtuelle : arguments dans le choix du traitement chirurgical des endométrioses colorectales. ACTA ACUST UNITED AC 2011; 39:339-45. [DOI: 10.1016/j.gyobfe.2011.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Indexed: 01/07/2023]
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Fourquet J, Báez L, Figueroa M, Iriarte RI, Flores I. Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity. Fertil Steril 2011; 96:107-12. [PMID: 21621771 DOI: 10.1016/j.fertnstert.2011.04.095] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/13/2011] [Accepted: 04/28/2011] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To quantify the impact of endometriosis-related symptoms on physical and mental health status, health-related quality of life, and work-related aspects (absenteeism, presenteeism, work productivity, and activity impairment). DESIGN Cross-sectional quantitative study. SETTING Academic and research institution. PATIENT(S) Women (n = 193) with self-reported surgically diagnosed endometriosis from the Endometriosis Patient Registry at Ponce School of Medicine and Health Sciences (PSMHS). INTERVENTION(S) Anonymous questionnaire divided into three sections consisting of questions from the Patient Health Survey (SF-12), the Endometriosis Health Profile (EHP-5), and the Work Productivity and Activity Impairment Survey (WPAI). MAIN OUTCOME MEASURE(S) Quantification of impact of endometriosis symptoms on physical and mental health status, health-related quality of life, absenteeism, presenteeism, work productivity, and activity impairment. RESULT(S) Patients had SF-12 scores denoting statistically significant disability in the physical and mental health components. They also reported an average of 7.41 hours (approximately one working day) of work time lost during the week when the symptoms are worse. In addition, the WPAI scores showed a high impact on work-related domains: 13% of average loss in work time (absenteeism), 65% of work impaired (presenteeism), 64% of loss in efficiency levels (work productivity loss), and 60% of daily activities perturbed (activity impairment). CONCLUSION(S) Endometriosis symptoms such as chronic, incapacitating pelvic pain and infertility negatively and substantially impact the physical and mental health status, health-related quality of life, and productivity at work of women.
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Affiliation(s)
- Jessica Fourquet
- Microbiology Department, Ponce School of Medicine and Health Sciences, Ponce, Puerto Rico 00731, USA
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Kondo W, Bourdel N, Jardon K, Tamburro S, Cavoli D, Matsuzaki S, Botchorishvili R, Rabischong B, Pouly JL, Mage G, Canis M. Comparison between standard and reverse laparoscopic techniques for rectovaginal endometriosis. Surg Endosc 2011; 25:2711-7. [PMID: 21424199 DOI: 10.1007/s00464-011-1635-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 02/14/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study was designed to compare the surgical outcomes of standard and reverse laparoscopic techniques for the treatment of rectovaginal endometriosis. METHODS A retrospective study was conducted in a teaching and research hospital (tertiary center), which included 75 women subjected to laparoscopic treatment of rectovaginal endometriosis that required both vaginal resection and rectal surgery. Standard and reverse laparoscopic techniques were compared in 35 and 40 women, respectively. Student's t test, Mann-Whitney test, and Fisher's exact test were performed to compare groups when needed; p < 0.05 was considered statistically significant. RESULTS There was no statistically significant difference in operating time, blood loss, conversion rate, major intraoperative complications, length of hospital stay, and minor postoperative complications between the two techniques. The rate of major postoperative complications for the standard technique was 22.9%, whereas only 5% for the reverse technique (p = 0.02). The rate of postoperative rectovaginal fistula was the same for both techniques. CONCLUSIONS Major postoperative complications were reduced by using the reverse technique.
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Affiliation(s)
- William Kondo
- Department of Gynecologic Surgery, CHU Estaing, Clermont-Ferrand, France.
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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]
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Kavallaris A, Mebes I, Evagyelinos D, Dafopoulos A, Beyer DA. Follow-up of dysfunctional bladder and rectum after surgery of a deep infiltrating rectovaginal endometriosis. Arch Gynecol Obstet 2011; 283:1021-6. [PMID: 21221979 DOI: 10.1007/s00404-010-1833-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 12/23/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization. Major goal of this review article is to compare different surgical techniques of deep infiltrating endometriosis and their follow-up results. METHODS The research strategy included the online search of databases [MEDLINE, EMBASE, SCOPUS] for the diagnosis of deep infiltrating endometriosis with the indication of an operative resection. The outcome of the follow-up terms were noticed and compared. RESULTS All in all, 16 trials could be identified with included follow-up. In all patients at least single-sided resection of the uterosacral ligaments were performed. Follow-up was heterogeneous in all trials ranging from 1 to 92 months. Postoperative symptoms, such as dysmenorrhoea, pelvic pain, and dyspareunia were commonly described in the majority of trials. Nevertheless, a tendency towards lower comorbidity after nerve sparing resection of endometriosis could be observed. CONCLUSION Identification of the inferior hypogastric nerve and plexus was feasible in the minority of trials. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
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Affiliation(s)
- A Kavallaris
- Department of Gynecology and Obstretics, University of Schleswig-Holstein Campus Luebeck, Luebeck, Germany
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Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, Michot F, Tuech JJ. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 2010; 26:274-81. [PMID: 21131296 DOI: 10.1093/humrep/deq332] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Two surgical approaches are usually employed in the treatment of deep infiltrating endometriosis of the rectum (DIER): colorectal resection removing the rectal segment affected by the disease, and nodule excision either without opening the rectum (shaving) or by removing the nodule along with the surrounding rectal wall (full thickness or disc excision). Although the present available data are from retrospective series reported by surgeons who generally perform only one technique, there is no evidence to support the risk of recurrences as a valid argument in favour of colorectal resection over rectal nodule excision. The advantage of a lower morbidity associated with nodule excision is not necessarily at the cost of an increased rate of pain recurrences, especially in women benefiting from post-operative medical treatment. The symptom-guided surgical approach in DIER primarily focuses on the relief of digestive symptoms and pelvic pains, rather than on mandatory 'carcinologic' resection of lesions. In addition, the risk of new post-operative unpleasant symptoms as a result of a compulsory and systematic excision of all endometriotic foci may be avoided. In a majority of cases, pelvic anatomy and digestive function can be restored by shaving or disc excision, as well as by colorectal resection; thus digestive complaints can be resolved even when the rectum is conserved. The most accurate evaluation of the results of DIER surgery should be provided by post-operative evolution in digestive function. Even though quality of life is improved for the majority of patients managed by colorectal resection, the question is whether or not a greater health improvement can be achieved by performing nodule excision, which avoids various post-operative and functional digestive complications. In addition, continuous medical treatment leads to a decrease in endometriotic nodules and prevents post-operative pain recurrences. Instead of choosing between medical and surgical management in the treatment of DIER, it is most likely that the two therapies should be associated.
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Affiliation(s)
- Horace Roman
- Department of Gynecology and Obstetrics, Clinique Gynécologique et Obstétricale, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, France.
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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.
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Affiliation(s)
- W Kondo
- Department of Gynaecologic Surgery, CHU Estaing, Clermont-Ferrand, France.
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Is the 30-item Endometriosis Health Profile (EHP-30) suitable as a self-report health status instrument for clinical trials? Fertil Steril 2010; 94:1928-32. [DOI: 10.1016/j.fertnstert.2010.01.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/13/2010] [Accepted: 01/15/2010] [Indexed: 11/17/2022]
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Roman H, Opris I, Resch B, Tuech JJ, Sabourin JC, Marpeau L. Histopathologic features of endometriotic rectal nodules and the implications for management by rectal nodule excision. Fertil Steril 2009; 92:1250-1252. [PMID: 19409552 DOI: 10.1016/j.fertnstert.2009.03.073] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 03/06/2009] [Accepted: 03/18/2009] [Indexed: 02/07/2023]
Abstract
Using data from 27 women with deep rectal endometriosis, managed by segmental resection, we observed that in 89% of cases active glandular endometrial foci were responsible for a deeper infiltration of rectal layers than that of fibrosis and smooth fibers by 5 mm on average. These data might be useful for surgeons performing rectal nodule excision, suggesting the benefits of administrating postoperative medical treatment to reduce the risk of rectal recurrences caused by remaining active endometriotic foci.
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Affiliation(s)
- Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
| | - Ioana Opris
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Benoit Resch
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
| | | | | | - Loïc Marpeau
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France
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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]
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