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Crestani A, de Labrouhe E, Le Gac M, Kolanska K, Ferrier C, Touboul C, Dabi Y, Darai E. To drain or not to drain: A propensity score analysis of abdominal drainage after colorectal surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol 2024; 297:227-232. [PMID: 38691975 DOI: 10.1016/j.ejogrb.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
AIM To assess the benefit of prophylactic abdominal drainage (AD) after colorectal surgery for endometriosis. METHODS We conducted a retrospective study of 215 patients who underwent colorectal surgery for endometriosis using a mini-invasive approach in our center from February 2019 to July 2023. A propensity score matched (PSM) analysis (1:1 ratio) identified two groups of patients with similar characteristics. Postoperative outcomes were then compared. RESULTS In the unmatched cohort, 151 patients (70 %) had AD at the end of surgery and 64 (30 %) did not. Clinical characteristics and surgical procedures were comparable between the groups after PSM. After PSM, AD was associated with a longer hospital stay (p < 0.001) and a greater number of postoperative complications (p = 0.03). There were no differences for readmission, repeat surgery, or severe postoperative complications. CONCLUSION In this retrospective cohort of patients undergoing colorectal resection for endometriosis using a mini-invasive approach, prophylactic AD was not found to be beneficial.
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Affiliation(s)
- Adrien Crestani
- Franco-European Multidisciplinary Endometriosis Institut (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux 33000, France.
| | - Eric de Labrouhe
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France
| | - Marjolaine Le Gac
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France
| | - Kamila Kolanska
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
| | - Clément Ferrier
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
| | - Yohann Dabi
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
| | - Emile Darai
- Sorbonne University, Department of Obstetrics and Reproductive Medicine, Hôpital Tenon, 4 rue de la Chine, Paris 75020, France; Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France; Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, INSERM UMR_S_938, Paris 75020, France
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Li Q, Zhang L, Fang F, Xu P, Zhang C. Research progress of indocyanine green fluorescence technology in gynecological applications. Int J Gynaecol Obstet 2024; 165:936-942. [PMID: 37953657 DOI: 10.1002/ijgo.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Abstract
Indocyanine green is a near-infrared fluorescent dye which is widely used in various fields of surgery and gynecology. It is currently mainly used to detect various malignant tumors, sentinel lymph nodes, endometriosis lesions, ureter or intestinal occlusion, vaginal perfusion, uterine arterial blood perfusion, pelvic nerve, uterine niche, lymphatic edema, metastatic lesion shadow, and so on, providing new methods for decision-making during surgery. This article elaborates the application progress of indocyanine green fluorescence technology in gynecology.
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Affiliation(s)
- Qing Li
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Li Zhang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Fang Fang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Ping Xu
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
| | - Chunhua Zhang
- Department of Gynecology, Huaian Maternity and Child Clinical College of Xuzhou Medical University, Huaian, Jiangsu, China
- Macau University of Science and Technology, Macau, China
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3
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Schneyer RJ, Hamilton KM, Meyer R, Nasseri YY, Siedhoff MT. Surgical treatment of colorectal endometriosis: an updated review. Curr Opin Obstet Gynecol 2024:00001703-990000000-00128. [PMID: 38743685 DOI: 10.1097/gco.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis. RECENT FINDINGS The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design. SUMMARY The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made.
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Affiliation(s)
- Rebecca J Schneyer
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kacey M Hamilton
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Yosef Y Nasseri
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew T Siedhoff
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Kar E, Philip CE, Eskandar K, Polat I, Bastu E. Natural Orifice Specimen Extraction as a Promising Alternative for Minilaparotomy in Bowel Resection due to Endometriosis: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2024:S1553-4650(24)00183-3. [PMID: 38679194 DOI: 10.1016/j.jmig.2024.04.017] [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: 02/07/2024] [Revised: 03/25/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE This study focuses on evaluating the effectiveness, safety and efficacy of two surgical tissue extraction methods for treating bowel endometriosis: natural orifice specimen extraction (NOSE) and minilaparotomy. DATA SOURCES A systematic search was conducted in MedLine, Embase, and Cochrane Library databases in October 2023, without date restrictions. METHODS OF STUDY SELECTION This study included studies that directly compared NOSE and minilaparotomy in colectomy patients due to endometriosis. Primary outcomes were defined as operation duration, length of hospital stay, intraoperative blood loss and major postoperative complication rates. The Clavien-Dindo classification was used to categorize complications. Statistical analysis was performed using Review Manager Software by Cochrane, with a DerSimonian and Laird random-effects model to account for anticipated high heterogeneity. Subgroup analysis was conducted for patients undergoing full laparoscopic (L/S) resection. TABULATION, INTEGRATION AND RESULTS Out of 1,236 identified studies, six met the inclusion criteria, comprising 372 patients. One study was a randomized controlled trial, and five were observational. Operation duration did not significantly differ between NOSE and minilaparotomy (MD: -10.85 min; 95% CI: [-23.33, 1.63]; p = .09). NOSE was associated with a significantly reduced length of hospital stay (MD: -0.76 day; 95% CI: [-1.21, -0.31]; p = .008). The major postoperative complication rates were 3.77% for NOSE and 5.55% for minilaparotomy, with no significant difference (OR: 0.84; 95% CI: [0.27, 2.60]; p = .76). Subgroup analysis revealed that Full L/S had significantly shorter operation duration (MD: -26.06 min; 95% CI: [-45.85, -6.27]; p = .01), reduced length of stay (MD: -0.75 day; 95% CI: [-1.25, -0.25]; p = .003), and lower blood loss (MD: -15.01 mL; 95% CI: [-29.64, -0.37]; p = .04). CONCLUSION NOSE emerged as a potentially safer alternative to minilaparotomy for tissue extraction in colectomy for bowel endometriosis. However, standardization of the procedure and additional randomized controlled trials are needed to validate these findings. PRéCIS (SUMMATION): The NOSE (Natural Orifice Specimen Extraction) method presents as a safe and promising alternative to minilaparotomy as an extraction technique in patients with bowel endometriosis.
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Affiliation(s)
- Emre Kar
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey.
| | | | - Karine Eskandar
- Department of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Ibrahim Polat
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Basaksehir, Istanbul, Turkey
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Robertson J, Abbott J, Corbett-Burns S, Bukhari M, Perera S, Kalantan A, Sarofim M, Chou R, Cario G, Rosen D, Choi S, Wynn-Williams M, Condous G, Chou D. Treatment of rectosigmoid endometriosis by laparoscopic reverse submucosal dissection (LRSD): The Sydney partial thickness discoid excision technique. Aust N Z J Obstet Gynaecol 2024; 64:147-153. [PMID: 37905841 DOI: 10.1111/ajo.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Laparoscopic reverse submucosal dissection (LRSD) is a standardised surgical technique for removal of rectosigmoid endometriosis which optimises the anatomical dissection plane for excision of endometriotic nodules. AIM This cohort study assesses the outcomes of the first cohort of women treated by LRSD, for deeply infiltrating rectosigmoid endometriosis. MATERIALS AND METHODS Primary outcomes assessed were complication rate as defined by the Clavien-Dindo system, and completion of the planned LRSD. Secondary outcomes include mucosal breach, specimen margin involvement, length of hospital admission, and a comparison of pre-operative and post-operative pain, bowel function and quality of life surveys. These included the Endometriosis Health Profile Questionnaire (EHP-30), the Knowles-Eccersley-Scott Symptom Questionnaire (KESS) and the Wexner scale. RESULTS Of 19 patients treated, one required a segmental resection. The median length of hospital admission was two days (range 1-5) and no post-operative complications occurred. Median pain visual analogue scales (scale 0-10) were higher prior to surgery (dysmenorrhoea 9.0, dyspareunia 7.5, dyschezia 9.0, pelvic pain 6.0) compared to post-surgical median scores (dysmenorrhoea 5.0, dyspareunia 4.0, dyschezia 2.0, pelvic pain 4.0) at a median of six months (range 4-32). Quality of life studies suggested improvement following surgery with pre-operative median EHP-30 and KESS scores (EHP-30: 85 (5-106), KESS score 9 (0-20)) higher than post-operative scores (EHP-30: 48.5 (0-80), KESS score: 3 (0-19)). CONCLUSION This series highlights the feasibility of LRSD with low associated morbidity as a progression of partial thickness discoid excision (rectal shaving) for the treatment of rectosigmoid deep infiltrating endometriosis.
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Affiliation(s)
- Jessica Robertson
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Jason Abbott
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| | | | - Mujahid Bukhari
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Shevy Perera
- Sydney Colorectal Associates, Sydney, New South Wales, Australia
| | - Assem Kalantan
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Mikhail Sarofim
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - Rebecca Chou
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Greg Cario
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | - David Rosen
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
| | - Sarah Choi
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
| | | | - George Condous
- OMNI Ultrasound and Gynaecological Care, Sydney, New South Wales, Australia
| | - Danny Chou
- Sydney Women's Endosurgery Centre, Sydney, New South Wales, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Sydney, New South Wales, Australia
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Crestani A, Merlot B, Goualard PH, Grigoriadis G, Chanavaz Lacheray I, Dennis T, Roman H. Bowel endometriosis: Surgical customization is demanding. Best Pract Res Clin Obstet Gynaecol 2024; 94:102495. [PMID: 38593673 DOI: 10.1016/j.bpobgyn.2024.102495] [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: 01/28/2024] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-made surgery will always be to preserve the organ. The surgeon then has three options: shaving, discoid resection and segmental resection. The more extensive the resection, the greater the risk of severe short- and long-term complications. Surgery must therefore be adapted to the patient's specific situation and needs. Moreover, personalized care must extend beyond surgery. It must begin before the operation, preparing the patient for the operation like an athlete before a race, and continue afterwards by adapting the follow-up to the surgery performed.
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Affiliation(s)
- Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France.
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates
| | - Paul-Henri Goualard
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | | | - Isabelle Chanavaz Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
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Mijatovic V, Vercellini P. Towards comprehensive management of symptomatic endometriosis: beyond the dichotomy of medical versus surgical treatment. Hum Reprod 2024; 39:464-477. [PMID: 38199787 DOI: 10.1093/humrep/dead262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
Except when surgery is the only option because of organ damage, the presence of suspicious lesions, or the desire to conceive, women with endometriosis-associated pain often face a choice between medical and surgical treatment. In theory, the description of the potential benefits and potential harms of the two alternatives should be standardized, unbiased, and based on strong evidence, enabling the patient to make an informed decision. However, doctor's opinion, intellectual competing interests, local availability of specific services and (mis)information obtained from social media, and online support groups can influence the type of advice given and affect patients' choices. This is compounded by the paucity of robust data from randomized controlled trials, and the anxiety of distressed women who are eager to do anything to alleviate their disabling symptoms. Vulnerable patients are more likely to accept the suggestions of their healthcare provider, which can lead to unbalanced and physician-centred decisions, whether in favour of either medical or surgical treatment. In general, treatments should be symptom-orientated rather than lesion-orientated. Medical and surgical modalities appear to be similarly effective in reducing pain symptoms, with medications generally more successful for severe dysmenorrhoea and surgery more successful for severe deep dyspareunia caused by fibrotic lesions infiltrating the posterior compartment. Oestrogen-progestogen combinations and progestogen monotherapies are generally safe and well tolerated, provided there are no major contraindications. About three-quarters of patients with superficial peritoneal and ovarian endometriosis and two-thirds of those with infiltrating fibrotic lesions are ultimately satisfied with their medical treatment although the remainder may experience side effects, which may result in non-compliance. Surgery for superficial and ovarian endometriosis is usually safe. When fibrotic infiltrating lesions are present, morbidity varies greatly depending on the skill of the individual surgeon, the need for advanced procedures, such as bowel resection and ureteral reimplantation, and the availability of expert colorectal surgeons and urologists working together in a multidisciplinary approach. The generalizability of published results is adequate for medical treatment but very limited for surgery. Moreover, on the one hand, hormonal drugs induce disease remission but do not cure endometriosis, and symptom relapse is expected when the drugs are discontinued; on the other hand, the same drugs should be used after lesion excision, which also does not cure endometriosis, to prevent an overall cumulative symptom and lesion recurrence rate of 10% per postoperative year. Therefore, the real choice may not be between medical treatment and surgery, but between medical treatment alone and surgery plus postoperative medical treatment. The experience of pain in women with endometriosis is a complex phenomenon that is not exclusively based on nociception, although the role of peripheral and central sensitization is not fully understood. In addition, trauma, and especially sexual trauma, and pelvic floor disorders can cause or contribute to symptoms in many individuals with chronic pelvic pain, and healthcare providers should never take for granted that diagnosed or suspected endometriosis is always the real, or the sole, origin of the referred complaints. Alternative treatment modalities are available that can help address most of the additional causes contributing to symptoms. Pain management in women with endometriosis may be more than a choice between medical and surgical treatment and may require comprehensive care by a multidisciplinary team including psychologists, sexologists, physiotherapists, dieticians, and pain therapists. An often missing factor in successful treatment is empathy on the part of healthcare providers. Being heard and understood, receiving simple and clear explanations and honest communication about uncertainties, being invited to share medical decisions after receiving detailed and impartial information, and being reassured that a team member will be available should a major problem arise, can greatly increase trust in doctors and transform a lonely and frustrating experience into a guided and supported journey, during which coping with this chronic disease is gradually learned and eventually accepted. Within this broader scenario, patient-centred medicine is the priority, and whether or when to resort to surgery or choose the medical option remains the prerogative of each individual woman.
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Affiliation(s)
- Velja Mijatovic
- Department of Gynaecology & Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Crestani A, Le Gac M, de Labrouhe É, Touboul C, Bendifallah S, Ferrier C, Dabi Y, Darai E. Outcomes of discoid excision and segmental resection for colorectal endometriosis: robotic versus conventional laparoscopy. J Robot Surg 2024; 18:87. [PMID: 38386205 DOI: 10.1007/s11701-024-01854-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
Surgery for deep endometriosis with colorectal involvement is an option after medical treatment failure. Over the past decade, robotic laparoscopy has emerged as an alternative to conventional laparoscopy. We aimed to evaluate surgical outcomes of robotic versus conventional laparoscopy for discoid excision and segmental resection. From 2019 to 2023, we conducted a retrospective cohort study of 152 consecutive patients with colorectal endometriosis who underwent robotic or conventional laparoscopy for discoid excision and colorectal resection. Ninety of the patients 152 underwent robotic surgery and 62 conventional laparoscopy. The mean total surgical room occupancy and operating times were longer in the robotic group: 270 ± 81 min vs 240 ± 79 min, p = 0.010, and 216 ± 78 min vs 190 ± 76, p = 0.027, respectively. The mean intraoperative blood loss, and the incidence of intra- and postoperative complications (according to Clavien-Dindo classification) were similar in the two groups. The mean hospital stay was greater after conventional laparoscopy (8 ± 5 vs 7 ± 4 days; p = 0.03), and the rate of persistent voiding dysfunction was higher in the conventional group (9/11, 25% vs 2/11, 5%; p = 0.01). A higher incidence of persistent voiding dysfunction was also observed after segmental resection by conventional laparoscopy (25% vs 4.8%, p = 0.01). Our results support the use of robotic surgery as an alternative to conventional laparoscopy for discoid excision and segmental resection for colorectal endometriosis.
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Affiliation(s)
- Adrien Crestani
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France.
| | - Marjolaine Le Gac
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - Éric de Labrouhe
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
| | - Cyril Touboul
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Clément Ferrier
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Yohann Dabi
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
| | - Emile Darai
- Department of Obstetrics and Reproductive Medicine, Sorbonne University, Hôpital Tenon, 4 rue de la Chine, Paris, France
- Clinical Research Group (GRC) Paris 6, Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), Paris, France
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9
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Hebert T. Robotic assisted laparoscopy for deep infiltrating endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102422. [PMID: 38007964 DOI: 10.1016/j.bpobgyn.2023.102422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 10/09/2023] [Accepted: 10/22/2023] [Indexed: 11/28/2023]
Abstract
Deep infiltrative endometriosis is a condition affecting up to 15 % of women of childbearing age, defined by extra uterine location of endometrial like tissues. The symptoms of endometriosis range from severe dysmenorrhea to infertility, chronic pelvic pain, bowel dysfunction and urinary tract involvement to name the most common. Endometriosis has an impact on the quality of life of patients, with personal and social consequences. Although medical treatment is indicated in the first instance, surgery may be necessary. Standard laparoscopy has become the gold standard for this surgery. However, surgery for deep infiltrative endometriosis is known to be highly complex, and the significant development of robotic assistance in recent years has had an impact on the evolution of surgical practice. This comprehensive review of the literature provides an overview of the contributions of robotic surgery in the field of endometriosis and gives an insight into the next steps in its development.
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Affiliation(s)
- T Hebert
- Centre Olympe de Gouges, Gynecologic Surgery Department, University Hospital, Tours, France.
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10
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Verrelli L, Merlot B, Chanavaz-Lacheray I, Braund S, D'Ancona G, Kade S, Dennis T, Roman H. Robotic Surgery for Severe Endometriosis: A Preliminary Comparative Study of Cost Estimation. J Minim Invasive Gynecol 2024; 31:95-101.e1. [PMID: 37935331 DOI: 10.1016/j.jmig.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
STUDY OBJECTIVE To compare the postoperative outcomes and the overall expenses between conventional laparoscopy and robotic surgery, in a series of consecutive patients managed for only severe endometriosis in our institute. DESIGN A cohort comparative study. SETTING Center of Excellence in Multidisciplinary Endometriosis Care. PATIENTS A total of 175 symptomatic patients undergoing surgery for only severe endometriosis from March 2021 to August 2022. INTERVENTIONS We treated patients with endometriosis involving the digestive tract such as rectum, sigmoid colon, and ileocecal junction by rectal shaving, discoid resection, or segmental resection (141 surgeries) with or without bladder (23 surgeries), sacral plexus (19 surgeries), and diaphragm involvements (14 surgeries). MEASUREMENTS AND MAIN RESULTS Postoperative outcomes were evaluated in terms of total surgical time (total surgical room occupancy time and total operating time), hospitalization period, postoperative complications, rehospitalization, and second surgical procedures. A statistically higher total surgical room occupancy (203 minutes vs 151 minutes) and operating time (150 minutes vs 105 minutes) were observed in the robotic group (p = .001). No differences in terms of mean hospital stay (p = .06), postoperative complications (p = .91), rehospitalization (p = .48), and secondary surgical treatment (p = .78) were identified. Concerning the cost analysis only for disposable supply, the cost of colorectal resection was totaled at 2604 euros for the laparoscopic conventional approach vs 2957 euros for the robotic approach (+352.6 euros, +14%). The cost of rectal disc excision was 1527 euros for the laparoscopic conventional approach vs 1905.85 euros (+378 euros, +25%). CONCLUSIONS Our study confirms the feasibility of the robotic approach for the treatment of severe endometriosis, with however a higher cost of robotic approach. Next studies should identify specific indications for robotic surgery, where technical advantages provided by the technology are followed by objective improvement of patients' outcomes.
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Affiliation(s)
- Ludovica Verrelli
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman); Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman)
| | - Isabella Chanavaz-Lacheray
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Sophia Braund
- Expert Center in Multidisciplinary Endometriosis Management, Rouen University Hospital, Rouen, France (Dr. Roman)
| | - Gianmarco D'Ancona
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman)
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman)
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos, Bordeaux, France (Drs. Verrelli, Merlot, Chanavaz-Lacheray, D'Ancona, Dennis, and Roman); Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, UAE (Drs. Merlot, Kade, and Roman); Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark (Drs. Braund and Roman).
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11
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Cho A, Park CM. Minimally invasive surgery for deep endometriosis. Obstet Gynecol Sci 2024; 67:49-57. [PMID: 37883994 DOI: 10.5468/ogs.23176] [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: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Deep endometriosis (DE) is endometriotic tissue that invades the peritoneum by >5 mm. Surgery is the treatment of choice for symptomatic DE, and laparoscopic surgery is preferred over laparotomy due to better vision and postoperative pain. In this review, we aimed to collect and summarize recent literature on DE surgery and share laparoscopic procedures for rectovaginal and bowel endometriosis.
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Affiliation(s)
- Angela Cho
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Chul-Min Park
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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12
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Meyer R, Nasseri YY, Barnajian M, Siedhoff MT, Wright KN, Hamilton KM, Levin G, Truong MD. Risk factors for major complications following colorectal resections for endometriosis in the USA. Int J Colorectal Dis 2023; 39:1. [PMID: 38055072 DOI: 10.1007/s00384-023-04577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE We aimed to describe the incidence and identify risk factors for the occurrence of short-term major posto-perative complications following colorectal resection for endometriosis. METHODS A cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020. We included patients with a primary diagnosis of endometriosis who underwent colon or rectal resections for endometriosis. RESULTS Of 755 women who underwent colorectal resection, 495 (65.6%) had laparoscopic surgery and 260 (34.4%) had open surgery. The major complication rate was 13.5% (n = 102). Women who underwent open surgery had a higher proportion of major complications (n = 53, 20.4% vs. n = 49, 9.9%, p < 0.001). In a multivariable regression analysis, Black race (aOR 95%CI 2.81 (1.60-4.92), p < 0.001), Hispanic ethnicity (aOR 95%CI 3.02 (1.42-6.43), p = 0.004), hypertension (aOR 95%CI 1.89 (1.08-3.30), p = 0.025), laparotomy (aOR 95%CI 1.64 (1.03-3.30), p = 0.025), concomitant enterotomy (aOR 95%CI 3.02 (1.26-7.21), p = 0.013), and hysterectomy (aOR 95%CI 2.59 (1.62-4.15), p < 0.001) were independently associated with major post-operative complications. In a subanalysis of laparoscopies only, Hispanic ethnicity, chronic hypertension, lysis of bowel adhesions, and hysterectomy were independently associated with major complications. In a subanalysis of laparotomies only, Black race and hysterectomy were independently positively associated with the occurrence of major complications. CONCLUSION This study provides a current population-based estimate of short-term complications after surgery for colorectal endometriosis in the USA. The identified risk factors for complications can assist during preoperative shared decision-making and informed consent process.
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Affiliation(s)
- Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Ramat-Gan, Israel.
| | - Yosef Y Nasseri
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moshe Barnajian
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew T Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kacey M Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Crestani A, Bibaoune A, Le Gac M, Dabi Y, Kolanska K, Ferrier C, Bendifallah S, Touboul C, Darai E. Changes in hospital consumption of opioid and non-opioid analgesics after colorectal endometriosis surgery. J Robot Surg 2023; 17:2703-2710. [PMID: 37606871 DOI: 10.1007/s11701-023-01691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023]
Abstract
The aim of this study was to analyze postoperative consumption of analgesics during hospitalization following colorectal surgery for endometriosis. We conducted a retrospective study at Tenon University Hospital, Paris, France from February 2019 to December 2021. One hundred sixty-two patients underwent colorectal surgery: eighty-nine (55%) by robotic and seventy-three (45%) by conventional laparoscopy. The type of procedure had an impact on acetaminophen and nefopam consumed per day: consumption for colorectal shaving, discoid resection, and segmental resection was, respectively, 2(0.5), 2.1(0.6), 2.4(0.6) g/day (p = 10-3), and 25(7), 30(14), 31(11) mg/day (p = 0.03). The total amount of tramadol consumed was greater following robotic surgery compared with conventional laparoscopy (322(222) mg vs 242(292) mg, p = 0.04). We observed a switch in analgesic consumption over the years: tramadol was used by 70% of patients in 2019 but only by 7.1% in 2021 (p < 10-3); conversely, ketoprofen was not used in 2019, but was consumed by 57% of patients in 2021 (p < 10-3). A history of abdominal surgery (OR = 0.37 (0.16-0.78, p = 0.011) and having surgery in 2020 rather than in 2019 (OR = 0.10 (0.04-0.24, p < 10-3)) and in 2021 than in 2019 (OR = 0.08 (0.03-0.20, p < 10-3)) were the only variables independently associated with the risk of opioid use. We found that neither clinical characteristics nor intraoperative findings had an impact on opioid consumption in this setting, and that it was possible to rapidly modify in-hospital analgesic consumption modalities by significantly reducing opioid consumption in favor of NSAIDS or nefopam.
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Affiliation(s)
- Adrien Crestani
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France.
| | - Amine Bibaoune
- Department of Pharmacy, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Marjolaine Le Gac
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Kamila Kolanska
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
- UMRS 938, Centre de Recherche Saint Antoine, Faculté de Médecine Sorbonne Université, 75012, Paris, France
| | - Clément Ferrier
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
- Department of Pharmacy, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75020, Paris, France
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Wang EB, Chang S, Bossa D, Rosero EB, Kho KA. Association between Endometriosis and Surgical Complications among Benign Hysterectomies. J Minim Invasive Gynecol 2023; 30:990-998. [PMID: 37709129 DOI: 10.1016/j.jmig.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
STUDY OBJECTIVE To investigate the effect of endometriosis on perioperative outcomes in patients undergoing hysterectomy for benign disease. DESIGN A retrospective cohort study. SETTING The American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS A total of 127 556 hysterectomies performed for benign gynecologic indications INTERVENTIONS: Differences in the primary outcomes were compared between patients with and without endometriosis after adjustment for group differences in covariates using inverse probability of treatment weighting approach. MEASURES AND MAIN RESULTS Of the 127 556 hysterectomies identified, 19 618 (15.4%) had a diagnosis of endometriosis. Patients with endometriosis were younger with a lower prevalence of chronic comorbidities but had higher rates of concurrent pelvic inflammatory disease and previous abdominal operations. The incidence of postoperative complications was higher in patients with endometriosis (9.9% vs 8.1%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.17-1.34). The incidence of 30-day mortality (0.1% vs 0.03%; OR, 1.98; 95% CI, 0.69-5.65) and reoperations (1.50% vs 1.36%; OR, 1.18; 95% CI, 0.98-1.42) were not different in patients with and without endometriosis. CONCLUSION Postoperative complications are more likely in hysterectomies involving endometriosis than those without endometriosis, likely owing to anatomic distortion incurring increased surgical complexity. Patients and surgeons should be aware of the increased risk of complications and plan for mitigating these increased risks before and during surgery for suspected endometriosis.
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Affiliation(s)
- Emily B Wang
- Department of Obstetrics and Gynecology (Drs. Wang, Chang, Bossa, and Kho)
| | - Stephanie Chang
- Department of Obstetrics and Gynecology (Drs. Wang, Chang, Bossa, and Kho).
| | - Deina Bossa
- Department of Obstetrics and Gynecology (Drs. Wang, Chang, Bossa, and Kho)
| | - Eric B Rosero
- Department of Anesthesiology and Pain Management (Dr. Rosero), University of Texas Southwestern Medical Center, Dallas, TX
| | - Kimberly A Kho
- Department of Obstetrics and Gynecology (Drs. Wang, Chang, Bossa, and Kho)
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Volodarsky-Perel A, Merlot B, Denost Q, Dennis T, Chanavaz-Lacheray I, Roman H. Robotic-assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications. Colorectal Dis 2023; 25:2233-2242. [PMID: 37849058 DOI: 10.1111/codi.16785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023]
Abstract
AIM The aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic-assisted versus a conventional laparoscopic approach. METHODS We conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc excision or colorectal resection. All the surgeries were performed in one endometriosis reference institute. To evaluate factors significantly associated with the risk of anastomosis leakage or fistula and bladder atony, we conducted a multivariate logistic regression model. RESULTS A total of 548 patients with rectal endometriotic nodule over 3 cm in diameter (#ENZIAN C3) were included in the final analysis. The demography and clinical characteristics of women managed by the robotic-assisted (n = 97) approach were similar to those of patients who underwent conventional laparoscopy (n = 451). The multivariate logistic regression demonstrated that the surgical approach (robotic-assisted vs. laparoscopic) was not associated with the rate of anastomosis leakage or fistula (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.3-4.0) and bladder dysfunction (aOR 0.5, 95% CI 0.1-1.8). A rectal nodule located lower than 6 cm from the anal verge was significantly associated with anastomosis leakage (aOR 4.1, 95% CI 1.4-10.8) and bladder atony (aOR 4.3, 95% CI 1.5-12.3). Anastomosis leakage was also associated with smoking (aOR 3.2, 95% CI 1.4-7.4), significant vaginal infiltration (aOR 2.7, 95% CI 1.2-6.7) and excision of nodules involving sacral roots (aOR 5.6, 95% CI 1.7-15.5). CONCLUSION The robotic-assisted approach was not associated with increased risk of main postoperative complications compared to conventional laparoscopy for the treatment of large rectal endometriotic nodules.
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Affiliation(s)
- Alexander Volodarsky-Perel
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Isabella Chanavaz-Lacheray
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates
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Meyer R, Siedhoff M, Truong M, Hamilton K, Fan S, Levin G, Barnajian M, Nasseri Y, Wright K. Risk Factors for Major Complications Following Minimally Invasive Surgeries for Endometriosis in the United States. J Minim Invasive Gynecol 2023; 30:820-826. [PMID: 37321298 DOI: 10.1016/j.jmig.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
STUDY OBJECTIVE To study the rate and risk factors for short-term postoperative complications of patients undergoing minimally invasive surgery (MIS) for endometriosis in the United States. DESIGN Retrospective cohort study. SETTING American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. PATIENTS Patients with endometriosis diagnosis. INTERVENTIONS Laparoscopic surgery for endometriosis. MEASUREMENTS AND MAIN RESULTS We compared women with and without 30-day postoperative major complications, defined according to the Clavien-Dindo classification. A total of 28 697 women underwent MIS during the study period, of which 2.6% had major postoperative complications. Organ space surgical site infection and reoperation were the most common complications (47.0% and 39.8%, respectively). In multivariable regression analysis, African American race (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.61 [1.29-2.01], p <.001), hypertension (aOR 95% CI 1.23 [1.01-1.50], p = .036), bleeding disorders (aOR 95% CI 1.96 [1.03-3.74], p = .041), bowel procedures (aOR 95% CI 1.93 [1.37-2.72], p <.001) and hysterectomy (aOR 95% CI 2.09 [1.67-2.63], p <.001) were independently associated with increased risk of major complications. In multivariable regression analysis of laparoscopies without bowel procedures, African American race, bleeding disorders, and hysterectomy were independently associated with increased major complication risk. Among cases with bowel procedures, African American race and colectomy were independently associated with increased major complication risk. In multivariable regression analysis of women who underwent hysterectomy, African American race, bleeding disorders, and lysis of adhesions were independently associated with increased major complications risk. Among women who underwent uterine-sparing surgery, African American race, hypertension, preoperative blood transfusion, and bowel procedures were independently associated with increased major complications risk. CONCLUSION Among women undergoing MIS for endometriosis, African American race, hypertension, bleeding disorders, and bowel surgery or hysterectomy are risk factors for major complications. African American race is a risk factor for major complications among women undergoing surgeries with and without bowel procedures or hysterectomy.
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Affiliation(s)
- Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Meyer, Siedhoff, Truong, Hamilton, Fan, and Wright); The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center (Dr. Meyer), Tel Hashomer, Ramat-Gan, Israel.
| | - Matthew Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Meyer, Siedhoff, Truong, Hamilton, Fan, and Wright)
| | - Mireille Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Meyer, Siedhoff, Truong, Hamilton, Fan, and Wright)
| | - Kacey Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Meyer, Siedhoff, Truong, Hamilton, Fan, and Wright)
| | - Shannon Fan
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Meyer, Siedhoff, Truong, Hamilton, Fan, and Wright)
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research (Dr. Levin), Jewish General Hospital, McGill University, Quebec, Canada
| | - Moshe Barnajian
- Department of General Surgery (Drs. Barnajian, and Nasseri), Cedars Sinai Medical Center, Los Angeles, CA
| | - Yosef Nasseri
- Department of General Surgery (Drs. Barnajian, and Nasseri), Cedars Sinai Medical Center, Los Angeles, CA
| | - Kelly Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology (Drs. Meyer, Siedhoff, Truong, Hamilton, Fan, and Wright)
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Chaggar P, Tellum T, Cohen A, Jurkovic D. Intra- and interobserver reproducibility of transvaginal ultrasound for the detection and measurement of endometriotic lesions of the bowel. Acta Obstet Gynecol Scand 2023; 102:1306-1315. [PMID: 37641421 PMCID: PMC10541154 DOI: 10.1111/aogs.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The number and invasion depth of endometriotic bowel lesions, total length of bowel affected by endometriosis, lesion-to-anal verge distance, and extent of pouch of Douglas obliteration are important factors in preoperatively determining risk and complexity of endometriosis surgery. The intra- and interobserver reproducibility of transvaginal ultrasound in the evaluation of many of these parameters has not yet been investigated. Our study aimed to assess the intra- and interobserver reproducibility of transvaginal ultrasound between an experienced and less experienced examiner for all of these parameters. MATERIAL AND METHODS This prospective observational cross-sectional study was conducted between July 2019 and November 2020. Fifty consecutive premenopausal women who underwent transvaginal ultrasound examination in our clinic for the first time, were examined by the same two operators during the same attendance. Outcomes of interest were the inter-rater reproducibility of transvaginal ultrasound for detecting the presence, number, depth and size of bowel endometriotic nodules, lesion-to-anal-verge distance, total length of bowel affected, and pouch of Douglas obliteration. The intraobserver reproducibility was assessed for the continuous parameters. Cohen's kappa (κ) statistic, Cohen's weighted kappa (κ), proportions of agreement, intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement were used to assess the reproducibility of the parameters. RESULTS The inter-rater agreement and reliability were very good for identifying bowel endometriosis, the number and invasion depth of bowel nodules, determining whether the maximum nodule length was <3 cm, and lesion-to-anal-verge distance <8 cm (proportion of agreement 0.92, 0.94, 0.97, 0.94, 0.96; κ 0.92, 0.91, 0.92, 0.82, 0.89). The inter-rater agreement and reliability were good for assessing pouch of Douglas obliteration (proportion of agreement 0.86, κ 0.80). The intra-rater reliability for the mean nodule diameter (ICC 0.93 and 0.97) and total length of bowel affected (ICC 0.94 and 0.91) were excellent for operators A and B, respectively. The inter-rater reliability for the mean nodule diameter was good (ICC 0.80), and moderate for the total length of bowel affected (ICC 0.70). The Bland-Altman limits of agreement demonstrated clinically acceptable ranges for these two parameters. CONCLUSIONS This study demonstrated a high intra- and inter-rater reproducibility of transvaginal ultrasound in the diagnosis of bowel endometriosis and measurement of its various components.
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Affiliation(s)
- Prubpreet Chaggar
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Tina Tellum
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Department of GynecologyOslo University HospitalOsloNorway
| | - Abigail Cohen
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Davor Jurkovic
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
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Hudelist G, Pashkunova D, Darici E, Rath A, Mitrowitz J, Dauser B, Senft B, Bokor A. Pain, gastrointestinal function and fertility outcomes of modified nerve-vessel sparing segmental and full thickness discoid resection for deep colorectal endometriosis - A prospective cohort study. Acta Obstet Gynecol Scand 2023; 102:1347-1358. [PMID: 37694901 PMCID: PMC10541157 DOI: 10.1111/aogs.14676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION There is an ongoing debate on surgical techniques for colorectal deep endometriosis (DE) and their effects on gastrointestinal (GI) function. The aim of this study was to prospectively investigate the differences in pre- and postsurgical GI function, health profiles and pain symptoms in women undergoing colorectal surgery for symptomatic DE either with a modified segmental resection technique, so-called nerve-vessel sparing segmental resection (NVSSR), or full thickness discoid resection (FTDR). Complication rates and fertility outcomes were also evaluated. MATERIAL AND METHODS A total of 162 consecutive patients, 125 (77.2%) of whom underwent NVSSR and 37 (22.8%) FTDR, were evaluated regarding complication rates. Furthermore a lower anterior resection syndrome (LARS) scores, gastrointestinal function-related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP-30) parameters were analyzed pre- and post-surgery in a final cohort of 121 patients. RESULTS There was no difference between postsurgical prevalence of LARS in either surgery group (14/98, 14.1% NVSSR; 2/23, 8.6% FTDR), with significantly decreased LARS scores and increased GIQLI values before vs after surgery in both groups (P < 0.001). The overall grade III complication rate was 7/162 (4.3%) with no significant differences between NVSSR and FTDR groups. Overall, EHP-30 and pain scores significantly decreased after a median follow-up of 41 (± 17.6) months (EHP-30 51.1, SD 21.5 vs 12.7, SD 19.3, P < 0.001; dysmenorrhea, dyspareunia, dyschezia all P < 0.001 both cohorts, respectively). The overall life birth rate and postsurgical pregnancy in infertile patients undergoing NVSSR and FTDR was respectively 58.1% in 25/43 patients; 55.6% in 5/9 patients; 56.0% in 14/25 patients and 100% in 5/5 patients. CONCLUSIONS NVSSR and FTDR for symptomatic colorectal DE confer a significant amelioration of GI function reflected by decreased LARS symptoms and increased GIQLI scores with no differences in postsurgical function in between the two techniques. Both techniques confer similar complication rates and effects on pain reduction and health profiles.
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Affiliation(s)
- Gernot Hudelist
- Department of Gynecology, Center for EndometriosisHospital St. John of GodViennaAustria
- Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Daria Pashkunova
- Department of Gynecology, Center for EndometriosisHospital St. John of GodViennaAustria
| | - Ezgi Darici
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis BrusselVrije Universiteit BrusselBrusselsBelgium
| | - Anna Rath
- Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Johanna Mitrowitz
- Department of Gynecology, Center for EndometriosisHospital St. John of GodViennaAustria
| | - Bernhard Dauser
- Department of General Surgery, Center for EndometriosisHospital St. John of GodViennaAustria
| | - Birgit Senft
- Statistix Statistical Calculations CompanyKlagenfurtAustria
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Center for EndometriosisSemmelweis University BudapestBudapestHungary
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19
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Misiak M, Dworak M, Wyszomirska M, Kurt M, Walędziak M, Różańska-Walędziak A. Gynecological Fistulae-Has Anything Changed in the Diagnosis and Treatment over the Last Decade? A Narrative Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1455. [PMID: 37629745 PMCID: PMC10456619 DOI: 10.3390/medicina59081455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/21/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
Gynecological fistulae are a rare but severe complication of radiation therapy, pelvic surgery, prolonged labor, cesarean deliveries, or inflammatory bowel diseases. A gynecological fistula is an abnormal pathway formed between the urinary and gynecological tract, most commonly located between the urinary bladder and vagina. Vesico-uterine and vesicovaginal fistulae are an important health issue, common in women of reproductive age in developing countries with limited access to obstetrical care. Various surgical techniques have been described for VVF repair, depending on the location, severity, and cause of the fistula and the surgeon's experience. The purpose of our review was to evaluate the present state of knowledge about the prevalence and treatment of gynecological fistulae. The PubMed scientific database was searched for original articles on the subject of gynecological fistulae that had been published between 2013 and 2023.
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Affiliation(s)
- Marek Misiak
- Interdisciplinary Students Association of Metabolic and Systemic Disease “Salus Aegroti” Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warszawa, Poland; (M.M.); (M.D.); (M.W.); (M.K.)
| | - Michalina Dworak
- Interdisciplinary Students Association of Metabolic and Systemic Disease “Salus Aegroti” Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warszawa, Poland; (M.M.); (M.D.); (M.W.); (M.K.)
| | - Małgorzata Wyszomirska
- Interdisciplinary Students Association of Metabolic and Systemic Disease “Salus Aegroti” Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warszawa, Poland; (M.M.); (M.D.); (M.W.); (M.K.)
| | - Maria Kurt
- Interdisciplinary Students Association of Metabolic and Systemic Disease “Salus Aegroti” Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warszawa, Poland; (M.M.); (M.D.); (M.W.); (M.K.)
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warszawa, Poland;
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20
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Yunker AC. Surgical Excision of Invasive Bowel Endometriosis: Can We Get Any Better? J Minim Invasive Gynecol 2023; 30:599-600. [PMID: 37330136 DOI: 10.1016/j.jmig.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Amanda Cofer Yunker
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, Nashville, Tennessee, United States.
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21
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Ceccaroni M, Ceccarello M, Raimondo I, Roviglione G, Clarizia R, Bruni F, Mautone D, Manzone M, Facci E, Rettore L, Rossini R, Bertocchi E, Barugola G, Ruffo G, Barra F. "A Space Odyssey" on Laparoscopic Segmental Rectosigmoid Resection for Deep Endometriosis: A Seventeen-year Retrospective Analysis of Outcomes and Postoperative Complications among 3050 Patients Treated in a Referral Center. J Minim Invasive Gynecol 2023; 30:652-664. [PMID: 37116746 DOI: 10.1016/j.jmig.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 04/30/2023]
Abstract
STUDY OBJECTIVE To evaluate the feasibility of laparoscopic rectosigmoid resection for bowel endometriosis (RSE), reporting surgical and short-term postoperative outcomes in a consecutive large series of patients. DESIGN A retrospective cohort study. SETTING Third-level national referral center for deep endometriosis (DE). PATIENTS 3050 patients with symptomatic RSE requiring surgical treatment. INTERVENTIONS Nerve-sparing laparoscopic resection for RSE perfomed by a multidisciplinary team. After collecting intraoperative surgical characteristics, postoperative complications were collected by evaluating the risk factors associated with their onset. MEASUREMENTS AND MAIN RESULTS Clavien-Dindo IIIb postoperative complications were noted in 13.1% of patients, with anastomotic leakage and rectovaginal fistula accounting for 3.0% and 1.9%, respectively. Postoperative bladder impairment was observed in 13.9% of patients during hospital discharge but spontaneously decreased to 4.5% at the first evaluation after 30 days, alongside a statistically significant change towards global symptom improvement. Multivariate analyses were done to identify the risk factors for segmental bowel resection in terms of occurrence of postoperative major complications. Ultralow (≤5 cm from the anal verge), low rectal anastomosis (<8 cm, >5 cm), parametrectomy, vaginal resection, and previous surgeries seemed more related to anastomotic leakage, rectovaginal fistula, and bladder retention. CONCLUSIONS Laparoscopic rectosigmoid resection for RSE seems an effective and feasible procedure. The surgical complication rate is not negligible but could be reduced by implementing a multidisciplinary approach, an endless improvement in nerve-sparing techniques and surgical anatomy, as well as technological enhancements. Real future challenges will be to reduce the time for the first diagnosis of DE and the likelihood of surgical indications.
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Affiliation(s)
- Marcello Ceccaroni
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Matteo Ceccarello
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ivano Raimondo
- Gynecology and Breast Care Center (Dr. Raimondo), Mater Olbia Hospital, Olbia, Italy; School in Biomedical Sciences (Dr. Raimondo), University of Sassari, Sassari, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Francesco Bruni
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Daniele Mautone
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Maria Manzone
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Enrico Facci
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Lorenzo Rettore
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Roberto Rossini
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elisa Bertocchi
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giuliano Barugola
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giacomo Ruffo
- Department of General Surgery (Drs. Facci, Rettore, Rossini, Bertocchi, Barugola, and Ruffo), IRCSS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Fabio Barra
- Department of Obstetrics and Gynecology (Drs. Ceccaroni, Ceccarello, Roviglione, Clarizia, Bruni, Mautone, Manzone, and Barra), Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy; Department of Health Sciences (DISSAL) (Dr. Barra), University of Genoa, Genoa, Italy
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22
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Xu T, Qiu B, Xu Q, Qu J, Zhuang D, Xu Q. Case study of colorectal endometriosis treated with endoscopic submucosal excavation. Front Physiol 2023; 14:1073241. [PMID: 37275230 PMCID: PMC10233404 DOI: 10.3389/fphys.2023.1073241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/17/2023] [Indexed: 06/07/2023] Open
Abstract
Colorectal endometriosis (CEM) is a rare and complicated form of deep invasive endometriosis. Its treatment methods include drug therapy and surgery. However, it is often difficult to alleviate symptoms and address problems, such as infertility, using drug treatment alone. Surgical intervention provides a histologic diagnosis, allows assessment of pelvic cysts or masses with features concerning for malignancy, and reduces pain by destroying the endometriotic implants. We consider surgery in women with the following: Persistent pain despite medical therapy; Contraindications to or refusal of medical therapy; Need for a tissue diagnosis of endometriosis; Exclusion of malignancy in an adnexal mass; Obstruction of the bowel or urinary tract. But there is no consensus about the surgical methods. With the rapid development of gastroenteroscopy technology in recent years, many local gastrointestinal tumors that previously required surgical resection can now be removed by endoscopic surgery. Herein, we report one case of CEM treated by endoscopic submucosal excavation (ESE) to provide a new treatment option for the radical resection of single CEM.
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23
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Thomassin-Naggara I, Monroc M, Chauveau B, Fauconnier A, Verpillat P, Dabi Y, Gavrel M, Bolze PA, Darai E, Touboul C, Lamrabet S, Collinet P, Zareski E, Bourdel N, Roman H, Rousset P. Multicenter External Validation of the Deep Pelvic Endometriosis Index Magnetic Resonance Imaging Score. JAMA Netw Open 2023; 6:e2311686. [PMID: 37140921 PMCID: PMC10160872 DOI: 10.1001/jamanetworkopen.2023.11686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/18/2023] [Indexed: 05/05/2023] Open
Abstract
Importance Preoperative mapping of deep pelvic endometriosis (DPE) is crucial as surgery can be complex and the quality of preoperative information is key. Objective To evaluate the Deep Pelvic Endometriosis Index (dPEI) magnetic resonance imaging (MRI) score in a multicenter cohort. Design, Setting, and Participants In this cohort study, the surgical databases of 7 French referral centers were retrospectively queried for women who underwent surgery and preoperative MRI for DPE between January 1, 2019, and December 31, 2020. Data were analyzed in October 2022. Intervention Magnetic resonance imaging scans were reviewed using a dedicated lexicon and classified according to the dPEI score. Main outcomes and measures Operating time, hospital stay, Clavien-Dindo-graded postoperative complications, and presence of de novo voiding dysfunction. Results The final cohort consisted of 605 women (mean age, 33.3; 95% CI, 32.7-33.8 years). A mild dPEI score was reported in 61.2% (370) of the women, moderate in 25.8% (156), and severe in 13.1% (79). Central endometriosis was described in 93.2% (564) of the women and lateral endometriosis in 31.2% (189). Lateral endometriosis was more frequent in severe (98.7%) vs moderate (48.7%) disease and in moderate vs mild (6.7%) disease according to the dPEI (P < .001). Median operating time (211 minutes) and hospital stay (6 days) were longer in severe DPE than in moderate DPE (operating time, 150 minutes; hospital stay 4 days; P < .001), and in moderate than in mild DPE (operating time; 110 minutes; hospital stay, 3 days; P < .001). Patients with severe disease were 3.6 times more likely to experience severe complications than patients with mild or moderate disease (odds ratio [OR], 3.6; 95% CI, 1.4-8.9; P = .004). They were also more likely to experience postoperative voiding dysfunction (OR, 3.5; 95% CI, 1.6-7.6; P = .001). Interobserver agreement between senior and junior readers was good (κ = 0.76; 95% CI, 0.65-0.86). Conclusions and Relevance The findings of this study suggest the ability of the dPEI to predict operating time, hospital stay, postoperative complications, and de novo postoperative voiding dysfunction in a multicenter cohort. The dPEI may help clinicians to better anticipate the extent of DPE and improve clinical management and patient counseling.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Department of Radiology, Assistance Publique Hôpitaux de Paris–Hôpital Tenon, Paris, France
- Service Imageries Radiologiques et Interventionnelles Spécialisées Sorbonne Université, Paris, France
| | - Michele Monroc
- Department of Radiology, Clinique Saint-Antoine, Bois-Guillaume, France
| | - Benoit Chauveau
- Radiology Department, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Université Paris-Saclay, UVSQ, Unité de recherche 7285 Risques cliniques et sécurité en santé des femmes et en santé périnatale, Montigny-le-Bretonneux, France
- Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Gynecologie et Obstétrique, Poissy CEDEX, France
| | | | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Assistance Publique Hôpitaux de Paris–Sorbonne Université, Hôpital Tenon, Paris, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Pierre-Adrien Bolze
- Department of Gynecological and Oncological Surgery, Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738 CICLY, Pierre Bénite, France
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Assistance Publique Hôpitaux de Paris–Sorbonne Université, Hôpital Tenon, Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Assistance Publique Hôpitaux de Paris–Sorbonne Université, Hôpital Tenon, Paris, France
| | - Samia Lamrabet
- Department of radiology. Centre Hospitalier intercommunal de Creteil
| | - Pierre Collinet
- Hôpital privé Le Bois, Ramsay Lille métropole, Lille, France
| | - Elise Zareski
- Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Radiologie, Poissy CEDEX, France
| | - Nicolas Bourdel
- Gynecology Department, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Horace Roman
- IFEMEndo, Clinique Tivoli-Ducos, Bordeaux, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
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24
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O'Brien L, Morarasu S, Morarasu BC, Neary PC, Musina AM, Velenciuc N, Roata CE, Dimofte MG, Lunca S, Raimondo D, Seracchioli R, Casadio P, Clancy C. Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes. Int J Colorectal Dis 2023; 38:55. [PMID: 36847868 DOI: 10.1007/s00384-023-04352-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection. METHODS The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes. RESULTS Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable. CONCLUSION Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.
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Affiliation(s)
- Luke O'Brien
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Stefan Morarasu
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland. .,2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania. .,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania.
| | | | - Paul C Neary
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Mihail Gabriel Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
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25
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Roman H, Dennis T, Forestier D, François MO, Assenat V, Tuech JJ, Hennetier C, Merlot B. Disk Excision Using End-to-End Anastomosis Circular Stapler for Deep Endometriosis of the Rectum: A 492-Patient Continuous Prospective Series. J Minim Invasive Gynecol 2023; 30:122-130. [PMID: 36334913 DOI: 10.1016/j.jmig.2022.10.009] [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: 10/05/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To report a large series including women managed by disk excision using end-to-end anastomosis (EEA) circular transanal stapler to assess the feasibility of the technique, the features of nodules suitable for removal by disk excision, and the rate of major early complications. DESIGN Retrospective study on data prospectively recorded in 2 databases. SETTING Two tertiary referral centers. PATIENTS A total of 492 patients undergoing surgery for rectal endometriosis from May 2011 to June 2022. INTERVENTIONS Rectal disk excision using the EEA stapler. MEASUREMENT AND MAIN RESULTS Disk excision using EEA was performed in 492 patients (24.2%) of 2,029 women receiving surgery for deep endometriosis infiltrating the rectum during the 11-year study period. Deep endometriosis involved low rectum in 11% and mid rectum in 55.3%. The diameter of rectal nodules exceeded 3 cm in 65.9%. Mean operative time was 2 hours, mean diameter of rectal patches removed was 41 ± 11 mm, and the mean rectal suture height was 9.2 ± 5.5 cm. The presence of microscopic foci on the edges of rectal patches was identified in 30.2% of cases. Rectal fistula was recorded in 20 patients (4%). The distance from the anal verge was significantly lower in patients with fistula than women with no fistula (5.9 ± 2 cm vs 9.2 ± 5.6 cm, p = .027). Follow-up ranged from 1 to 120 months, with a median value of 36 months. Magnetic resonance imaging in 3 patients during follow-up revealed a recurrent nodule infiltrating the previous stapled line (0.6%) after a postoperative delay of, respectively, 36, 48, and 84 months. CONCLUSION Disk excision using the EEA stapler is suitable in nodules >3 cm if surgeons ensure deep shaving of the rectum, to allow complete inclusion of the shaved area into the stapler jaws. Postoperative rectal recurrences seem incidental, whereas bowel leakage rate is comparable with that after colorectal resection. This technique is suitable in almost a quarter of patients managed for rectal endometriosis nodules and is therefore a valuable technique that warrants more widespread use.
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Affiliation(s)
- Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot); Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark (Dr. Roman, Dr. Tuech, Dr. Hennetier).
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Damien Forestier
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Marc Olivier François
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Vincent Assenat
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Jean Jacques Tuech
- Department of Surgery, Rouen University Hospital, Rouen, France (Dr. Tuech)
| | - Clotilde Hennetier
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Dr. Hennetier)
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
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Frumkin N, Schmädecker R, Isermann R, Keckstein J, Ulrich UA. Surgical Treatment of Deep Endometriosis. Geburtshilfe Frauenheilkd 2023; 83:79-87. [PMID: 36643873 PMCID: PMC9833890 DOI: 10.1055/a-1799-2658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023] Open
Abstract
In deep endometriosis (DE), clusters of endometrium-like cells penetrate more than 5 mm below the peritoneum: The affected organs and tissue structures can eventuate in an alteration of the anatomy with eliminated organ boundaries, which in some cases can pose a real surgical challenge, even for experienced surgeons. A comprehensive description of the different manifestations of the disease can be found in the #Enzian classification. Since the operation is usually the foundation for the successful treatment of DE, what is important are conclusive indications, appropriate preoperative preparation and, above all, appropriate experience on the part of the surgical team. This article aims to provide a review of the surgical options that are currently available.
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Affiliation(s)
- Nora Frumkin
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Rasmus Schmädecker
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Ricarda Isermann
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany
| | - Jörg Keckstein
- Endometriosezentrum Ordination Dres. Keckstein, Villach, Austria
| | - Uwe Andreas Ulrich
- 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther Krankenhaus, Johannesstift Diakonie, Berlin, Germany,Korrespondenzadresse Prof. Dr. Uwe Andreas Ulrich 303449Klinik für Gynäkologie und Geburtshilfe, Endometriosezentrum, Martin Luther
Krankenhaus, Johannesstift DiakonieCaspar-Theyß-Str. 27–3114193
BerlinGermany
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Kathopoulis N, Vlachos DE, Kypriotis K, Diakosavvas M, Chatzipapas I, Protopapas A. Laparoscopic Discoid Excision of Bowel Endometriosis Using Sutures for Closure. J Minim Invasive Gynecol 2023; 30:11-12. [PMID: 36403694 DOI: 10.1016/j.jmig.2022.11.007] [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: 07/25/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device. DESIGN Stepwise demonstration of the technique with narrated video footage. SETTING Bowel endometriosis is a common pattern of deep endometriosis [1]. Discoid excision is 1 of the 3 surgical interventions applied to manage this pathologic entity, with shaving and segmental resection being the other 2 [2]. When discoid excision is performed, a transanal stapler device is used for bowel closure in most cases [3,4]. Only a few studies so far have reported the application of sutures for this purpose [5]. This video highlights the technique of bowel suturing after discoid excision. INTERVENTIONS This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect (Supplemental Video 1). The key surgical steps are as follows: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve. 3. Detachment of the nodule from the cervix. 4. Detachment of the nodule from the bowel, beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using 2 layers of Vicryl 3-0 sutures, the first being interrupted and the second continuous. CONCLUSION The described technique of bowel closure using sutures may be a safe and effective alternative to the transanal stapler. Its advantage is that it can be performed when the pathology is located higher than 15 cm from the anal verge or the diameter of the nodule is more than 30 mm.
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Affiliation(s)
- Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors).
| | - Dimitrios-Efthimios Vlachos
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
| | - Athanasios Protopapas
- 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece (all authors)
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Weyl A, Sevy V, Lepage B, Vidal F, Kirzin S, Legac YT, Lesourd F, Gosset A, Capdet J, Leguevaque P, Bournet B, Lenfant F, Brierre T, Gornes H, Buscail E, Chantalat E. Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis. Arch Gynecol Obstet 2022; 307:1459-1468. [PMID: 36581714 DOI: 10.1007/s00404-022-06899-1] [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: 09/26/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the quality of care following the establishment of a multidisciplinary care pathway for patient operated on for deep pelvic endometriosis with digestive impairment. METHODS We conducted a retrospective monocentric study of patients suffering from deep infiltrating endometriosis, treated in Gynaecological Department at Toulouse University Hospital from January 2018 to December 2020. We compared our results to those of our previous study, Gornes et al. which showed a postoperative complication occurred in 37.8% of the cases and a postoperative severe complication according to the Clavien-Dindo classification (grades 3b) rate of 18.3%. RESULTS 98 patients were included. Our study shows a clear decrease in postoperative complications with an overall complication rate of 19.4% and severe complications (grades 3b) of 4.1%. The rate of complication appeared to be significantly less frequent in the case of shaving in relation to other digestive procedures (p = 0.008) and in the case of a lesion of < 20 mm by MRI (p = 0.01). The use of multidisciplinary surgical care was more frequent in the case of multiple locations (66.7% vs. 41.8%, p = 0.07) and was more frequent in the case of transmural damage with echo endoscopy (and to a lesser degree in the case of damage of the muscularis or mucous membrane) (p = 0.05). CONCLUSIONS Multidisciplinary care of endometriosis with digestive damage appears to be indispensable. The intraoperative intervention of a skilled digestive surgeon of bowel endometriosis helps create the best balance between effectiveness-complications-functional prognosis, with a reduction of severe postoperative complications.
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Affiliation(s)
- Ariane Weyl
- Department of Gynecologic Surgery, University Hospital Center, Toulouse, France.,I2MC, National Institute of Health and Medical Research (INSERM) U1297, University of Toulouse 3 and Toulouse University Hospital, Toulouse, France
| | - Virginie Sevy
- Department of Gynecologic Surgery, Hospital Center, Montauban, France
| | - Benoît Lepage
- Department of Epidemiology, University Hospital Center, Toulouse, France
| | - Fabien Vidal
- Department of Gynecologic Surgery, La Croix du Sud Hopital, Quint Fonsegrives, France
| | - Sylvain Kirzin
- Department of Digestive Surgery, La Croix du Sud Hopital, Quint Fonsegrives, France
| | - Yann Tanguy Legac
- Department of Gynecologic Surgery, University Hospital Center, Toulouse, France
| | - Florence Lesourd
- Department of Medical Gynecology, University Hospital Center, Toulouse, France
| | - Anna Gosset
- Department of Medical Gynecology, University Hospital Center, Toulouse, France
| | - Jérome Capdet
- Department of Gynecologic Surgery, Rive Gauche Hospital, Toulouse, France
| | - Pierre Leguevaque
- Department of Gynecologic Surgery, Pasteur Hospital, Toulouse, France
| | - Barbara Bournet
- Department of Gastroenterology, University Hospital Center, Toulouse, France
| | - Françoise Lenfant
- I2MC, National Institute of Health and Medical Research (INSERM) U1297, University of Toulouse 3 and Toulouse University Hospital, Toulouse, France
| | - Thibaut Brierre
- Department of Urology, University Hospital Center, Toulouse, France
| | - Hugo Gornes
- Department of Gynecologic Surgery, Occitanie Hospital, Toulouse, France
| | - Etienne Buscail
- Department of Digestive Surgery, University Hospital Center, Toulouse, France
| | - Elodie Chantalat
- Department of Gynecologic Surgery, University Hospital Center, Toulouse, France. .,I2MC, National Institute of Health and Medical Research (INSERM) U1297, University of Toulouse 3 and Toulouse University Hospital, Toulouse, France.
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Di Buono G, Micheli M, Russo G, Vella R, Amato G, Geraci G, Agrusa A. Colorectal infiltrating deep endometriosis: Laparoscopic treatment. A case report. Front Surg 2022; 9:1021944. [PMID: 36406353 PMCID: PMC9669275 DOI: 10.3389/fsurg.2022.1021944] [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: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 08/29/2023] Open
Abstract
Endometriosis is a disease affecting approximately 10% of women of fertile age. A particular presentation is deep infiltrating endometriosis of the rectosigmoid colon with symptoms that can mimic an intestinal obstruction or neoplasm. We report the case of a 39-year-old woman with pelvic pain during the menstrual cycle and significant anemia who presented an ectopic endometrial tissue in correspondence of the rectum. Because of the thickness of the lesion the patient underwent a segmental laparoscopic colorectal resection with end-to-end anastomosis.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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Legendri S, Carbonnel M, Feki A, Moawad G, Aubry G, Vallée A, Ayoubi JM. Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis. J Clin Med 2022; 11:jcm11206132. [PMID: 36294462 PMCID: PMC9605320 DOI: 10.3390/jcm11206132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022] Open
Abstract
This study addressed the improvement in the quality of life of patients 2 years after minimally invasive surgery for painful deep infiltrating endometriosis (DIE), evaluated with EHP-5 (Endometriosis Health Profile-5) scores and the intensity of dysmenorrhea and dyspareunia. This was a retrospective study, performed in a referral centre for endometriosis, between January 2010 and January 2019. EHP-5 scores were complete for 54 patients, and two subgroups were analysed: classic laparoscopy (CL) vs. robotic laparoscopy (RL), and conservative surgery (ConservS) vs. total surgery (TS). There was an important decrease in 2-year post-operative EHP-5 scores in the global population (pre-op: 61.36 (42.18−68.75) and 2-year post-op: 20.45 (0−38.06); p < 0.001). The Visual Analogic Scale (VAS) was also lower for dysmenorrhea (pre-op: 8 (7−9.75) vs. 2-year post-op: 3 (2−5.25); p < 0.001) and dyspareunia (pre-op: 6 (3.1−8.9) vs. 2-year post-op: 3 (0−6); p < 0.001). In the subgroup analysis, EHP-5 scores were improved in the RL group (pre-op: 65.9 (59.09−71.02) vs. 2-year post-op: 11.4 (0−38.06); p < 0.001) and the CL group (pre-op: 50 (34.65−68.18) vs. 2-year post-op: 27.27 (14.20−40.90); p < 0.001), with a slight advantage for RL (p = 0.04), and the same improvements were found for ConservS (pre-op: 61.4 (38.06−71.59) vs. 2-year post-op: 22.7 (11.93−38.07); p < 0.001) and TS groups (pre-op: 61.59 (51.70−68.75) vs. 2-year post-op: 13.63 (0−44.30); p < 0.001). Minimally invasive surgery improved the quality of life for DIE patients 2 years after surgery, and conservative surgery showed comparable results to total surgery.
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Affiliation(s)
- Sophie Legendri
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines, 55 Avenue de Paris, 78000 Versailles, France
| | - Marie Carbonnel
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines, 55 Avenue de Paris, 78000 Versailles, France
- Correspondence:
| | - Anis Feki
- Department of Obstetrics and Gynecology, Cantonal Hospital Fribourg, 1702 Fribourg, Switzerland
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC 20037, USA
| | - Gabrielle Aubry
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
| | - Jean-Marc Ayoubi
- Department of Obstetrics and Gynecology, Foch Hospital, 40 Rue Worth, 92150 Suresnes, France
- Medical School, University of Versailles, Saint-Quentin-en-Yvelines, 55 Avenue de Paris, 78000 Versailles, France
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Alborzi S, Roman H, Askary E, Poordast T, Shahraki MH, Alborzi S, Hesam Abadi AK, Najar Kolaii EH. Colorectal endometriosis: Diagnosis, surgical strategies and post-operative complications. Front Surg 2022; 9:978326. [PMID: 36268216 PMCID: PMC9577108 DOI: 10.3389/fsurg.2022.978326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The present work aimed to investigate the feasibility, complications, recurrence rate, and infertility outcomes of the radical and conservative surgical methods for colorectal endometriosis in short- and long-term follow-ups. Methods In this prospective study, the patients with confirmed diagnosis of colorectal DIE were included from March 2015 to March 2021, who were referred to an Endometriosis Surgery Center affiliated with Shiraz University of Medical Sciences (SUMS). Information on demographics, surgical approaches, intra-operative, and post-operative findings as well as complications were collected and compared. Six- and 12-month interviews were conducted to evaluate the functional outcomes of all the procedures. Results Out of 3,111 patients who underwent endometriosis surgery, 837 (28.19%) with the average age of 34.2 ± 5.9 years and average ASRM score of 102.1 ± 36.8 had rectosigmoid endometriosis. Laparoscopic rectal shaving was performed in 263(30.0%) patients while 326 (37.2%) underwent segmental bowel resection, and 248 (28.30%) were treated with disc excision. Prophylactic ileostomy was performed in six (0.68%) patients and peritonitis was reported in four (0.45%). Five (0.58%) subjects developed rectovaginal fistula and one (0.11%) was diagnosed with bladder atonia. The recurrence rate was 3.8%, 1.2%, and 0.3% in rectal shaving, disc, and segmental bowel resection techniques, respectively. Dysmenorrhea, dyspareunia, and dyschezia were improved after surgery by 7.3, 9.4, and 12.5 times, respectively. We observed 25.2% of total pregnancy following the operation, the majority of which occurred in the first year after the surgery. Conclusion There were very few short-term or long-term complications in the three different techniques when the choice was correct.
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Affiliation(s)
- Saeed Alborzi
- Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Horace Roman
- Department of Gynecology and Obstetrics, Clinique Gynécologique et Obstétrical, Rouen University Hospital, Rouen, France
| | - Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Elham Askary
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Soroush Alborzi
- Cardiologist, Student Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alimohammad Keshtvarz Hesam Abadi
- Master of Biostatistics in Clinical Research Development Center of Nemazee Hospital, Department of Statistics, Shiraz University of Medical Sciences, Shiraz, Iran
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Alcázar JL, Eguez PM, Forcada P, Ternero E, Martínez C, Pascual MÁ, Guerriero S. Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:477-486. [PMID: 35289968 PMCID: PMC9825886 DOI: 10.1002/uog.24900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis, using laparoscopy as the reference standard. METHODS A search for studies evaluating the role of the sliding sign in the assessment of pouch of Douglas obliteration and/or bowel involvement using laparoscopy as the reference standard published from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, The Cochrane Library, ClinicalTrials.gov and SCOPUS databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the studies. Analyses were performed using MIDAS and METANDI commands in STATA. RESULTS A total of 334 citations were identified. Eight studies were included in the analysis, resulting in 938 and 963 patients available for analysis of the diagnostic accuracy of the sliding sign for pouch of Douglas obliteration and bowel involvement, respectively. The mean prevalence of pouch of Douglas obliteration was 37% and the mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting pouch of Douglas obliteration were 88% (95% CI, 81-93%), 94% (95% CI, 91-96%), 15.3 (95% CI, 10.2-22.9), 0.12 (95% CI, 0.07-0.21) and 123 (95% CI, 62-244), respectively. The heterogeneity was moderate for sensitivity and low for specificity for detecting pouch of Douglas obliteration. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting bowel involvement were 81% (95% CI, 64-91%), 95% (95% CI, 91-97%), 16.0 (95% CI, 9.0-28.6), 0.20 (95% CI, 0.10-0.40) and 81 (95% CI, 34-191), respectively. The heterogeneity for the meta-analysis of diagnostic accuracy for bowel involvement was high. CONCLUSION The sliding sign on TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J. L. Alcázar
- Department of Obstetrics and GynecologyClínica Universidad de NavarraPamplonaSpain
| | - P. M. Eguez
- Department of Obstetrics and GynecologyUniversity HospitalBadajozSpain
| | - P. Forcada
- Department of Obstetrics and GynecologyUniversity HospitalCastellónSpain
| | - E. Ternero
- Department of Obstetrics and GynecologyPuerta de Mar University HospitalCadizSpain
| | - C. Martínez
- Department of Obstetrics and GynecologyLa Fe University HospitalValenciaSpain
| | - M. Á. Pascual
- Department of Obstetrics, Gynecology, and ReproductionHospital Universitari DexeusBarcelonaSpain
| | - S. Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita e Diagnostica Ostetrico–GinecologicaAzienda Ospedaliero Universitaria–Policlinico Duilio Casula MonserratoMonserratoItaly
- Department of Obstetrics and GynecologyUniversity of CagliariCagliariItaly
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Pascoal E, Wessels JM, Aas-Eng MK, Abrao MS, Condous G, Jurkovic D, Espada M, Exacoustos C, Ferrero S, Guerriero S, Hudelist G, Malzoni M, Reid S, Tang S, Tomassetti C, Singh SS, Van den Bosch T, Leonardi M. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:309-327. [PMID: 35229963 DOI: 10.1002/uog.24892] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Pascoal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J M Wessels
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- AIMA Laboratories Inc., Hamilton, Canada
| | - M K Aas-Eng
- Department of Gynecology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M S Abrao
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - D Jurkovic
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Espada
- Department of Obstetrics and Gynaecology, Blue Mountains ANZAC Memorial Hospital, Katoomba, Australia
- Sydney Medical School, Sydney, Australia
| | - C Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Cagliari, Italy
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, St John of God Hospital, Vienna, Austria
- Scientific Endometriosis Foundation (SEF), Westerstede, Germany
| | - M Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - S Reid
- Department of Obstetrics and Gynaecology, Western Sydney University, Sydney, Australia
| | - S Tang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - S S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - M Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Sydney Medical School, Sydney, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Hudelist G, Korell M, Burkhardt M, Chvatal R, Darici E, Dimitrova D, Drahonovsky J, Haj Hamoud B, Hornung D, Krämer B, Noe G, Oppelt P, Schäfer S, Seeber B, Ulrich UA, Wenzl R, De Wilde RL, Wimberger P, Senft B, Keckstein J, Montanari E, Vaineau C, Sillem M. Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis-a retrospective multicenter observational study. Acta Obstet Gynecol Scand 2022; 101:1057-1064. [PMID: 35818905 PMCID: PMC9812092 DOI: 10.1111/aogs.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries. MATERIAL AND METHODS This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared. RESULTS The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups. CONCLUSIONS A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.
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Affiliation(s)
- Gernot Hudelist
- Department of Gynecology, Center for EndometriosisHospital St. John of God; Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Matthias Korell
- Department of Obstetrics and GynecologyJohanna‐Etienne‐HospitalNeussGermany
| | - Michael Burkhardt
- Department of Obstetrics and GynecologyMedius Klinik OstfildernOstfildernGermany
| | - Radek Chvatal
- Department of Obstetrics and GynecologyZnojmo District HospitalZnojmoCzech Republic
| | - Ezgi Darici
- Brussels IVF, Center for Reproductive Medicine Universitair Ziekenhuis BrusselVrije Universiteit BrusselBrusselsBelgium
| | - Desislava Dimitrova
- Department of Obstetrics and Gynecology with Center for Oncological SurgeryCharité – Universitätsmedizin, Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Jan Drahonovsky
- Department of Obstetrics and Department of GynecologyUniversity of PraguePragueCzech Republic
| | - Bashar Haj Hamoud
- Department of Obstetrics and GynecologyUniversity SaarlandHomburgGermany
| | - Daniela Hornung
- Department of Obstetrics and GynecologyVidiakliniken, Diakonissen Hospital KarlsruheKarlsruheGermany
| | - Bernhard Krämer
- Department of Obstetrics and Department of GynecologyUniversity of TübingenTübingenGermany
| | - Guenter Noe
- Department of Obstetrics and Department of GynecologyRhineland ClinicDormagenGermany
| | - Peter Oppelt
- Department of Gynecology and ObstetricsKepler Medical University of LinzLinzAustria
| | | | - Beata Seeber
- Department of Gynecologic Endocrinology and Reproductive MedicineMedical University of InnsbruckInnsbruckAustria
| | - Uwe Andreas Ulrich
- Department of Obstetrics and GynecologyMartin Luther Hospital BerlinBerlinGermany
| | - Rene Wenzl
- Department of Gynecology and ObstericsMedical University of ViennaViennaAustria
| | - Rudy Leon De Wilde
- Department of Gynecology and ObstetricsPius Hospital, Universitätsmedizin Oldenburg, Carl von Ossietzky University of OldenburgOldenburgGermany
| | - Pauline Wimberger
- Department of Obstetrics and GynecologyTechnical University DresdenDresdenGermany
| | | | | | - Eliana Montanari
- Department of Gynecology, Center for EndometriosisHospital St. John of God; Rudolfinerhaus Private Clinic and CampusViennaAustria
| | - Cloe Vaineau
- Department of Gynecology and ObstericsMedical University of Bern, InselspitalBernSwitzerland
| | - Martin Sillem
- Department of Obstetrics and GynecologyUniversity SaarlandHomburgGermany,Praxisklinik am RosengartenMannheimGermany
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Darici E, Denkmayr D, Pashkunova D, Dauser B, Birsan T, Hudelist G. Long-term surgical outcomes of nerve-sparing discoid and segmental resection for deep endometriosis. Acta Obstet Gynecol Scand 2022; 101:972-977. [PMID: 35822249 DOI: 10.1111/aogs.14411] [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: 03/06/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate long-term outcomes in terms of pain, quality of life (QoL), and gastrointestinal symptoms in women following colorectal surgery for deep endometriosis. MATERIAL AND METHODS In this historical cohort, women who underwent surgical treatment for deep endometriosis by either nerve-sparing full-thickness discoid resection (DR) or colorectal segmental resection (SR) between March 2011 and August 2016 were re-evaluated through telephone interviews about their long-term pain symptoms, subjective overall QoL as rated using a score from 0 (worst) to 10 (optimal), and gastrointestinal outcomes reflected by lower anterior resection syndrome (LARS) following a first postsurgical evaluation (visit 1) published previously and a long-term follow-up evaluation (visit 2). RESULTS The median long-term follow-up time was 35.4 months at visit 1 and 86 months at visit 2. Of 134 patients, 77 were eligible for final analysis and 57 were lost to follow-up. Compared with presurgical values, QoL scores were significantly increased at both postsurgical evaluation visits in both the SR cohort (scores of 3, 8.5, and 10 at the presurgical visit, visit 1, and visit 2, respectively; p < 0.001) and the DR cohort (scores of 3, 9, and 10, respectively; p < 0.001). Pain scores for dysmenorrhea (SR group scores of 8, 2, and 2, respectively; p < 0.001; DR group scores of 9, 2, and 1, respectively; p < 0.001), dyspareunia (SR group scores of 4, 0, and 0, respectively; p < 0.001; DR group scores of 5, 0, and 1, respectively; p = 0.003), and dyschezia (SR group scores of 8, 2, and 2, respectively; p < 0.001; DR group scores of 9, 2, and 1, respectively; p < 0.001) significantly decreased after surgery and remained stable in both cohorts over the follow-up period. Minor and major LARS, reflecting gastrointestinal function, was observed in 6.5% and 8.1% of the SR group and in 13.3% and 6.7% of the DR group, respectively, at visit 1 and in 3.2% and 3.2% of the SR group and 0% and 0% of the DR group, respectively, at visit 2, without significant differences between the SR and DR groups. CONCLUSIONS Colorectal surgery for deep endometriosis, either by DR or SR, provides stable and long-term pain relief with low rates of permanent gastrointestinal function impairment.
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Affiliation(s)
- Ezgi Darici
- Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria.,Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Zeynep Kâmil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.,European Endometriosis League, Unterhaching, Germany
| | - Denise Denkmayr
- Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
| | | | - Bernhard Dauser
- Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
| | - Tudor Birsan
- Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
| | - Gernot Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria.,European Endometriosis League, Unterhaching, Germany.,Rudolfinerhaus Private Clinic and Campus, Vienna, Austria
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Kristine Aas-Eng M, Keckstein J, Condous G, Abrão MS, Hudelist G. Deep endometriosis: can surgical complexity and associated risk factors be evaluated with transvaginal sonography and classification systems? Eur J Obstet Gynecol Reprod Biol 2022; 276:204-206. [DOI: 10.1016/j.ejogrb.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
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Darici E, Salama M, Bokor A, Oral E, Dauser B, Hudelist G. Different segmental resection techniques and postoperative complications in patients with colorectal endometriosis: A systematic review. Acta Obstet Gynecol Scand 2022; 101:705-718. [PMID: 35661342 DOI: 10.1111/aogs.14379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the available literature by conducting a systematic review to assess the possible effects of nerve-sparing segmental resection and conventional bowel resection on postoperative complications for the treatment of colorectal endometriosis. MATERIAL AND METHODS Pubmed, Clinical Trials.gov, Cochrane Library, and Web of Science were comprehensively searched from 1997 to 2021 in order to perform a systematic review. Studies including patients undergoing segmental resection for colorectal endometriosis including adequate follow-up, data on postoperative complications and postoperative sequelae were enrolled in this review. Selected articles were evaluated and divided in two groups: Nerve-sparing resection (NSR), and conventional segmental resection not otherwise specified (SRNOS). Within the NSRs, studies mentioning preservation of the rectal artery supply (artery and nerve-sparing SR - ANSR) and not reporting preservation of the artery supply (NSR not otherwise specified - NSRNOS) were further analyzed. PROSPERO ID CRD42021250974. RESULTS A total of 7549 patients from 63 studies were included in the data analysis. Forty-three of these publications did not mention the preservation or the removal of the hypogastric nerve plexus, or main rectal artery supply and were summarized as SRNOS. The remaining 22 studies were listed under the NSR group. The mean size of the resected deep endometriosis lesions and patients' body mass index were comparable between SRNOS and NSR. A mean of 3.6% (0-16.6) and 2.3% (0-10.5%) of rectovaginal fistula development was reported in patients who underwent SRNOS and NSR, respectively. Anastomotic leakage rates varied from 0% to 8.6% (mean 1.7 ± 2%) in SRNOS compared with 0% to 8% (mean 1.7 ± 2%) in patients undergoing NSR. Urinary retention (4.5% and 4.9%) and long-term bladder catheterization (4.9% and 5.6%) were frequently reported in SRNOS and NSR. There was insufficient information about pain or the recurrence rates for women undergoing SRNOS and NSR. CONCLUSIONS Current data describe the outcomes of different segmental resection techniques. However, the data are inhomogeneous and not sufficient to reach a conclusion regarding a possible advantage of one technique over the other.
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Affiliation(s)
- Ezgi Darici
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Zeynep Kâmil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.,European Endometriosis League, Bordeaux, France
| | - Mohamed Salama
- Department of Thoracic Surgery, Nord Hospital, Vienna, Austria
| | - Attila Bokor
- European Endometriosis League, Bordeaux, France.,Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Engin Oral
- European Endometriosis League, Bordeaux, France.,Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bernhard Dauser
- Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
| | - Gernot Hudelist
- European Endometriosis League, Bordeaux, France.,Center for Endometriosis, Department of Gynecology, Hospital St. John of God, Vienna, Austria
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Bocanegra-Ballesteros AF, Cuello-Salcedo AM, Villegas-Echeverri JD, López-Isano JD, López-Jaramillo JD. Resección intestinal discoide para el manejo de las pacientes con endometriosis intestinal profunda. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2022; 73:225-226. [PMID: 35939408 PMCID: PMC9395195 DOI: 10.18597/rcog.3912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li J, Li S, Wang Y, Shang A. Functional, morphological and molecular characteristics in a novel rat model of spinal sacral nerve injury-surgical approach, pathological process and clinical relevance. Sci Rep 2022; 12:10026. [PMID: 35705577 PMCID: PMC9200741 DOI: 10.1038/s41598-022-13254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/19/2022] [Indexed: 02/05/2023] Open
Abstract
Spinal sacral nerve injury represents one of the most serious conditions associated with many diseases such as sacral fracture, tethered cord syndrome and sacral canal tumor. Spinal sacral nerve injury could cause bladder denervation and detrusor underactivity. There is limited clinical experience resolving spinal sacral nerve injury associated detrusor underactivity patients, and thus the treatment options are also scarce. In this study, we established a spinal sacral nerve injury animal model for deeper understanding and further researching of this disease. Forty 8 w (week) old Sprague Dawley rats were included and equally divided into sham (n = 20) and crush group (n = 20). Bilateral spinal sacral nerves of rats were crushed in crush group, and sham group received same procedure without nerve crush. Comprehensive evaluations at three time points (1 w, 4 w and 6 w) were performed to comprehend the nature process of this disease. According to urodynamic test, ultrasonography and retrograde urography, we could demonstrate severe bladder dysfunction after spinal sacral nerve injury along the observation period compared with sham group. These functional changes were further reflected by histological examination (hematoxylin-eosin and Masson's trichrome staining) of microstructure of nerves and bladders. Immunostaining of nerve/bladder revealed schwann cell death, axon degeneration and collagen remodeling of bladder. Polymerase Chain Reaction results revealed vigorous nerve inflammation and bladder fibrosis 1 week after injury and inflammation/fibrosis returned to normal at 4 w. The CatWalk gait analysis was performed and there was no obvious difference between two groups. In conclusion, we established a reliable and reproducible model for spinal sacral nerve injury, this model provided an approach to evaluate the treatment strategies and to understand the pathological process of spinal sacral nerve injuries. It allowed us to understand how nerve degeneration and bladder fibrosis changed following spinal sacral nerve injury and how recovery could be facilitated by therapeutic options for further research.
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Affiliation(s)
- Junyang Li
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Neurosurgery, General Hospital of Chinese People Liberty Army, No. 28 Fuxing Road, Beijing, 100853 China
| | - Shiqiang Li
- The 80Th Group Army Hospital of Chinese People Liberty Army, Shandong, 261021 China
| | - Yu Wang
- grid.414252.40000 0004 1761 8894Institute of Orthopedics, 4th, Chinese People Liberty Army General Hospital, Beijing, China ,grid.260483.b0000 0000 9530 8833Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, 226007 People’s Republic of China
| | - Aijia Shang
- grid.216938.70000 0000 9878 7032The School of Medicine, Nankai University, Tianjin, 300071 China ,grid.414252.40000 0004 1761 8894Department of Neurosurgery, General Hospital of Chinese People Liberty Army, No. 28 Fuxing Road, Beijing, 100853 China ,grid.260483.b0000 0000 9530 8833Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, 226007 People’s Republic of China
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Ferrier C, Le Gac M, Kolanska K, Boudy A, Dabi Y, Touboul C, Bendifallah S, Daraï E. Comparison of robot‐assisted and conventional laparoscopy for colorectal surgery for endometriosis: A prospective cohort study. Int J Med Robot 2022; 18:e2382. [DOI: 10.1002/rcs.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Clément Ferrier
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
| | - Marjolaine Le Gac
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
| | - Kamila Kolanska
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
| | - Anne‐Sophie Boudy
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
| | - Yohan Dabi
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
| | - Cyril Touboul
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
- Groupe de Recherche Clinique en endometriose (GRC‐6 Sorbonne University) Centre Expert En Endometriose (C3E) Paris France
| | - Sofiane Bendifallah
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
- Groupe de Recherche Clinique en endometriose (GRC‐6 Sorbonne University) Centre Expert En Endometriose (C3E) Paris France
| | - Emile Daraï
- Department of Gynecology‐Obstetrics and Medicine of Reproduction Hôpital Tenon, Sorbonne University, Assistance Publique des Hôpitaux de Paris Paris France
- UMRS‐938 Sorbonne University Paris France
- Groupe de Recherche Clinique en endometriose (GRC‐6 Sorbonne University) Centre Expert En Endometriose (C3E) Paris France
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Montanari E, Bokor A, Szabó G, Kondo W, Trippia CH, Malzoni M, Di Giovanni A, Tinneberg HR, Oberstein A, Rocha RM, Leonardi M, Condous G, Alsalem H, Keckstein J, Hudelist G. Accuracy of sonography for non-invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:385-391. [PMID: 34919760 DOI: 10.1002/uog.24833] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare the preoperative detection of endometriosis using transvaginal sonography (TVS) supplemented by transabdominal sonography (TAS) with surgical assessment of disease, using the #Enzian classification for endometriosis. METHODS This was a prospective multicenter diagnostic accuracy study of women undergoing TVS/TAS and radical surgery for deep endometriosis (DE) at different tertiary referral centers. The localization and grade of severity of the endometriotic lesions and adhesions were described according to the criteria of the #Enzian classification, both at preoperative ultrasound examination and during surgery. According to the #Enzian classification, the small pelvis is divided into three compartments for DE: A (rectovaginal septum and vagina); B (uterosacral and cardinal ligaments, parametrium and pelvic sidewalls); and C (rectum). In addition, further locations (F) are classified as adenomyosis (FA), urinary bladder involvement (FB) and ureteric involvement with signs of obstruction (FU). Other intestinal locations (FI) and other extragenital locations (FO) are also included. Ovarian endometriosis and adhesions at the level of the tubo-ovarian unit are listed as O and T, respectively. The #Enzian grade of severity (Grade 1-3) was determined for #Enzian compartments O, T, A, B and C based on the size of the lesion or the severity of the adhesions. Concordance between preoperative assessment using TVS/TAS and evaluation at surgery was assessed. The sensitivity, specificity, positive and negative predictive values and accuracy of TVS/TAS in the detection of endometriotic lesions/adhesions in the different #Enzian compartments were calculated. RESULTS In total, 745 women were included in the analysis. Preoperative TVS/TAS and surgical findings showed a concordance rate ranging between 86% and 99% for the presence or absence of endometriotic lesions/adhesions, depending on the evaluated #Enzian compartment. The concordance rate between TVS and surgery ranged between 71% and 92% for different severity grades, in #Enzian compartments O, T, A, B and C. Determining the presence or absence of adhesions at the level of the tubo-ovarian unit and classifying them accurately as Grade 1, 2 or 3 on TVS was more difficult than determining the presence and severity of endometriotic lesions in #Enzian compartments O, A, B and C. The sensitivity of TVS/TAS for the detection of endometriotic lesions ranged from 50% (#Enzian compartment FI) to 95% (#Enzian compartment A), specificity from 86% (#Enzian compartment Tleft ) to 99% (#Enzian compartment FI) and 100% (#Enzian compartments FB, FU and FO), positive predictive value from 90% (#Enzian compartment Tright ) to 100% (#Enzian compartment FO), negative predictive value from 74% (#Enzian compartment Bleft ) to 99% (#Enzian compartments FB and FU) and accuracy from 88% (#Enzian compartment Bright ) to 99% (#Enzian compartment FB). CONCLUSIONS The localization and severity of endometriotic lesions/adhesions, as described and classified according to the #Enzian classification, can be diagnosed accurately and non-invasively using TVS/TAS. The #Enzian classification provides a uniform classification system for describing endometriotic lesions, which can be used both at TVS/TAS and during surgical evaluation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Montanari
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
| | - A Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - G Szabó
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - W Kondo
- Department of Gynecology and Minimally Invasive Unit, Vita Batel Hospital, Curitiba, Brazil
| | - C H Trippia
- Department of Radiology, Roentgen Diagnóstico Institute, Curitiba, Brazil
| | - M Malzoni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino, Italy
| | - A Di Giovanni
- Endoscopica Malzoni, Centre for Advanced Pelvic Surgery, Avellino, Italy
| | - H R Tinneberg
- Department of Obstetrics and Gynecology, Nordwest Hospital, Frankfurt, Germany
| | - A Oberstein
- Department of Obstetrics and Gynecology, Nordwest Hospital, Frankfurt, Germany
| | - R M Rocha
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - M Leonardi
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - G Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - H Alsalem
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J Keckstein
- Stiftung Endometrioseforschung (SEF), Westerstede, Germany
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, Hospital St John of God, Vienna, Austria
- Stiftung Endometrioseforschung (SEF), Westerstede, Germany
- Rudolfinerhaus Private Clinic, Vienna, Austria
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Casas Diaz O, Savoni J, Morozov VV. Radical Endometriosis Surgery: A Review of Surgical Techniques and Associated Challenges. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Olivia Casas Diaz
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Jessica Savoni
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Vadim V. Morozov
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, Washington, District of Columbia
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia
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Sloss S, Mooney S, Ellett L, Readman E, Ma T, Brouwer R, Yang N, Ireland-Jenkin K, Stone K, Maher P. Preoperative Imaging in Patients with Deep Infiltrating Endometriosis (DIE): An Important aid in Predicting Depth of Infiltration in Rectosigmoid Disease. J Minim Invasive Gynecol 2022; 29:633-640. [PMID: 34990811 DOI: 10.1016/j.jmig.2021.12.015] [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: 10/12/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To determine the diagnostic accuracy of specialist transvaginal ultrasound (TVUS) and pelvic magnetic resonance imaging (MRI) modalities in predicting depth of deep infiltrating endometriosis (DIE) of the rectosigmoid by comparison with histological specimens obtained at surgery. DESIGN A retrospective analysis, which met the STARD (2015) guidelines for a diagnostic accuracy study. SETTING Tertiary teaching hospital. PATIENTS 194 cases who underwent preoperative discussion at the Gynaecological Endosurgery Unit multidisciplinary meeting (MDM) between January 2012 and December 2019 were eligible for inclusion. INTERVENTIONS Retrospective assessment of the accuracy of TVUS and MRI in predicting histological depth of rectosigmoid DIE following operative management. MEASUREMENTS AND MAIN RESULTS 135 surgeries were performed for DIE; 20 underwent a rectal shave, 14 had a disc/wedge resection, 38 an anterior/segmental resection, 63 had no rectosigmoid surgery. Of the 52 patients with full thickness rectal wall excision, all patients had at least one imaging modality available for review; 42 (81%) had both. At least one imaging modality was in agreement with histological depth in 48 (92%) cases (sensitivity 94%, specificity 50%, positive predictive values (PPV) 97.9%, negative predictive value (NPV) 25.0%; area under the receiver operating curves (AUROC) 0.720, 95%CI: 0.229, 1.000). When TVUS was assessed in isolation, the test remained sensitive for any rectal wall involvement (sensitivity 93.6%, specificity 50.0%, PPV 97.8%, NPV 25.0%; AUROC 0.718, 95%CI: 0.227, 1.000). When only MRI was assessed, the test demonstrated both high sensitivity and specificity for rectal wall disease (sensitivity 86.4%, specificity 100%, PPV 100%, NPV 14.2). CONCLUSION Specialised performed TVUS and MRI are accurate in predicting depth of disease in rectosigmoid endometriosis. These modalities were similar in their diagnostic performance at assessing depth of rectal wall involvement and their use is justified in the preoperative planning of these gynaecological surgeries.
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Affiliation(s)
- Samantha Sloss
- Department of Gynaecology (Drs. Sloss, Mooney, Ellett, Readman, and Ma and Prof Maher).
| | - Samantha Mooney
- Department of Gynaecology (Drs. Sloss, Mooney, Ellett, Readman, and Ma and Prof Maher)
| | - Lenore Ellett
- Department of Gynaecology (Drs. Sloss, Mooney, Ellett, Readman, and Ma and Prof Maher)
| | - Emma Readman
- Department of Gynaecology (Drs. Sloss, Mooney, Ellett, Readman, and Ma and Prof Maher)
| | - Tony Ma
- Department of Gynaecology (Drs. Sloss, Mooney, Ellett, Readman, and Ma and Prof Maher)
| | | | | | - Kerryn Ireland-Jenkin
- Department of Anatomical Pathology (A/Prof Ireland-Jenkin) Austin Hospital, Heidelberg, Australia
| | - Kate Stone
- Department of Medical Imaging (Dr Stone), Mercy Hospital for Women, Heidelberg, Australia
| | - Peter Maher
- Department of Gynaecology (Drs. Sloss, Mooney, Ellett, Readman, and Ma and Prof Maher)
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Goncharov AL, Chicherina MA, Chernyshenko TA, Levshin FA, Nenakhov FV, Kabeshov AM, Zhakiyev NS, Gallyamov EA. [The results of colorectal resection for bowel deep infiltrating endometriosis]. Khirurgiia (Mosk) 2022:54-58. [PMID: 36562673 DOI: 10.17116/hirurgia202212254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To study the early postoperative outcomes of segmental bowel resections in patients with colorectal endometriosis. MATERIAL AND METHODS A retrospective study included 60 patients diagnosed with deep infiltrative endometriosis who underwent surgical treatment with segmental bowel resection between 2016 and 2022. RESULTS All surgeries performed by two teams (gynecologic & colorectal). 59 operations were performed by laparoscopic access and one open. The average operation time was 263.5±86.0 min, estimated blood loss 126.1 ml (10-400 ml). There were no intraoperative complications. There were no conversions during laparoscopic surgery. A protective stoma was not required in any patient. The median postoperative hospital stay was 7.5±4.2 days. Bowel function was restored by an average of 4.3±3.1 days. Postoperative complications were in 7 cases (11.6%). Anastomotic leakage occurred in one patient (1.6%). The incidence of urine retention requiring repeated bladder catheterization was 2 (3.3%). CONCLUSION The use of a minimally invasive multidisciplinary approach makes it possible to perform the required volume of surgery with excision of all tissues affected by endometriosis with a low level of complications and the absence of conversions.
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Affiliation(s)
- A L Goncharov
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | - M A Chicherina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - T A Chernyshenko
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | | | - F V Nenakhov
- Central Clinical Hospital with Polyclinic of Administrative Directorate of the President of the Russian Federation, Moscow, Russia
| | | | - N S Zhakiyev
- Regional Perinatal Center, Aktau, Republic of Kazakhstan
| | - E A Gallyamov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Moawad GN, Klebanoff JS, Habib N, Bendifallah S. Colorectal endometriosis: ample data without definitive recommendations. Facts Views Vis Obgyn 2021; 13:3-7. [PMID: 33889855 PMCID: PMC8051188 DOI: 10.52054/fvvo.13.1.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The preoperative work-up and optimal surgical approach to colorectal endometriosis is a highly studied topic lacking definitive recommendations. Synthesis of the available data can be extremely challenging for surgeons due to the heterogeneity of existing comparisons, a variety of studied surgical outcomes, and a predominant focus on operative complications. While these considerations are extremely important for surgeons performing such complex gynaecologic surgery there is still much to be desired with regards to evidence based guidelines for the preoperative assessment and surgical technique for colorectal endometriosis. Having an established guideline stating in which clinical situations endometriosis surgeons should performing rectovaginal shaving, versus discoid excision, versus segmental resection would be extremely important for all pelvic surgeons, even those operating in high-volume centres dedicated to the surgical management of complex endometriosis. This perspective highlights the shortcomings of the available data and attempts to create an algorithm surgeons can follow when performing surgery for colorectal endometriosis. This algorithm is based on our expert opinion after synthesising available data.
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Affiliation(s)
- G N Moawad
- Department of Obstetrics and Gynecology, The George Washington University, Washington, DC.,The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC
| | - J S Klebanoff
- Department of Obstetrics and Gynecology, Main Line Health, Wynewood, PA
| | - N Habib
- Department of Obstetrics and Gynecology, Francois Quesnay Hospital, Mantes-la-Jolie, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hopitaux de Paris (AP-HP), Sorbonne University, France
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Klebanoff JS, Barnes WA, Denny K, Mangini MG, Kazma J, Laganà AS, Habib N, Ayoubi JM, Moawad GN. Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection. Horm Mol Biol Clin Investig 2021; 43:145-150. [PMID: 33611866 DOI: 10.1515/hmbci-2020-0065] [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: 09/16/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressive techniques are winning favor among gynecologic surgeons. Shaving, discoid excision, and segmental bowel resection are all feasible surgical management options for bowel endometriosis. Segmental resection is associated with the highest rates of both anastomotic leak and fistula formation, while shaving is associated with the lowest.
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Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA.,Department of Obstetrics and Gynecology, Main Line Health System, Wynnewood, PA, USA
| | - Whitney A Barnes
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Katherine Denny
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Marissa G Mangini
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynaecology, Beaujon Hospital-University of Paris, Clichy Cedex, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gyncology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA
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