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Turco LC, Raimondo D, Raffone A, Raimondo I, Vargiu V, Raspollini A, Travaglino A, Tinelli R, Zanetti E, Ferrandina G, Seracchioli R, Casadio P, Scambia G, Cosentino F. Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study. Int J Gynaecol Obstet 2024; 164:550-556. [PMID: 37715533 DOI: 10.1002/ijgo.15109] [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: 01/22/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To compare safety and effectiveness of two-different directions of suturing the posterior vaginal breach (horizontal [Ho] vs vertical [Ve]) in women undergoing recto-vaginal endometriosis (RVE) nodule resection. METHODS A multicenter, retrospective, observational, cohort study was performed including all women of reproductive age undergoing RVE nodule resection between March 2013 and December 2018 at our tertiary centers. Patients included in the present study were divided into two groups based on the direction in suturing the posterior vaginal fornix defect, for comparisons in terms of rate of postoperative complications, pain relief, pain and anatomical recurrence, and length of hospital stay. Univariate comparisons were performed adopting the t test or the Mann-Whitney test for continuous data and the chi-square test or the Fisher exact test for categorical data, with a significant P value set to <0.05. RESULTS A total of 101 women were included: 67 in the Ho-group and 34 in the Ve-group. The two groups did not significantly differ in length of hospital stay (6.7 ± 6.9 vs 6.6 ± 3.3 days; P = 0.95), overall postoperative complications (32.8% vs 14.7%; P = 0.05), pain recurrence (35.8% vs 26.5%; P = 0.34) and anatomical recurrence rate (19.4% vs 23.5%; P = 0.62). Conversely, grade III complications were significantly more common in the Ho-group than in the Ve-group (22.7% vs 20%, P = 0.009), while pain relief in terms of deep dyspareunia, dyschezia, dysuria and chronic pelvic pain was more consistent in the Ve-group patients (P = 0.04, 0.04, 0.05, 0.004, respectively). CONCLUSION In symptomatic women undergoing RVE nodule resection, Ho suturing of the vaginal breach appears more commonly associated with severe postoperative complications and a worse pain control.
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Affiliation(s)
- Luigi Carlo Turco
- Ovarian Cancer Center, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Ivano Raimondo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy
| | - Virginia Vargiu
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
| | - Arianna Raspollini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Travaglino
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Pathology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, Antonio Perrino Hospital, Brindisi, Italy
| | - Enrico Zanetti
- Gynecology and Obstetrics Unit, University of Brescia, Italy
| | - Gabriella Ferrandina
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni Scambia
- Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Science, "V.Tiberio" Università Degli Studi del Molise, Campobasso, Italy
- Gynecologic Onocology Unit, Gemelli Molise SpA, Campobasso, Italy
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Song Z, Li S, Luo M, Li H, Zhong H, Wei S. Assessing the role of robotic surgery versus laparoscopic surgery in patients with a diagnosis of endometriosis: A meta-analysis. Medicine (Baltimore) 2023; 102:e33104. [PMID: 38115379 PMCID: PMC10727685 DOI: 10.1097/md.0000000000033104] [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: 01/08/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Surgical management of endometriosis can be carried out with the traditional standard laparoscopic technique or the robotic surgery technique; however, it is not clear if there is a significant difference between techniques. This meta-analysis aims to evaluate and compare the impact of robotic and standard laparoscopic techniques in endometriosis regarding the clinical outcome. METHODS Studies comparing robotic surgery to laparoscopic surgery for endometriosis were among the studies from various languages that met the inclusion criteria. Using dichotomous and continuous random-effect models, the results of these investigations (surgery time, hospitalization time, blood loss, complications, and conversion rate) were examined, and the mean difference with 95% confidence intervals was computed. RESULTS Eight studies from 2013 to 2022 were selected for the current analysis including 1741 patients with endometriosis. The studied data revealed a statistically significant (P = .01) lower operation time related to laparoscopic surgery compared with the robotic technique. In addition, the hospitalization time of laparoscopic surgery is significantly (P = .03) lower than that of robotic surgery. On the other hand, blood loss, rehospitalization, postoperative and intraoperative complications, and conversion rates were not significantly different between both techniques. Heterogeneity values were variable according to the analysis factor, from 0% to 91%. CONCLUSION Both robotic and standard laparoscopic techniques have similar outcomes regarding blood loss, rehospitalization, conversion rate, and rate of complication. However, the substantial difference between techniques was in favor of standard laparoscopic surgery regarding operation and hospitalization time.
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Affiliation(s)
- Zhihua Song
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Songtao Li
- Department of Oncology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Mei Luo
- Department of Gynecology, Chongqing Institute of Traditional Chinese Medicine, Chongqing, China
| | - Hongjun Li
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Hanzhi Zhong
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Shaobin Wei
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
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Angioni S, Nappi L, Sorrentino F, Peiretti M, Daniilidis A, Pontis A, Tinelli R, D'Alterio MN. Laparoscopic treatment of deep endometriosis with a diode laser: our experience. Arch Gynecol Obstet 2021; 304:1221-1231. [PMID: 34448038 PMCID: PMC8490256 DOI: 10.1007/s00404-021-06154-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/21/2021] [Indexed: 11/06/2022]
Abstract
Purpose To evaluate whether laparoscopic treatment with a diode laser is feasible, safe, and effective in symptomatic patients affected by deep endometriosis (DE). Methods This retrospective study was performed using medical record data. The surgical reports, chronic pain scores, and quality of life (QoL) data were evaluated for 50 patients who had undergone laparoscopic surgery between November 2017 and March 2019 at two university hospitals (Monserrato (CA) and Foggia, Italy). Indications for surgery were chronic pelvic pain and/or infertility in patients who wished to conceive spontaneously. Endometriosis lesions/nodules were excised using a diode laser (Leonardo®, Biolitec® DUAL 45) that can combine 980 and 1470 nm wavelengths transmitted through a 1000 µm conical optical fibre. Results The median patient age was 32 years (range 21–44), with a body mass index (BMI) mean of 21.7 ± 2.9 kg/m2. The mean operation time was 147 min (range 106–190). No intraoperative or early complications (< 30 days) were reported. All patients left the hospital, on average, within 3 days (range 2–9 days) after surgery. A significant improvement in pain was observed at the 3-, 6-, and 12-month follow-up (p < 0.01) in all patients. Moreover, patients reported a significant QoL improvement at the 12-month follow-up. Conclusion The diode laser confirmed its feasibility and safety for treating endometriosis. During the shaving surgical procedure, the diode laser system ensures a safe and effective laparoscopic dissection of deep endometriotic lesions. Further comprehensive randomized trials are necessary to confirm these preliminary data in terms of efficacy, recurrence rates, and pregnancy outcomes.
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Affiliation(s)
- Stefano Angioni
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy.
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Michele Peiretti
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy
| | - Angelos Daniilidis
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Raffaele Tinelli
- U.O.C. Obstetrics and Gynecology, 'Valle d'Itria' Hospital, Martina Franca, Taranto, Italy
| | - Maurizio Nicola D'Alterio
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Cagliari, Italy
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D'Alterio MN, Saponara S, D'Ancona G, Russo M, Laganà AS, Sorrentino F, Nappi L, Angioni S. Role of surgical treatment in endometriosis. Minerva Obstet Gynecol 2021; 73:317-332. [PMID: 34008386 DOI: 10.23736/s2724-606x.21.04737-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endometriosis can take one of three forms depending on its clinical presentation and management: endometriotic ovarian cyst (ovarian endometrioma), superficial or peritoneal endometriosis and deep infiltrating endometriosis (DIE).1Among them, DIE is considered the most aggressive, and the patient is often affected by more than one type together. The therapeutic methodology should not be influenced by a combination of different types of endometriotic lesion. According to the clinical context and the patient's needs, the treatment of this pathology can be medical or surgical. Although medical therapy could improve endometriosis-associated symptoms, it never offers a definite treatment for symptomatic patients, who often require surgical treatment. The rationale behind endometriosis surgical treatment is to achieve the complete removal of all lesions through a one-step surgical procedure; to obtain promising long-term results for pelvic pain, recurrence rate, and fertility; and to protect the functionality of the involved organs. Achieving these results depends on the total removal of the pathology from the pelvis, in an attempt to preserve, as much as possible, the healthy tissues surrounding the site of the disease. The choice of a surgical approach rather than medical therapy is subject to the patient's expectations, such as pregnancy desire, the effectiveness of treatment compared to possible complications, the type of pain and its intensity, and the location and severity of the disease. In this context, surgical management using a multidisciplinary endometriosis team is an important factor for achieving good outcomes.
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Affiliation(s)
- Maurizio N D'Alterio
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy -
| | - Stefania Saponara
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gianmarco D'Ancona
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Margherita Russo
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio S Laganà
- Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Stefano Angioni
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Arcoverde F, Andres MP, Souza CC, Neto JS, Abrão MS. Deep endometriosis: medical or surgical treatment? Minerva Obstet Gynecol 2021; 73:341-346. [PMID: 34008388 DOI: 10.23736/s2724-606x.21.04705-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Deep endometriosis (DE) is classically defined as disease that infiltrates structures by more than 5 mm, such as bowel, ureters, bladder and vagina. The two major symptoms related to DE are pain and infertility. A lot of debate goes on upon the best treatment choice for DE. Treatments include medical therapy with oral progestins or combined contraceptives, and surgery for resection of DE nodules. In this review we focus on the best option treatment for the symptomatic patients with DE not seeking conception. We performed a narrative review of literature searching for the latest evidence on efficacy and outcomes of medical and surgical treatment of DE patients. Results showed that 2/3 of patients with DE will be satisfied with hormonal treatment, and surgery will be effective in improving QoL in most patients with DE. Most studies published regarding surgical outcomes involve bowel endometriosis, and their complication rates should not be extrapolated to all DE. DE that does not infiltrate pelvic viscera accounts for most cases of DE. Together with DE affecting the urinary tract, a much lower rate of severe complications is reported when compared to bowel endometriosis. This distinction should influence decision making. Medical treatment should be first option for non-complicated DE patients not seeking conception. Surgery should be indicated for those who do not tolerate nor improve with medical treatment, as well as those cases complicated by visceral impairment.
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Affiliation(s)
- Fernanda Arcoverde
- Unit of Gynecology, Natus Lumine Maternidade, São Luís do Maranhão, Brazil
| | - Marina P Andres
- Section of Endometriosis, Division of Gynecology, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Division of Gynecologic, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Carolina C Souza
- Division of Gynecologic, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Joao S Neto
- Section of Endometriosis, Division of Gynecology, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Division of Gynecologic, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Mauricio S Abrão
- Section of Endometriosis, Division of Gynecology, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil - .,Division of Gynecologic, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
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D'Alterio MN, D'Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S. Management Challenges of Deep Infiltrating Endometriosis. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:88-94. [PMID: 33687160 PMCID: PMC8052801 DOI: 10.22074/ijfs.2020.134689] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022]
Abstract
Deep infiltrating endometriosis (DIE) is the most aggressive of the three phenotypes that constitute endometriosis. It can affect the whole pelvis, subverting the anatomy and functionality of vital organs, with an important negative impact on the patient's quality of life. The diagnosis of DIE is based on clinical and physical examination, instrumental examination, and, if surgery is needed, the identification and biopsy of lesions. The choice of the best therapeutic approach for women with DIE is often challenging. Therapeutic options include medical and surgical treatment, and the decision should be dictated by the patient's medical history, disease stage, symptom severity, and personal choice. Medical therapy can control the symptoms and stop the development of pathology, keeping in mind the side effects derived from a long-term treatment and the risk of recurrence once suspended. Surgical treatment should be proposed only when it is strictly necessary (failed hormone therapy, contraindications to hormone treatment, severity of symptoms, infertility), preferring, whenever possible, a conservative approach performed by a multidisciplinary team. All therapeutic possibilities have to be explained by the physicians in order to help the patients to make the right choice and minimize the impact of the disease on their lives.
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Affiliation(s)
| | - Gianmarco D'Ancona
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Mohamed Raslan
- Department of Obstetrics and Gynaecology, Tanta University, Tanta, Egypt
| | - Raffaele Tinelli
- Department of Obstetrics and Gynaecology, 'Valle d'Itria' Hospital, Martina Franca, Taranto, Italy
| | - Angelos Daniilidis
- Department of Obstetrics and Gynaecology, 2nd University Clinic of Obstetrics and Gynaecology, Aristotele University of Thessaloniki, Thessaloniki, Greece
| | - Stefano Angioni
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
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Zhou Y, Su Y, Liu H, Wu H, Xu J, Dong F. Accuracy of transvaginal ultrasound for diagnosis of deep infiltrating endometriosis in the uterosacral ligaments: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2020; 50:101953. [PMID: 33148442 DOI: 10.1016/j.jogoh.2020.101953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of uterosacral ligaments (USL) in patients with clinical suspicion of deep infiltrating endometriosis (DIE). METHODS Extensive searches were conducted in PubMed, EMBASE and Cochrane libraries to search studies published between January 1989 and September 2, 2019. The inclusion criteria were the preoperative assessment of USL endometriosis by TVS in patients with clinically suspected DIE, using laparoscopy and histological results as the reference standard. The assessment of research quality uses preferred reporting items, including the System Review and Meta Analysis (PRISMA) guidelines, as well as the quality assessment of diagnostic accuracy study 2 (QUADAS-2) tools. RESULTS During our advanced search, 7562 studies were identified. Finally, 11 of which were recognized as qualified and incorporated into this study. The pooled sensitivity, specificity, positive probability ratio (LR+) and negative probability ratio(LR-) of TVS for detecting DIE in the USL were 65 %(95 %CI:43-83), 92 %(95 %CI:84-96), 7.80 (95 %CI:4.7-13.0) and 0.38(95 %CI:0.22-0.66), respectively. There was significant heterogeneity in sensitivity (I2: 97.40 %; Cochran Q, 385.09; P<0.001) and specificity (I2, 93.89 %; Cochran Q, 163.75; P < 0.001). CONCLUSION TVS provides an excellent comprehensive diagnostic performance for DIE of the USL. However, further research is required to improve the diagnostic quality.
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Affiliation(s)
- Yuli Zhou
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Youhuan Su
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Huiyu Liu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Huaiyu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China.
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China.
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Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis. Arch Gynecol Obstet 2020; 302:957-967. [PMID: 32661754 PMCID: PMC7471187 DOI: 10.1007/s00404-020-05686-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
Abstract
Introduction Deep infiltrating endometriosis (DIE) affects between 3.8% and 37% of all endometriosis patients, mostly affecting rectovaginal septum or retrocervical space and characterized by the severe endometriosis-related complaints. Nowadays, generally managed with surgery. However, this is associated with a risk of postoperative complications. To better evaluate intra- and postoperative complications and outcomes for rectovaginal (RVE) and retrocervical endometriosis (RCE), the preoperative management should be accurately described and compared. Methodology This is a cohort retrospective study performed at the Endometriosis Centre of Charité-University Clinic, Berlin. 34 patients were investigated in their reproductive age, n = 19 with RVE and n = 15 RCE, operated between 2011 and 2015. The surgical approach was divergent in both groups. Single laparoscopy was performed in RCE patients (RCEP) and vaginal assisted laparoscopy in RVE patients (RVEP). Long-term postoperative outcome included complications, fertility rate and recurrence rate. Results The median follow-up time was three years (y). Symptom-free status was revealed in n = 12 RVEP and n = 9 RCEP. Postoperatively, endometriosis-related complaints were presented in n = 7 RVEP and n = 6 RCEP, but with significant pain relief. From n = 8 RVE patients seeking fertility, pregnancy occurred in n = 7 and from n = 9 RCEP pregnancy appeared in n = 5 patients in the meantime of 6 months. Postoperative complications were reported in n = 1 RVEP with early postoperative bleeding, after ureter leakage and n = 1 RCEP with postoperative anastomotic insufficiency. The postoperative recurrence rate was equivalent to zero. Conclusion The appropriate surgical approach for each group, preserving anatomy and functionality of the organs, seems to be very essential and efficient.
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Burnett TL, Feldman MK, Huang JQ. The role of imaging as a guide to the surgical treatment of endometriosis. Abdom Radiol (NY) 2020; 45:1840-1846. [PMID: 31925491 DOI: 10.1007/s00261-019-02399-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.
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Affiliation(s)
- Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Myra K Feldman
- Imaging Institute, Section of Abdominal Imaging, Cleveland Clinic, 9500 Euclid Ave A-21, Cleveland, OH, USA
| | - Jian Qun Huang
- Department of Obstetrics and Gynecology, New York University, 550 First Avenue, New York, NY, 10016, USA
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Restaino S, Mereu L, Finelli A, Spina MR, Marini G, Catena U, Turco LC, Moroni R, Milani M, Cela V, Scambia G, Fanfani F. Robotic surgery vs laparoscopic surgery in patients with diagnosis of endometriosis: a systematic review and meta-analysis. J Robot Surg 2020; 14:687-694. [DOI: 10.1007/s11701-020-01061-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/29/2020] [Indexed: 12/21/2022]
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Raimondo D, Turco LC, Cosentino F, Mabrouk M, Mastronardi M, Borghese G, Giaquinto I, Vargiu V, Fagotti A, Meriggiola MC, Chiantera V, Scambia G, Seracchioli R. Feasibility and safety of two different surgical routes for the eradication of recto‐vaginal endometriosis with vaginal mucosa infiltration (Endo‐Vag‐r study). Acta Obstet Gynecol Scand 2020; 99:1050-1056. [DOI: 10.1111/aogs.13824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Diego Raimondo
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Luigi C. Turco
- Division of Gynecologic Oncology Fondazione di Ricerca e Cura Giovanni Paolo II Università Cattolica del Sacro Cuore Campobasso Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology Fondazione di Ricerca e Cura Giovanni Paolo II Università Cattolica del Sacro Cuore Campobasso Italy
| | - Mohamed Mabrouk
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
- Department of Obstetrics and Gynecology Faculty of Medicine University of Cambridge Cambridge UK
- Department of Obstetrics and Gynecology Faculty of Medicine University of Alexandria Alexandria Egypt
| | - Manuela Mastronardi
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Ilaria Giaquinto
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Virginia Vargiu
- Department of Women's and Children's Health Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Anna Fagotti
- Gynecologic Oncology Università Cattolica del Sacro Cuore Rome Italy
| | - Maria C. Meriggiola
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology University of Palermo Palermo Italy
| | - Giovanni Scambia
- Gynecologic Oncology Università Cattolica del Sacro Cuore Rome Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) S. Orsola Hospital University of Bologna Bologna Italy
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Pelizzo G, Nakib G, Calcaterra V. Pediatric and adolescent gynecology: Treatment perspectives in minimally invasive surgery. Pediatr Rep 2019; 11:8029. [PMID: 31871603 PMCID: PMC6908954 DOI: 10.4081/pr.2019.8029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/05/2019] [Indexed: 12/01/2022] Open
Abstract
Minimally invasive surgery (MIS) is widely utilized across multiple surgical disciplines, including gynecology. To date, laparoscopy is considered a common surgical modality in children and adolescents to treat gynecological conditions. Robotic surgical devices were developed to circumvent the limitations of laparoscopy and have expanded the surgical armamentarium with better magnification, dexterity enhanced articulating instruments with 5-7 degrees of freedom, and ability to scale motion thus eliminating physiologic tremor. There are well-documented advantages of MIS over laparotomy, including decreased post-operative pain, shorter recovery times, and better cosmetic results. Indications for MIS in pediatric gynecology are reported in this review and technical considerations are described to highlight new treatment perspectives in children and adolescents, which have already been described in the literature regarding adult patients.
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Affiliation(s)
- Gloria Pelizzo
- Pediatric Surgery Department, Children's Hospital, ARNASCivico-Di Cristina-Benfratelli, Palermo, Italy
| | - Ghassan Nakib
- Department of Pediatric Surgery, Mediclinic Middle East, Mediclinic City Hospital Dubai, UAE
| | - Valeria Calcaterra
- Pediatric Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy
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13
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Stochino Loi E, Pontis A, Cofelice V, Pirarba S, Fais MF, Daniilidis A, Melis I, Paoletti AM, Angioni S. Effect of ultramicronized-palmitoylethanolamide and co-micronized palmitoylethanolamide/polydatin on chronic pelvic pain and quality of life in endometriosis patients: An open-label pilot study. Int J Womens Health 2019; 11:443-449. [PMID: 31496832 PMCID: PMC6697671 DOI: 10.2147/ijwh.s204275] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/12/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the present study was to evaluate the effectiveness of the ultramicronized-palmitoylethanolamide (um-PEA) and co-micronised palmitoylethanolamide/polydatin m(PEA/PLD) in the management of chronic pelvic pain related to endometriosis in patients desiring pregnancy. Patients and methods Thirty symptomatic women with laparoscopic diagnosis of endometriosis and pregnancy desire were enrolled. Patients were treated with um-PEA twice daily for 10 days followed by m(PEA/PLD) twice daily for 80 days. Intensity of chronic pelvic pain, dyspareunia, dysmenorrhea, dyschezia, and dysuria were evaluated at baseline, after 10, 30, 60, 90 days and after 30 days from the end of treatment, by VAS. Quality of life and women's psychological well-being were evaluated at baseline and at the end of the treatment after 90 days with 36-Item Short Form Health Survey questionnaire and Symptom Check list-90 questionnaire, respectively. All collected data were analyzed with the non-parametric Wilcoxon test. Results At the end of the treatment, all patients showed a significant improvement in chronic pelvic pain, deep dyspareunia, dysmenorrhea, dyschezia, as well as in quality of life and psychological well-being. Conclusion In spite of the study's limited sample size and the open-label design, this research suggests the efficacy of um-PEA and m(PEA/PLD) in reducing painful symptomatology and improving quality of life as well as psychological well-being in patients suffering from endometriosis. Additionally, this treatment did not show any serious side effect, proving particularly suitable for women with pregnancy desire and without other infertility factors.
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Affiliation(s)
- Emanuela Stochino Loi
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Alessandro Pontis
- Division of Gynecology and Obstetric, Hospital San Francesco, Nuoro, Italy
| | - Vito Cofelice
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Silvia Pirarba
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maria Francesca Fais
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Angelos Daniilidis
- 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Irene Melis
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Anna Maria Paoletti
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Opoku-Anane J, Tyan P, Klebanoff JS, Clay J, Moawad GN. Postoperative Hormonal Suppression for Prevention of Deeply Infiltrative Endometriosis Recurrence After Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Vallée A, Ploteau S, Abo C, Stochino-Loi E, Moatassim-Drissa S, Marty N, Merlot B, Roman H. Surgery for deep endometriosis without involvement of digestive or urinary tracts: do not worry the patients! Fertil Steril 2018; 109:1079-1085.e1. [DOI: 10.1016/j.fertnstert.2018.02.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/03/2018] [Accepted: 02/19/2018] [Indexed: 10/28/2022]
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16
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Franck C, Poulsen MH, Karampas G, Giraldi A, Rudnicki M. Questionnaire-based evaluation of sexual life after laparoscopic surgery for endometriosis: a systematic review of prospective studies. Acta Obstet Gynecol Scand 2018; 97:1091-1104. [DOI: 10.1111/aogs.13369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Cecilie Franck
- Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
| | - Marlene H. Poulsen
- Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
| | - Grigorios Karampas
- Department of Obstetrics & Gynecology; Skåne University Hospital; Malmö-Lund Sweden
| | - Annamaria Giraldi
- Sexological Clinic; Psychiatric Center Copenhagen; Copenhagen Denmark
| | - Martin Rudnicki
- Department of Obstetrics & Gynecology; Odense University Hospital; Odense Denmark
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Abstract
Endometriosis is a common disease affecting reproductive age women. Pain is one of the most common symptoms associated with endometriosis. When medical therapy has failed or in known deeply infiltrating endometriosis, surgical management is warranted. Laparoscopy is the gold standard for diagnosis and treatment of endometriosis. Recent developments in surgery have shown the feasibility of robotic surgery for endometriosis, although these methods have not been shown to be superior to conventional laparoscopy. Enhanced imaging techniques including fluorescence imaging and narrow band imaging have also been studied. However, long-term clinical benefits have yet to be demonstrated.
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18
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Saccardi C, Cocco A, Tregnaghi A, Cosmi E, Baldan N, Ancona E, Litta PS. Deep Pelvic Endometriosis: From Diagnosis to Wellness. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2284026509001003-405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose to determine the efficacy of laparoscopic excision of deep pelvic endometriosis (DPE). Methods One hundred and two highly symptomatic women with DPE underwent clinical examination, transvaginal ultrasound, nuclear magnetic resonance (NMR) and sonovaginography. Among the 102 women, 50 patients, with severe symptoms, underwent laparoscopic excision of DPE. Endoscopic surgery was performed with complete separation of the rectovaginal space and resection of the node. In the case of vaginal involvement vaginal exeresis was performed, in the case of rectal wall involvement of more than 50%, segmental bowel resection was performed. Operative data as well as dysmenorrhea, dyspareunia, chronic pelvic pain and dyschezia before and 6 and 12 months after surgical treatment were recorded. Results Mean operative time was 126.4 ± 34.7 min, mean blood loss was 76.2 ± 22 ml. In 17 (34%) cases we performed excision of the posterior vaginal fornix due to vaginal wall involvement. In six (12%) cases we performed excision of the rectal wall. At 12-month follow-up 39 (78%) women revealed absent or mild dysmenorrhea, 45 (90%) women revealed absent or mild dyspareunia, 46 (92%) women revealed absent or mild chronic pelvic pain, 48 (96%) women revealed absent or mild dyschezia. Conclusions Surgical management of DPE could be a radical approach for this disease but conservative for the patients, ensuring good improvement in symptoms and good patient satisfaction, and only performing vaginal or rectal exeresis when strictly necessary.
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Affiliation(s)
- Carlo Saccardi
- Department of Gynecological Sciences and Human Reproduction, Padua University, School of Medicine, Padua - Italy
| | - Andrea Cocco
- Department of Gynecological Sciences and Human Reproduction, Padua University, School of Medicine, Padua - Italy
| | - Alberto Tregnaghi
- Medical-Diagnostic Sciences and Special Therapies Department, Section of Radiology, Padua University, School of Medicine, Padua - Italy
| | - Erich Cosmi
- Department of Gynecological Sciences and Human Reproduction, Padua University, School of Medicine, Padua - Italy
| | - Nicola Baldan
- Third Clinic of General Surgery, Padua University, School of Medicine, Padua - Italy
| | - Ermanno Ancona
- Third Clinic of General Surgery, Padua University, School of Medicine, Padua - Italy
| | - Pietro S. Litta
- Department of Gynecological Sciences and Human Reproduction, Padua University, School of Medicine, Padua - Italy
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Angioni S, Mereu L, Maricosu G, Mencaglia L, Melis GB. Single Port Access Laparoscopy (SPAL) for Endometrioma Excision. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/228402651000200207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Puropose To evaluate the feasibility of single port access laparoscopy (SPAL) for the treatment of ovarian endometrioma. Case Report Three patients affected by single ovarian endometrioma underwent cyst excision using a laparoendoscopic single port approach with a new multiport, reusable trocar, and flexible, curved and standard laparoscopic instruments. Results No conversion to multi-access standard laparoscopic technique was required and no intraoperative or postoperative complications were observed. The mean operative time was 40 minutes. Conclusions We conclude that single portal access laparoscopy is feasible, safe and effective for the excision of ovarian endometrioma, with good results in terms of cosmesis, postoperative pain and patient satisfaction. This approach may be indicated in patients with single cysts without dense adherences in the bowel and/or deep infiltrating endometriosis.
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Affiliation(s)
- Stefano Angioni
- Division of Gynecology, Obstetrics and
Pathophysiology of Human Reproduction, University of Cagliari - Italy
| | - Liliana Mereu
- Division of Gynecology, Villanova
Hospital, Firenze - Italy
| | - Giovanni Maricosu
- Division of Gynecology, Obstetrics and
Pathophysiology of Human Reproduction, University of Cagliari - Italy
| | - Luca Mencaglia
- Division of Gynecology, Villanova
Hospital, Firenze - Italy
| | - Gian Benedetto Melis
- Division of Gynecology, Obstetrics and
Pathophysiology of Human Reproduction, University of Cagliari - Italy
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20
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Torky HA, ElSabaa KG, Soliman SM. Huge Retroperitoneal Endometriotic Mass Adherent to the Sheaths of the Great Pelvic Vessels: 10 Years After Panhysterectomy (Parasitic Endometriosis). J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Haitham Atef Torky
- Department of Obstetrics and Gynecology, October 6th University/As-Salam International Hospital/Air-Force Specialized Hospital, Cairo, Egypt
| | - Khaled Gaber ElSabaa
- Department of Obstetrics and Gynecology, Military Medical School/Air-Force Specialized Hospital, Cairo, Egypt
| | - Soliman Mohammed Soliman
- Department of Surgical Oncology, Military Medical School/Air-Force Specialized Hospital, Cairo, Egypt
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Barbara G, Facchin F, Buggio L, Somigliana E, Berlanda N, Kustermann A, Vercellini P. What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature. Reprod Sci 2017; 24:1566-1576. [PMID: 28558521 DOI: 10.1177/1933719117707054] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future research and treatment strategies. An electronic database research was performed to identify all the studies on the relation between endometriosis and sexual functioning published in the period 2000 to 2016. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After the screening process, a total of 9 studies investigating the relation between endometriosis and female sexual functioning were considered. Overall, these studies indicated that around two thirds of women with endometriosis have some form of sexual dysfunction not limited to deep dyspareunia. These findings suggest that the global sexual impact of endometriosis requires further investigation, focusing not only on pain during intercourse but also on psychological and relational dimensions, including partner's sexual functioning. Because sexual functioning is a complex, multidimensional phenomenon, the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team composed of gynecologists, sexologists, and psychologists/psychotherapists.
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Affiliation(s)
- Giussy Barbara
- 1 Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- 2 Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Laura Buggio
- 3 Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- 4 Infertility Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Nicola Berlanda
- 3 Department of Women's and Children's Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Kustermann
- 1 Department of Women's and Children's Health and Service for Sexual and Domestic Violence (SVSeD), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- 5 Unità Operativa Dipartimentale di Ginecologia Chirurgica ed Endometriosi, Università degli Studi di Milano, Milan, Italy.,6 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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22
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Barbara G, Facchin F, Meschia M, Berlanda N, Frattaruolo MP, VercellinI P. When love hurts. A systematic review on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning. Acta Obstet Gynecol Scand 2016; 96:668-687. [DOI: 10.1111/aogs.13031] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/24/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Giussy Barbara
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Federica Facchin
- Faculty of Psychology; Catholic University of Milan; Milan Italy
| | - Michele Meschia
- Department of Obstetrics and Gynecology; “G. Fornaroli” Hospital; Milan Italy
| | - Nicola Berlanda
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Maria P. Frattaruolo
- Department of Women's and Children's Health; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Paolo VercellinI
- Department of Clinical Science and Community Health, Università degli Studi di Milano; and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
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Kuntai Capsule Inhibited Endometriosis via Inducing Apoptosis in a Rat Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:5649169. [PMID: 27597876 PMCID: PMC4997064 DOI: 10.1155/2016/5649169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/27/2016] [Accepted: 07/10/2016] [Indexed: 01/11/2023]
Abstract
We evaluated the effectiveness of Kuntai Capsule (KTC) for treating endometriosis using rat model and investigated its preliminary mechanism of action involved. SD rats were implanted with endometrial tissues and treated with KTC for three weeks. Then, laparotomy was performed to examine volume changes of the autografts. The serum levels of TNF-α, IL-6, COX-2, E2, and P4 were measured through ELISA. TUNEL was performed to analyze the apoptosis on ectopic endometrium. Protein levels of caspases 8, 9, and 3 and cytochrome c in the ectopic and eutopic endometrium were measured by western blotting. Results showed that KTC significantly decreased the volumes of ectopic endometrium. The level of TNF-α increased and E2 decreased in the KTC treatment groups. TUNEL and western blot assay showed that KTC could induce apoptosis of endometriotic tissues, accompanied with the increased protein expression of caspases 8 and 9, activated caspase-3, and cytochrome c in a dose-dependent manner. However, these protein expression profiles were not affected in eutopic endometrium. Our findings suggest that KTC could inhibit the growth of ectopic endometrial tissue through upregulating the level of TNF-α and its downstream signaling, including caspases and cytochrome c.
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Angioni S, Nappi L, Pontis A, Sedda F, Luisi S, Mais V, Melis GB. Dienogest. A possible conservative approach in bladder endometriosis. Results of a pilot study. Gynecol Endocrinol 2015; 31:406-8. [PMID: 25776993 DOI: 10.3109/09513590.2015.1006617] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Deep endometriosis involvement of the bladder is uncommon but it is symptomatic in most of the cases. Although laparoscopic excision is very effective, some patients with no pregnancy desire require a medical approach. We performed a pilot study on the effect of a new progestin dienogest on bladder endometriosis. Six patients were treated for 12 months with dienogest 2 mg/daily. Pain, urinary symptoms, quality of life, nodule volume and side effects were recorded. During treatment, symptoms improved very quickly and the nodules exhibit a remarkable reduction in size. Dienogest may be an alternative approach to bladder endometriosis.
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Affiliation(s)
- Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari , Monserrato , Italy
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Angioni S, Cela V, Sedda F, Stochino Loi E, Cofelice V, Pontis A, Melis GB. Focusing on surgery results in infertile patients with deep endometriosis. Gynecol Endocrinol 2015; 31:595-8. [PMID: 26172932 DOI: 10.3109/09513590.2015.1062868] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Infertility is a common problem in patients with endometriosis and the involved mechanisms are still not completely known. The management of infertility in endometriosis patients includes surgery as well as assisted reproductive technology. Laparoscopic surgery has shown better results in infertility patients with endometriosis in comparison to laparotomy procedures. Laparoscopic surgery has proposed benefits in both minimal to moderate diseases. However, while there may be some benefits with severe diseases, there is still not enough evidence to recommend laparoscopic surgery as the recommended surgery when the main goal is to obtain fertility. We performed a MEDLINE search for articles on fertility in women with deep infiltrating endometriosis (DIE) published between 1990 and April 2015 using the following keywords: "endometriosis", "deep infiltrative endometriosis", "infertility", "fertility after surgery", "laparoscopy surgery", "laparotomy", "pregnancy", "fertility outcome", "bladder endometriosis", and "ureteral endometriosis". The aim of this review was to analyze the results of available clinical studies (randomized controlled or not controlled studies; retrospective cohort studies; or case-control and prospective studies) and guidelines on surgical treatment of infertile endometriosis patients, and pregnancy outcomes after surgery.
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Affiliation(s)
- Stefano Angioni
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - Vito Cela
- b Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Pisa , Italy , and
| | - Federica Sedda
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - Emanuela Stochino Loi
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | - Vito Cofelice
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
| | | | - Gian Benedetto Melis
- a Division of Gynecology and Obstetrics, Department of Surgical Sciences , University of Cagliari , Cagliari , Italy
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Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A. Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol 2014; 20:15616-15623. [PMID: 25400445 PMCID: PMC4229526 DOI: 10.3748/wjg.v20.i42.15616] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Endometriosis is a gynecological condition that presents as endometrial-like tissue outside the uterus and induces a chronic inflammatory reaction. Up to 15% of women in their reproductive period are affected by this condition. Deep endometriosis is defined as endometriosis located more than 5 mm beneath the peritoneal surface. This type of endometriosis is mostly found on the uterosacral ligaments, inside the rectovaginal septum or vagina, in the rectosigmoid area, ovarian fossa, pelvic peritoneum, ureters, and bladder, causing a distortion of the pelvic anatomy. The frequency of bowel endometriosis is unknown, but in cases of bowel infiltration, about 90% are localized on the sigmoid colon or the rectum. Colorectal involvement results in alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia, and, rarely, rectal bleeding. Differential diagnosis must be made in case of irritable bowel syndrome, solitary rectal ulcer syndrome, and a rectal tumor. A precise diagnosis about the presence, location, and extent of endometriosis is necessary to plan surgical treatment. Multidisciplinary laparoscopic treatment has become the standard of care. Depending on the size of the lesion and site of involvement, full-thickness disc excision or bowel resection needs to be performed by an experienced colorectal surgeon. Long-term outcomes, following bowel resection for severe endometriosis, regarding pain and recurrence rate are good with a pregnancy rate of 50%.
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Abstract
The management of endometriosis with OC or progestins is generally safe, effective and well-tolerated and should constitute the first line of medical treatment in symptomatic patients who do not want to have children. Progestins, synthetic progestational agents, have been used in the management of symptomatic endometriosis both as primary therapy and as an adjunct to surgical time. A variety of oral agents have been employed in this regard and investigators have demonstrated differing degrees of benefit. The lack of a standardized instrument to evaluate painful symptoms makes comparative analysis more difficult. Concern about efficacy and side effect has pushed the research on the development of new well-tolerated drugs and to develop new administration routes to minimize general side effects. Aim of the present review is to present the results of clinical studies on new trends of progestins in the treatment of endometriosis.
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Affiliation(s)
- Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari , Monserrato , Italy
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28
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Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
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Angioni S, Pontis A, Dessole M, Surico D, De Cicco Nardone C, Melis I. Pain control and quality of life after laparoscopic en-block resection of deep infiltrating endometriosis (DIE) vs. incomplete surgical treatment with or without GnRHa administration after surgery. Arch Gynecol Obstet 2014; 291:363-70. [PMID: 25151027 DOI: 10.1007/s00404-014-3411-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 08/07/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the role of post-surgical medical treatment with GnRHa in patients with DIE (Deep Infiltrating Endometriosis) that received complete or incomplete surgery laparoscopic excision. METHODS Hundred fifty-nine patients with deep infiltrating endometriosis of the cul-de-sac and of the rectovaginal septum with pelvic pain undergoing laparoscopic surgery in academic tertiary-care medical center. Eighty patients underwent complete laparoscopic excision of DIE (Arm A) while 79 patients underwent incomplete surgery (Arm B). After surgery each surgical arm was randomized in two groups: no treatment groups 1A [40 pts] and 1B [40 pts] and GnRHa treatment for 6 months groups 2A [40 pts] and 2B [39 pts]. Pain recurrence and quality of life were evaluated in follow-up of 12 months and compared between groups. RESULTS No differences were observed between patient groups 1A and 2A. Groups 1A, 2A and 2B obtained significantly lower pain scores than those achieved by the group 1B undergoing incomplete surgical treatment and no post-surgical therapy. At 1-year follow-up patients treated with en-block resection (Groups 1A and 2A) showed the lowest pain scores and the highest quality of life in comparison with the other two groups (Group 1B and 2B). CONCLUSION GnRHa administration is followed by a temporary improvement of pain in patients with incomplete surgical treatment. It seems that it has no role on post-surgical pain when the surgeon is able to completely excise DIE implants.
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Affiliation(s)
- S Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy,
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Silveira da Cunha Araújo R, Abdalla Ayroza Ribeiro HS, Sekula VG, da Costa Porto BT, Ayroza Galvão Ribeiro PA. Long-Term Outcomes on Quality of Life in Women Submitted to Laparoscopic Treatment for Bowel Endometriosis. J Minim Invasive Gynecol 2014; 21:682-8. [DOI: 10.1016/j.jmig.2014.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 02/01/2023]
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Posterior Deep Infiltrating Endometriotic Nodules: Operative Considerations according to Lesion Size, Location, and Geometry, during One's Learning Curve. ISRN OBSTETRICS AND GYNECOLOGY 2014; 2014:853902. [PMID: 24579050 PMCID: PMC3918354 DOI: 10.1155/2014/853902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/27/2013] [Indexed: 11/18/2022]
Abstract
We conducted this prospective cohort study to standardize our laparoscopic technique of excision of posterior deep infiltrating endometriosis (DIE) nodules, according to their size, location, and geometry, including 36 patients who were grouped, according to principal pelvic expansion of the nodule, into groups with central (group 1) and lateral (group 2) lesions, and according to nodule size, into ≤2 cm (group A) and >2 cm (group B) lesions, respectively. In cases of group 1 the following operative steps were more frequently performed compared to those of group 2: suspension of the rectosigmoid, colpectomy, and placement of bowel wall reinforcement sutures. The opposite was true regarding suspension of the adnexa, systematic ureteric dissection, and removal of the diseased pelvic peritoneum. When grouping patients according to nodule size, almost all of the examined parameters were more frequently applied to patients of group B: adnexal suspension, suspension of the rectosigmoid, systematic ureteric dissection, division of uterine vein, colpectomy, and placement of bowel wall reinforcement sutures. Nodule size was the single most important determinant of duration of surgery. In conclusion, during the building-up of one's learning curve of laparoscopic excision of posterior DIE nodules, technique standardization is very important to avoid complications.
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Multidisciplinary laparoscopic treatment for bowel endometriosis. Best Pract Res Clin Gastroenterol 2014; 28:53-67. [PMID: 24485255 DOI: 10.1016/j.bpg.2013.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/02/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Endometriosis is a handicapping disease affecting young females in the reproductive period. It mainly occurs in the pelvis and affects the bowel in 3-37%. Endometriosis can cause menstrual and non-menstrual pelvic pain and infertility. Colorectal involvement results in alterations of bowel habit such as constipation, diarrhoea, tenesmus, and rarely rectal bleeding. A precise diagnosis about the presence, location and extent is necessary. Based on clinical examination, the diagnosis of bowel endometriosis can be made by transvaginal ultrasound, barium enema examination and magnetic resonance imaging. Multidisciplinary laparoscopic treatment has become the standard of care and depending on size of the lesion and site of involvement full-thickness disc excision or bowel resection is performed by an experienced colorectal surgeon. Anastomotic complications occur around 1%. Long-term outcome after bowel resection for severe endometriosis is good with a pregnancy rate of 50%.
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Alexithymia in Women with Deep Endometriosis? A Pilot Study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2014. [DOI: 10.5301/je.5000172] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives The aim of the study was to evaluate the presence of alexithymia in a group of patients with endometriosis and chronic pelvic pain, and compare the results obtained, with those for a group of healthy controls. Methods Forty-one patients with pain and surgical diagnosis of deep endometriosis and 40 healthy controls were recruited for the study. All subjects were assessed using the Toronto Alexithymia Scale (TAS-20). Moreover, the intensity of chronic pelvic pain and dysmenorrhea in patients was evaluated using a modified version of the Biberoglu-Behrman pain scale. In addition, the patients' state of general health was investigated with the SF-36. Results A positive score for alexithymia was achieved in 14.6% (n = 6) of patients with endometriosis, while the condition was absent in the control group. Alexithymia was indeterminate in 29.3% (n = 12) and 12.5% (n = 5) of patients and controls, respectively, and absent in 56.1% (n = 22) and 87.5% (n = 35). Intergroup differences were significant for 3 factors evaluated by the TAS-20. Discussion The present study underlined how women with endometriosis are significantly more alexithymic compared with controls.
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Guerriero S, Ajossa S, Gerada M, Virgilio B, Pilloni M, Galvan R, Laparte MC, Alcázar JL, Melis GB. Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.6.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Impact of laparoscopic colorectal segment resection on quality of life in women with deep endometriosis: one year follow-up. Qual Life Res 2013; 23:639-43. [DOI: 10.1007/s11136-013-0481-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/27/2022]
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Mangler M, Medrano N, Bartley J, Mechsner S, Speiser D, Schneider A, Köhler C. Value of diagnostic procedures in rectovaginal endometriosis. Aust N Z J Obstet Gynaecol 2013; 53:389-94. [DOI: 10.1111/ajo.12108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Mandy Mangler
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Natalie Medrano
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Julia Bartley
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Sylvia Mechsner
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | | | - Achim Schneider
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
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Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, Rodriguez I. Three-dimensional sonography for diagnosis of rectovaginal septum endometriosis: interobserver agreement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:931-935. [PMID: 23716513 DOI: 10.7863/ultra.32.6.931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the interobserver agreement for diagnosis of deep endometriosis of the rectovaginal septum using introital 3-dimensional (3D) sonography. METHODS Two experienced observers (observers A and B) performed a retrospective review of stored 3D sonographic volumes from a sample of 84 consecutive patients with a clinical suspicion of endometriosis. Each observer, independently and blinded to each other, evaluated the presence or absence of involvement of the rectovaginal septum. When no lesion was seen, the observers were asked to judge whether the acquisition of the volume was suboptimal for interpretation or whether no lesion on the rectovaginal septum was detectable. One inadequate acquisition case was discarded; a total of 83 cases were evaluated. To calculate the performance of introital 3D sonography, 7 discordant cases were reviewed by a third observer. Interobserver agreement was assessed by calculating the κ index, and the sensitivity, specificity, positive predictive value, and negative predictive value for the 3 observers were also determined. RESULTS Interobserver agreement was 0.816 (95% confidence interval, 0.69-0.93), representing very good agreement. Sensitivity was 74.1%; specificity, 85.7%; positive predictive value, 71.4%; and negative predictive value, 87.3%. CONCLUSIONS Our results show that introital 3D sonography for diagnosis of deep endometriosis of the rectovaginal septum is reproducible, with very good interobserver agreement.
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Affiliation(s)
- Maria Angela Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
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Endometriosis in adolescence. Obstet Gynecol Int 2012; 2012:869191. [PMID: 23093966 PMCID: PMC3474254 DOI: 10.1155/2012/869191] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 11/18/2022] Open
Abstract
Endometriosis is a common cause of pelvic pain and infertility. The majority of women report symptoms since adolescence, and there are rare cases of endometriosis in premenarchal age patients. Symptoms in adolescence are similar to those in adulthood. Treatment usually consists of oral contraceptives and nonsteroidal anti-inflammatory drugs. In cases where this treatment is not successful, laparoscopy and biopsy of the lesions are necessary for diagnosis. However, emerging new technologies provide new options, in particular the use of serological markers.
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Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand 2012; 91:692-8. [PMID: 22404128 DOI: 10.1111/j.1600-0412.2012.01394.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate sexual function, quality of life and pelvic pain after endometriosis surgery including vaginal resection. DESIGN Prospective observational study with 12 months follow up. SETTING Regional central hospital and university hospital. POPULATION Twenty-two patients with deep endometriotic nodules in the posterior fornix of the vagina undergoing complete excision of endometriosis, including vaginal resection. METHODS Sexual functioning was measured with the McCoy Female Sexuality Questionnaire, quality of life with a generic questionnaire (15D) and pain with a 10-point visual analog scale. Questionnaires were completed before and 12 months after the surgery. Main outcome measures. Changes in sexual function scores, quality-of-life scores and pain. RESULTS Twelve months after surgery, the sexual satisfaction score was higher (p= 0.03) and the sexual problems score lower (p= 0.04) compared with baseline values. Health-related quality-of-life scores for discomfort and symptoms (p= 0.001), distress (p= 0.04), vitality (p= 0.03) and sexual activity (p= 0.001), and the overall 15D score (p < 0.001), were significantly improved. The severity of all studied types of pain was significantly decreased (p < 0.05). CONCLUSIONS Complete excision of endometriosis, including vaginal resection, seems to offer a significant improvement in sexual functioning, quality of life and pelvic pain in symptomatic patients with deeply infiltrating endometriotic nodules in the posterior fornix of the vagina. This surgery may be associated with complications and adverse new-onset symptoms, and should be performed only after thorough consultation with the patient.
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Affiliation(s)
- Marjaleena Setälä
- Department of Obstetrics and Gynaecology, Päijät-Häme Central Hospital, Lahti, Finland.
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Abstract
Endometriosis usually affects reproductive-aged women and can be responsible for pain symptoms and infertility. Deep infiltrating endometriosis may involve the uterine ligaments (utero-sacral and/or round ligaments), the retrocervical area, the rectovaginal septum, the rectum, the vagina, and the bladder. The pre-operative assessment of such lesions is required to plan full surgical excision of the disease. Endometriotic lesions have some typical imaging patterns on transvaginal ultrasound and magnetic resonance imaging enabling pre-operative mapping of the disease. In this paper the authors report the imaging features of deep infiltrating endometriosis and the laparoscopic correlation of such lesions.
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Mabrouk M, Montanari G, Guerrini M, Villa G, Solfrini S, Vicenzi C, Mignemi G, Zannoni L, Frasca C, Di Donato N, Facchini C, Del Forno S, Geraci E, Ferrini G, Raimondo D, Alvisi S, Seracchioli R. Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study. Health Qual Life Outcomes 2011; 9:98. [PMID: 22054310 PMCID: PMC3247061 DOI: 10.1186/1477-7525-9-98] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 11/06/2011] [Indexed: 01/30/2023] Open
Abstract
Background Deep infiltrating endometriosis (DIE) can affect importantly patients' quality of life (QOL). The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment. Methods It is a prospective cohort study. In a tertiary care university hospital, between April 2008 and December 2009, 100 patients underwent laparoscopic management of DIE and completed preoperatively and 6-months postoperatively a QOL questionnaire, the short form 36 (SF-36). Quality of life was measured through the SF-36 scores. Intra-operative details of disease site, number of lesions, type of intervention, period of hospital stay and peri-operative complications were noted. Results Six months postoperatively all the women had a significant improvement in every scale of the SF-36 (p < 0,0005). Among patients with intestinal DIE, significant differences in postoperative scores of SF-36 were not detected between patients submitted to nodule shaving and segmental resection (p > 0.05). There was no significant difference in the SF-36 scores at 6 months from surgery between patients who received postoperative medical treatment and patients who did not (p > 0.05). Conclusions Laparoscopic excision of DIE lesions significantly improves general health and psycho-emotional status at six months from surgery without differences between patients submitted to intestinal segmental resection or intestinal nodule shaving.
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Affiliation(s)
- Mohamed Mabrouk
- Minimally Invasive Gynaecological Surgery Unit, S.Orsola Hospital, University of Bologna, Italy
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Payá V, Hidalgo-Mora JJ, Diaz-Garcia C, Pellicer A. Surgical treatment of rectovaginal endometriosis with rectal involvement. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10397-011-0663-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, Rodriguez I. Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography. Fertil Steril 2010; 94:2761-5. [DOI: 10.1016/j.fertnstert.2010.02.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 02/22/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
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Endométriose et douleurs pelvipérinéales chroniques. Prog Urol 2010; 20:1010-8. [DOI: 10.1016/j.purol.2010.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/16/2010] [Indexed: 11/21/2022]
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Guerriero S, Alcázar JL, Ajossa S, Pilloni M, Melis GB. Three-dimensional sonographic characteristics of deep endometriosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1061-1066. [PMID: 19643789 DOI: 10.7863/jum.2009.28.8.1061] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this presentation is to investigate the potential role of 3-dimensional (3D) sonography in the assessment of deep endometriosis. METHODS Cases of deep endometriosis are presented to illustrate the spectrum of appearances obtained with 3D sonography. In addition, we evaluate the possible role of other functions included in 3D equipment, such as the niche mode and tomographic ultrasound imaging (TUI). RESULTS Three-dimensional image rendering could allow a good analysis of the endometriotic nodule; in fact, in all presented cases, this reconstruction seems to clearly show the irregular shapes and borders of the lesions. This technique allows unrestricted access to an infinite number of viewing planes, which can be very useful for correctly locating lesions within the pelvis and evaluating the relationship with other organs. The stored 3D volumes can be reassessed and compared by the same or different examiners over time. This characteristic may be relevant for monitoring the effect of medical therapies over time. In the niche mode, sonographic imaging is represented as a "cut-open" view of the internal aspect of the nodule and its surrounding tissue. This additional function, which is associated with TUI, could be particularly useful for evaluation of the extension of a nodule in the rectovaginal septum, the depth of infiltration, and the relationship with the rectosigmoid junction or ureter. CONCLUSIONS In the near future, 3D sonography in deep infiltrating endometriosis could be an interesting mode of research with positive effects in everyday clinical practice.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy.
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Matsuzaki S, Houlle C, Botchorishvili R, Pouly JL, Mage G, Canis M. Excision of the posterior vaginal fornix is necessary to ensure complete resection of rectovaginal endometriotic nodules of more than 2 cm in size. Fertil Steril 2009; 91:1314-5. [DOI: 10.1016/j.fertnstert.2008.01.101] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
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Tarjanne S, Sjöberg J, Heikinheimo O. Rectovaginal endometriosis-characteristics of operative treatment and factors predicting bowel resection. J Minim Invasive Gynecol 2009; 16:302-6. [PMID: 19269901 DOI: 10.1016/j.jmig.2008.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/19/2008] [Accepted: 12/26/2008] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to characterize operative treatment of patients with rectovaginal endometriosis (RVE), with special emphasis on factors predicting bowel resection. DESIGN A total of 153 symptomatic cases undergoing radical resection of RVE at our institution between January 2000 and May 2004 were reviewed. Univariable and multivariable association models were used in connection with various factors associated with bowel resection. SETTING Tertiary referral center. MEASUREMENTS AND MAIN RESULTS In all, 57 (37%) patients were treated laparoscopically, and 96 (63%) patients via laparotomy. Gastrointestinal and/or urologic surgeon was present in 30% of cases. A total of 54 (35%) patients underwent bowel resection. The median (range) operating times were 145 (75-315) minutes and 100 (20-300) minutes for patients with and without bowel resection, respectively (p <.0001). Four (2.6%) major complications occurred. In the univariable association model, the risk of bowel resection was increased among patients with previous surgery for endometriosis (OR 2.74, 95% CI 1.35-5.54), intestinal symptoms (OR 2.55, 95% CI 1.29-5.02), and revised American Fertility Society score IV (OR 4.71, 95% CI 2.06-10.78). Preoperative use of combined oral contraceptives was associated with a lower risk of bowel resection (OR 0.32, 95% CI 0.15-0.66). CONCLUSION Operative treatment of RVE is demanding; a multidisciplinary approach is often needed. Patients with intestinal symptoms and those with a history of endometriosis surgery are at increased risk of bowel resection.
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Affiliation(s)
- Satu Tarjanne
- Department of Obstetrics and Gynecology, University of Helsinki, Finland
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Daraï E, Coutant C, Bazot M, Dubernard G, Rouzier R, Ballester M. [Relevance of quality of life questionnaires in women with endometriosis]. ACTA ACUST UNITED AC 2009; 37:240-5. [PMID: 19246235 DOI: 10.1016/j.gyobfe.2008.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
Abstract
High recurrence rates have been reported in women treated for endometriosis despite advances in medical and surgical treatments improving both fertility and symptoms. It should therefore be considered a chronic disorder. In this particular setting, the main objectives for practitioners are to limit disease progression, recurrence and to improve quality of life (QOL). Previous studies have demonstrated a relation between an increase in pain intensity and a decrease in QOL. However, visual analogue scales to measure general well-being are insufficient to quantify the impact of endometriosis on QOL. Several generic questionnaires, mainly the SF-36, are available in various languages but are not specific of women with endometriosis. Some specific questionnaires are available but have been validated in English population for the most part rending comparison between countries difficult. Despite these limits, QOL should be systematically monitored over time by a validated questionnaire for this chronic disorder and could be a criterion for therapeutic strategy.
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Affiliation(s)
- E Daraï
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, université Pierre-et-Marie-Curie Paris-VI, Paris, France.
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Berardo PT, Abrao MS, Souza MLS, Machado DE, Silva LCF, Nasciutti LE. Composition of sulfated glycosaminoglycans and immunodistribution of chondroitin sulfate in deeply infiltrating endometriosis affecting the rectosigmoid. Micron 2009; 40:639-45. [PMID: 19278856 DOI: 10.1016/j.micron.2009.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 02/05/2009] [Accepted: 02/10/2009] [Indexed: 12/25/2022]
Abstract
The composition of sulfated glycosaminoglycans (GAGs) and the tissue distribution of chondroitin sulfate (CS) were analyzed in deeply infiltrating endometriosis (DIE) of rectosigmoid, using metachromatic staining, and biochemical analysis employing electrophoresis before and after specific enzymatic or chemical degradations, and immunostaining with an antibody against CS. The sulfated GAGs were characterized as dermatan sulfate (DS), heparan sulfate (HS) and CS; and DS strongly predominated compared to HS and CS. Immunostaining procedures showed that CS was concentrated in the endometriosis foci, distributed throughout the stroma around the glands. This is the first report describing the composition of sulfated GAGs and the tissue location of CS in DIE by means of histochemical, biochemical and immunohistochemical analyses. These results confirmed that in DIE of rectosigmoid, as in eutopic endometrium [Nasciutti, L.E., Ferrari, R., Berardo, P.T., Souza, M.L.S., Takiya, C.M., Borojevic, R., Abrao, M.S., Silva, L.C.F., 2006. Distribution of chondroitin sulfate in human endometrium. Micron 37, 544-550], CS was the dominant sulfated GAG in stroma of the lesion foci.
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Affiliation(s)
- Plínio T Berardo
- Departamento de Histologia e Embriologia, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Cidade Universitária-Ilha do Fundão, 21941-590 Rio de Janeiro, RJ, Brazil
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