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Oppenheimer A, Boitrelle F, Nicolas‐Boluda A, Fauconnier A. Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines. Acta Obstet Gynecol Scand 2024; 103:799-823. [PMID: 38226426 PMCID: PMC11019533 DOI: 10.1111/aogs.14768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Sexual function of patients with endometriosis should be assessed by patient-reported outcome measures (PROMs) that present high reliability and validity. The objective was to study the PROMs used to assess sexual function for patients with endometriosis to improve their selection for research and clinical practice. MATERIAL AND METHODS We performed a systematic literature review from January 2000 to September 2023. All studies including women with confirmed endometriosis and assessing sexual quality of life or sexual function or sexual distress were retrieved. Different properties of PROMs used for sexual dysfunction were assessed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. Properties evaluated were: structural validity, internal consistency, cross-cultural validity, reliability, measurement error, criterion validity, construct validity, and responsiveness. This literature review was registered on Prospero as 2018 CRD42018102278. RESULTS Seventy-four articles with evaluation of sexual function were included. Of the 25 PROMs assessing sexual function, the Female Sexual Function Index (FSFI) was the most frequently used (34/74 [45.9%] items), followed by the Female Sexual Distress Scale (9/74 [12.2%] items) and the Sexual Activity Questionnaire (SAQ) (8/74 [10.8%] items). The most commonly used measurement properties were "hypothesis testing" and "responsiveness". The PROMs with a high level of evidence for these two measurement properties were the FSFI, the SAQ, the Short Sexual Functioning Scale, the Sexual Satisfaction Scale for Women, Sexual Quality of Life-Female, the Brief Profile of Female Sexual Function, and the Sexual Health Outcomes in Women Questionnaire. The FSFI questionnaire appeared to be more relevant for evaluating medical treatment, and the SAQ for evaluating surgical treatment. Only one instrument was specific to endometriosis (the Subjective Impact of Dyspareunia Inventory [SIDI]). CONCLUSIONS In this systematic literature review of sexual function assessment questionnaires in endometriosis, the FSFI and the SAQ questionnaires emerged as having the best measurement properties according to the COSMIN criteria. The FSFI questionnaire appears to be suited for evaluating medical treatment, and the SAQ for surgical treatment. The SIDI is the only specific questionnaire, but its responsiveness remains to be defined.
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Affiliation(s)
- Anne Oppenheimer
- EA 7285 Research Unit “Risk and Safety in Clinical Medicine for Women and Perinatal Health”Versailles‐Saint‐Quentin University (UVSQ)Montigny‐le‐BretonneuxFrance
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Department of Reproductive MedicineClinique de La MuetteParisFrance
| | - Florence Boitrelle
- Department of Reproductive Biology, Fertility Preservation, Andrology and CECOSPoissy HospitalPoissyFrance
- Department BREED, UVSQ, INRAEParis Saclay UniversityJouy‐en‐JosasFrance
| | | | - Arnaud Fauconnier
- Department of Reproductive Medicine and Fertility PreservationUniversity hospital Antoine BéclèreClamartFrance
- Centre Hospitalier Intercommunal de Poissy‐Saint‐Germain‐en‐LayeDepartment of Gynecology and ObstetricsPoissyFrance
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Grigoriadis G, Daniilidis A, Merlot B, Stratakis K, Dennis T, Crestani A, Chanavaz-Lacheray I, Roman H. Surgical treatment of deep endometriosis: Impact on spontaneous conception. Best Pract Res Clin Obstet Gynaecol 2024; 93:102455. [PMID: 38181664 DOI: 10.1016/j.bpobgyn.2024.102455] [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: 11/23/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
Deep endometriosis (DE) is the most severe form of endometriosis and is commonly associated with infertility. Surgical treatment of DE appears to increase chances of spontaneous conception in appropriately selected patients wishing to conceive. Identifying, however, the exact impact of DE, and its surgical removal, on natural conception is highly challenging. The surgical approach should be favoured in symptomatic patients with pregnancy intention. Limited data from infertile patients suggest that outcomes may not differ from patients without known infertility. Complex DE surgery carries a risk of serious complications, therefore, it should be performed in centers of expertise. Such complications may, however, not have a significant negative impact on fertility outcomes, according to limited available data. Data on obstetric outcomes of spontaneous conceptions after DE surgery are too scarce. In asymptomatic, infertile patients the debate between primary surgery or Artifial Reproductive Technology is ongoing, until randomized studies report their results.
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Affiliation(s)
| | - Angelos Daniilidis
- 1st Department in Obstetrics and Gynecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643, Thessaloniki, Greece
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
| | - Konstantinos Stratakis
- 1st Surgical Department, Peripheral General Hospital Giorgos Gennimatas, 11527, Athens, Greece
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Isabella Chanavaz-Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark.
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Jones GL, Budds K, Taylor F, Musson D, Raymer J, Churchman D, Kennedy SH, Jenkinson C. A systematic review to determine use of the Endometriosis Health Profiles to measure quality of life outcomes in women with endometriosis. Hum Reprod Update 2024; 30:186-214. [PMID: 38007607 PMCID: PMC10905511 DOI: 10.1093/humupd/dmad029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/06/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women's QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms 'EHP30', 'EHP5', 'EHP-30', 'EHP-5', 'endometriosis health profile 30', and 'endometriosis health profile 5'. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs' robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the 'control and powerlessness' domain post-intervention, followed by 'pain'. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.
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Affiliation(s)
- Georgina L Jones
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Kirsty Budds
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Francesca Taylor
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | - Danielle Musson
- Department of Psychology, School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK
| | | | | | - Stephen H Kennedy
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Dabi Y, Ebanga L, Favier A, Kolanska K, Puchar A, Jayot A, Ferrier C, Touboul C, Bendifallah S, Darai E. Discoid excision for colorectal endometriosis associated infertility: A balance between fertility outcomes and complication rates. J Gynecol Obstet Hum Reprod 2024; 53:102723. [PMID: 38211693 DOI: 10.1016/j.jogoh.2024.102723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The objective of our study was to study the impact of discoid excision for deep endometriosis (DE) with colorectal involvement on fertility outcomes. METHODS 49 patients with a desire for pregnancy treated with discoid excision for colorectal endometriosis in our endometriosis expert center between January 2015 and August 2020 were selected from our prospectively maintained database. Indications for surgery were either infertility and / or pelvic pain. Postoperative complications were graded according to the Clavien-Dindo classification. Fertility outcomes, both spontaneous and post-ART pregnancies, were analyzed. RESULTS Among the 49 patients who underwent discoid excision exclusively (no other digestive resection) with a desire to conceive, 25 had a pregnancy after surgery and 24 did not. Double discoid excision was performed in 6.1 % of the cases (3/49). A colpectomy was performed in 12.2 % of the patients (6/49), and a protective stoma in 12.2 % (6/49). Fenestration of endometriomas was performed in 28.6 % of the patients (14/49), and parametrectomy in 40.8 % (20/49). The postoperative complication rate was 24.5 % (12/49) including 10.2 % (5/49) grade I, 12.2 % (6/49) grade II, and 2 % (1/49) grade III. Prior to surgery, 28 (57.1 %) patients had infertility including 13 (52 %) that successfully conceived following surgery and 15 (62.5 %) that remain infertile. Spontaneous pregnancy was achieved in 60 % (15/25) of infertile patients' prior surgery. The live-birth rate in patients conceiving spontaneously was 75 % (12/16). CONCLUSION Our results support that discoid excision is safe and associated with good fertility outcomes. Whether first-line surgery using discoid excision is superior to first-line ART remains to be determined.
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Affiliation(s)
- Yohann Dabi
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
| | - Lea Ebanga
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Amélia Favier
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Kamila Kolanska
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Puchar
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Aude Jayot
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Clément Ferrier
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyril Touboul
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; GRC-6 Sorbonne University: Centre Expert en Endométriose (C3E), Paris, France; Unité INSERM UMR S 938, Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; GRC-6 Sorbonne University: Centre Expert en Endométriose (C3E), Paris, France; Unité INSERM UMR S 938, Sorbonne University, Paris, France
| | - Emile Darai
- Sorbonne University, Tenon Hospital, Department of Gynecology, Obstetrics and Reproductive Medicine, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France; GRC-6 Sorbonne University: Centre Expert en Endométriose (C3E), Paris, France; Unité INSERM UMR S 938, Sorbonne University, Paris, France
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Cho A, Park CM. Minimally invasive surgery for deep endometriosis. Obstet Gynecol Sci 2024; 67:49-57. [PMID: 37883994 DOI: 10.5468/ogs.23176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Deep endometriosis (DE) is endometriotic tissue that invades the peritoneum by >5 mm. Surgery is the treatment of choice for symptomatic DE, and laparoscopic surgery is preferred over laparotomy due to better vision and postoperative pain. In this review, we aimed to collect and summarize recent literature on DE surgery and share laparoscopic procedures for rectovaginal and bowel endometriosis.
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Affiliation(s)
- Angela Cho
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Chul-Min Park
- Department of Obstetrics and Gynecology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
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Fertility Outcomes after Surgical Management of Colorectal Endometriosis: A Single-center Retrospective Study. J Minim Invasive Gynecol 2023; 30:230-239. [PMID: 36509394 DOI: 10.1016/j.jmig.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/26/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To assess the pregnancy rate after surgery for colorectal endometriosis. DESIGN A retrospective, single-center study performed from January 2014 to December 2019. SETTING A university tertiary referral center. PATIENTS Patients with the intention to get pregnant younger than the age of 43 years, with or without a history of infertility and who were surgically managed for colorectal endometriosis. INTERVENTIONS Complete excision of deeply infiltrating endometriosis. MEASUREMENTS AND MAIN RESULTS The postoperative pregnancy rate was assessed. Seventy-seven patients had surgery; their mean age was 32.5 ± 4.4 years. Preoperative documented infertility was present in 77.9% of patients (n = 60). The mean length of history of infertility was 36.2 ± 24.9 months. The procedure was performed by laparoscopic surgery in 92.2% of patients (n = 71). Nonconservative, conservative, and mixed treatment were performed in 66.2% (n = 51), 29.9% (n = 23), and 3.9% of patients (n = 3), respectively. According to the Clavien-Dindo classification, the 3B complication rate was 6.5% (n = 5). The mean follow-up was 46.7 ± 20.6 months. Clinical pregnancies were defined by the presence of intrauterine pregnancy with an embryo with cardiac activity. The postoperative pregnancy rate was 62.3% (n = 48), and 54.2% (n = 26) were spontaneous. The mean number of pregnancies was 1.2 ± 0.4 per patient. In addition, 18.7% of patients (n = 9) got pregnant twice. The mean time from surgery to pregnancy was 13.8 ± 13.1 months. The live birth rate was 89.1% (n = 41). There were no significant differences concerning the prognostic criteria reported in the literature (antimüllerian hormone level, age, presence of adenomyosis). There were no predictive criteria for live births. CONCLUSION According to this study, surgery for colorectal endometriosis results in a high postoperative pregnancy rate. Studies with a high level of evidence are needed to determine good candidates for this type of surgery.
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Daniilidis A, Angioni S, Di Michele S, Dinas K, Gkrozou F, D’Alterio MN. Deep Endometriosis and Infertility: What Is the Impact of Surgery? J Clin Med 2022; 11:jcm11226727. [PMID: 36431203 PMCID: PMC9693611 DOI: 10.3390/jcm11226727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
In women with deep endometriosis, the spontaneous fertility rate might range from 2 to 10%. The optimal management of these women is still an area of debate. Therefore, this review aims to explore the literature on the impact of deep endometriosis surgery on reproductive outcomes and pregnancy rates in women with and without prior infertility. A total of 392 articles were identified through database searching. Twenty-three studies were eligible to be included in the review. A total of 1548 women were identified, 814 of whom became pregnant, with a mean pregnancy rate of 52.6% (95% CI 49.7-63%). Our review suggests that surgery may improve fertility outcomes. Due to the variability in the studies, it is impossible to stratify fertility outcomes of surgery by the localization of deep endometriosis. More investigations are needed to determine whether surgical management should be first-intention or limited to the failure of medically assisted reproduction treatment.
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Affiliation(s)
- Angelos Daniilidis
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
| | - Stefano Angioni
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Stefano Di Michele
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
| | - Konstantinos Dinas
- Department of Obstetrics and Gynecology, Hippokratio Hospital, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
| | - Fani Gkrozou
- University Clinic in Obstetrics and Gynecology, University of Ioannina, 451 10 Ioannina, Greece
| | - Maurizio Nicola D’Alterio
- Department of Surgical Science, University of Cagliari, Cittadella Universitaria Blocco I, Asse Didattico Medicna P2, Monserrato, 09042 Cagliari, Italy
- Correspondence: (A.D.); (M.N.D.); Tel.: +39-07051093399 (M.N.D.)
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Giannini A, Tebache L, Noti G, Cosimi G, Nisolle M, Simoncini T. Impact on ovarian reserve and fertility using carbon dioxide laser for endometriosis treatment: a systematic review. Gynecol Endocrinol 2022; 38:617-622. [PMID: 35822466 DOI: 10.1080/09513590.2022.2087218] [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] [Indexed: 10/17/2022] Open
Abstract
BackgroundThe application of carbon dioxide (CO2) laser for laparoscopic gynecologic surgery was introduced in 1979 and spread after improving instrumentation, due to the versatility of the CO2 laser technology and the parallel increase of laparoscopic use. In a gynecologic setting, laser laparoscopy has been demonstrated to be effective in treating infertility and pain associated with mild to severe endometriosis.Aim and methods: This document aims at conducting a systematic review to provide a comprehensive literature overview regarding the rationale, indications, safety, and efficacy of CO2 laser treatment of endometriosis and related outcomes on ovarian reserve and fertility.ResultsCO2 laser seems to lead to lower heat damage in the ovarian tissue than bipolar energy during endometriomas treatment. Moreover, several reports have pointed out that laser vaporization allows to selectively destroy the endometrioma wall's internal surface, preserving the pericystic fibrotic capsule or the adjacent healthy ovarian cortex. Despite this, robust data we have so far indicates that the most effective laparoscopic approach for managing endometriomas is the traditional excisional technique providing better postoperative outcomes than drainage and electrocoagulation, and laser treatment. Data about fertility after treatment of deep infiltrating endometriosis (DIE) using dioxide laser are emerging but very poor.ConclusionsCurrent scientific evidence in this field is inconclusive, and the debate about the safety and efficacy of the CO2 laser on fertility outcomes is still ongoing. Further randomized case-control studies are mandatory to attain more consistent evidence.
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Affiliation(s)
- Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Linda Tebache
- Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Liège, Belgium
| | - Giacomo Noti
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Giulia Cosimi
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, Hospital CHR Liège, University of Liège, Liège, Belgium
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
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Darici E, Salama M, Bokor A, Oral E, Dauser B, Hudelist G. Different segmental resection techniques and postoperative complications in patients with colorectal endometriosis: A systematic review. Acta Obstet Gynecol Scand 2022; 101:705-718. [PMID: 35661342 DOI: 10.1111/aogs.14379] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the available literature by conducting a systematic review to assess the possible effects of nerve-sparing segmental resection and conventional bowel resection on postoperative complications for the treatment of colorectal endometriosis. MATERIAL AND METHODS Pubmed, Clinical Trials.gov, Cochrane Library, and Web of Science were comprehensively searched from 1997 to 2021 in order to perform a systematic review. Studies including patients undergoing segmental resection for colorectal endometriosis including adequate follow-up, data on postoperative complications and postoperative sequelae were enrolled in this review. Selected articles were evaluated and divided in two groups: Nerve-sparing resection (NSR), and conventional segmental resection not otherwise specified (SRNOS). Within the NSRs, studies mentioning preservation of the rectal artery supply (artery and nerve-sparing SR - ANSR) and not reporting preservation of the artery supply (NSR not otherwise specified - NSRNOS) were further analyzed. PROSPERO ID CRD42021250974. RESULTS A total of 7549 patients from 63 studies were included in the data analysis. Forty-three of these publications did not mention the preservation or the removal of the hypogastric nerve plexus, or main rectal artery supply and were summarized as SRNOS. The remaining 22 studies were listed under the NSR group. The mean size of the resected deep endometriosis lesions and patients' body mass index were comparable between SRNOS and NSR. A mean of 3.6% (0-16.6) and 2.3% (0-10.5%) of rectovaginal fistula development was reported in patients who underwent SRNOS and NSR, respectively. Anastomotic leakage rates varied from 0% to 8.6% (mean 1.7 ± 2%) in SRNOS compared with 0% to 8% (mean 1.7 ± 2%) in patients undergoing NSR. Urinary retention (4.5% and 4.9%) and long-term bladder catheterization (4.9% and 5.6%) were frequently reported in SRNOS and NSR. There was insufficient information about pain or the recurrence rates for women undergoing SRNOS and NSR. CONCLUSIONS Current data describe the outcomes of different segmental resection techniques. However, the data are inhomogeneous and not sufficient to reach a conclusion regarding a possible advantage of one technique over the other.
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Affiliation(s)
- Ezgi Darici
- Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Zeynep Kâmil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey.,European Endometriosis League, Bordeaux, France
| | - Mohamed Salama
- Department of Thoracic Surgery, Nord Hospital, Vienna, Austria
| | - Attila Bokor
- European Endometriosis League, Bordeaux, France.,Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Engin Oral
- European Endometriosis League, Bordeaux, France.,Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Bernhard Dauser
- Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna, Austria
| | - Gernot Hudelist
- European Endometriosis League, Bordeaux, France.,Center for Endometriosis, Department of Gynecology, Hospital St. John of God, Vienna, Austria
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Behbehani S, Suárez-Salvador E, Yi J, Buras M, Kosiorek H, Magrina J. Pregnancy Rates After Surgical Resection of Deep Infiltrating Endometriosis in Patients with Infertility: A Systematic Review and Meta-Analysis. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sadikah Behbehani
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Department of Obstetrics and Gynecology, University of California, Riverside, California, USA
| | - Elena Suárez-Salvador
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
- Hospital Valle de Hebron of the Universidad Autonoma Barcelona, Barcelona, Spain
| | - Johnny Yi
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Matthew Buras
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Heidi Kosiorek
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Javier Magrina
- Department of Gynecological Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Barra F, Mikhail E, Villegas-Echeverri JD, Ferrero S. Infertility in patients with bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2021; 71:161-171. [DOI: 10.1016/j.bpobgyn.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
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Bokor A, Hudelist G, Dobó N, Dauser B, Farella M, Brubel R, Tuech JJ, Roman H. Low anterior resection syndrome following different surgical approaches for low rectal endometriosis: A retrospective multicenter study. Acta Obstet Gynecol Scand 2020; 100:860-867. [PMID: 33188647 DOI: 10.1111/aogs.14046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is increasing evidence that intermediate and long-term bowel dysfunction may occur as a consequence of radical surgery for rectal deep endometriosis (DE). Typical symptoms include constipation, feeling of incomplete evacuation, clustering of stools, and urgency. This is described in the colorectal surgical literature as low anterior resection syndrome (LARS). Within this, several studies suggested that differences regarding functional outcomes could be favorable to more conservative surgical approaches, that is, excision of endometriotic tissue with preservation of the luminal structure of the rectal wall when compared with classical segmental resection techniques for DE, especially when performed for low DE. MATERIAL AND METHODS A total of 211 patients undergoing rectal surgery for low DE (≤7 cm from the anal verge) in three different tertiary referral centers between October 2009 and December 2018 were retrospectively reviewed regarding major complications and LARS. From the 211 eligible patients, six women were excluded because of loss to follow-up. Finally, a total number of 205 patients were enrolled for the statistical analysis; 139 with nerve- and vessel-sparing segmental resection (NVSSR) and 66 operated for laparoscopic-transanal disk excision (LTADE) were included. Gastrointestinal functional outcomes of the two procedures were compared using the validated LARS questionnaire. The median follow-up time was 46 ± 11 months. As a secondary outcome, the surgical sequelae were examined. RESULTS We found no statistically significant difference between the incidence of LARS (31.7% and 37.9%, respectively) among patients operated by LTADE when compared with NVSSR (P = .4). The occurrence of LARS was positively associated with the use of protective ileostomy or colostomy (P = .02). A higher rate of severe complications was observed in women undergoing LTADE (19.7%) when compared with patients with NVSSR (9.0%, P = .029). CONCLUSIONS LARS is not more frequent after NVSSR when compared with a more conservative approach such as LTADE in patients undergoing rectal surgery for low DE. To confirm our findings prospective studies are required.
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Affiliation(s)
- Attila Bokor
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Gernot Hudelist
- Department of Gynecology, Center for Endometriosis St. John of God, Hospital St. John of God, Vienna, Austria
| | - Noémi Dobó
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Bernhard Dauser
- Department of General Surgery, Center for Endometriosis St. John of God, Hospital St. John of God, Vienna, Austria
| | | | - Réka Brubel
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Jean-Jacques Tuech
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France.,Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France
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Bendifallah S, Puchar A, Vesale E, Moawad G, Daraï E, Roman H. Surgical Outcomes after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:453-466. [PMID: 32841755 DOI: 10.1016/j.jmig.2020.08.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of type of surgery for colorectal endometriosis-rectal shaving or discoid resection or segmental colorectal resection-on complications and surgical outcomes. DATA SOURCES We performed a systematic review of all English- and French-language full-text articles addressing the surgical management of colorectal endometriosis, and compared the postoperative complications according to surgical technique by meta-analysis. The PubMed, Clinical Trials.gov, Cochrane Library, and Web of Science databases were searched for relevant studies published before March 27, 2020. The search strategy used the following Medical Subject Headings terms: ("bowel endometriosis" or "colorectal endometriosis") AND ("surgery for endometriosis" or "conservative management" or "radical management" or "colorectal resection" or "shaving" or "full thickness resection" or "disc excision") AND ("treatment", "outcomes", "long term results" and "complications"). METHODS OF STUDY SELECTION Two authors conducted the literature search and independently screened abstracts for inclusion, with resolution of any difference by 3 other authors. Studies were included if data on surgical management (shaving, disc excision, and/or segmental resection) were provided and if postoperative outcomes were detailed with at least the number of complications. The risk of bias was assessed according to the Cochrane recommendations. TABULATION, INTEGRATION, AND RESULTS Of the 168 full-text articles assessed for eligibility, 60 were included in the qualitative synthesis. Seventeen of these were included in the meta-analysis on rectovaginal fistula, 10 on anastomotic leakage, 5 on anastomotic stenosis, and 9 on voiding dysfunction <30 days. The mean complication rate according to shaving, disc excision, and segmental resection were 2.2%, 9.7%, and 9.9%, respectively. Rectal shaving was less associated with rectovaginal fistula than disc excision (odds ratio [OR] = 0.19; 95% confidence interval [CI], 0.10-0.36; p <.001; I2 = 33%) and segmental colorectal resection (OR = 0.26; 95% CI, 0.15-0.44; p <.001; I2 = 0%). No difference was found in the occurrence of rectovaginal fistula between disc excision and segmental colorectal resection (OR = 1.07; 95% CI, 0.70-1.63; p = .76; I2 = 0%). Rectal shaving was less associated with leakage than disc excision (OR = 0.22; 95% CI, 0.06-0.73; p = .01; I2 = 86%). No difference was found in the occurrence of leakage between rectal shaving and segmental colorectal resection (OR = 0.32; 95% CI, 0.10-1.01; p = .05; I2 = 71%) or between disc excision and segmental colorectal resection (OR = 0.32; 95% CI, 0.30-1.58; p = .38; I2 = 0%). Disc excision was less associated with anastomotic stenosis than segmental resection (OR = 0.15; 95% CI, 0.05-0.48; p = .001; I2 = 59%). Disc excision was associated with more voiding dysfunction <30 days than rectal shaving (OR = 12.9; 95% CI, 1.40-119.34; p = .02; I2 = 0%). No difference was found in the occurrence of voiding dysfunction <30 days between segmental resection and rectal shaving (OR = 3.05; 95% CI, 0.55-16.87; p = .20; I2 = 0%) or between segmental colorectal and discoid resections (OR = 0.99; 95% CI, 0.54-1.85; p = .99; I2 = 71%). CONCLUSION Colorectal surgery for endometriosis exposes patients to a risk of severe complications such as rectovaginal fistula, anastomotic leakage, anastomotic stenosis, and voiding dysfunction. Rectal shaving seems to be less associated with postoperative complications than disc excision and segmental colorectal resection. However, this technique is not suitable for all patients with large bowel infiltration. Compared with segmental colorectal resection, disc excision has several advantages, including shorter operating time, shorter hospital stay, and lower risk of postoperative bowel stenosis.
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Affiliation(s)
- Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï); UMRS-938 (Drs. Bendifallah and Daraï); Groupe de Recherche Clinique 6, Centre Expert En Endométriose (Drs. Bendifallah and Daraï), Sorbonne University, Paris
| | - Anne Puchar
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï)
| | - Elie Vesale
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï)
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr. Moawad)
| | - Emile Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï); UMRS-938 (Drs. Bendifallah and Daraï); Groupe de Recherche Clinique 6, Centre Expert En Endométriose (Drs. Bendifallah and Daraï), Sorbonne University, Paris
| | - Horace Roman
- Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux (Dr Roman), France; Department of Surgical Gynaecology, University Hospital of Aarhus, Aarhus, Denmark (Dr. Roman).
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Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, D'Hooghe T, Bourne T, D'Hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman D. IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:255-266. [PMID: 31503381 DOI: 10.1002/uog.21868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. METHODS This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs. RESULTS Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE. CONCLUSIONS Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Bielen
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - C Tomassetti
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - D Vanbeckevoort
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - L De Wever
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - T D'Hooghe
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
| | - T Bourne
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Gynecology and Obstetrics, Imperial College Healthcare NHS Trust, London, UK
| | - A D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | | | - C Meuleman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
- Leuven University Endometriosis Center, KU Leuven University Hospitals, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
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Bafort C, van Elst B, Neutens S, Meuleman C, Laenen A, d'Hoore A, Wolthuis A, Tomassetti C. Outcome after surgery for deep endometriosis infiltrating the rectum. Fertil Steril 2020; 113:1319-1327.e3. [PMID: 32482260 DOI: 10.1016/j.fertnstert.2020.02.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the rate of postoperative complications between conservative surgery and segmental resection in patients with rectal endometriosis. DESIGN Single-center retrospective study. SETTING University hospital. PATIENT(S) A total of 232 women undergoing surgery for deep endometriosis infiltrating the rectum up to 15 cm from the anus with at least involvement of the muscularis layer, stratified into two arms according to surgical technique. Subgroup analysis was performed in patients without previous therapeutic laparoscopy for endometriosis (n = 108). A propensity-score approach was used to correct for group differences. INTERVENTION(S) All patients underwent CO2-laser laparoscopic surgery: 61 underwent conservative surgery, and 171 had a segmental resection. MAIN OUTCOME MEASURE(S) Postoperative complication rate (Clavien-Dindo classification). RESULT(S) Clavien-Dindo type 1 and 2 complications did not differ between both groups. Clavien-Dindo type 3 complications were more frequent in the segmental resection group (1/61 [1.6%] conservative vs. 18/171 [10.5%] segmental), after propensity analysis only a trend was retained. In the subgroup analysis, no difference or trend was found (1/27 [3.7%] conservative vs. 5/81 [6.2%] segmental). A low rate of temporary diverting stoma was recorded: 24/232 (10.3%). CONCLUSION(S) A higher major complication (Clavien-Dindo ≥3) rate for segmental resections compared with conservative surgical treatment was shown in the overall population, although after correction for group differences this was attenuated to a trend only. However, in patients without previous therapeutic laparoscopy no significant difference or trend was found regardless of the surgical technique used. This not only suggests that redo/repeated surgery has a potentially increased morbidity, but also emphasizes the importance of a well executed primary surgery.
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Affiliation(s)
- Celine Bafort
- Department of Obstetrics and Gynecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Barbara van Elst
- Department of Obstetrics and Gynecology, Delta Hospital, Brussels, Belgium
| | - Sofie Neutens
- Department of Obstetrics and Gynecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium
| | - Christel Meuleman
- Department of Obstetrics and Gynecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Department of Public Health, Interuniversity Center for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - André d'Hoore
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Carla Tomassetti
- Department of Obstetrics and Gynecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Bendifallah S, Vesale E, Daraï E, Thomassin-Naggara I, Bazot M, Tuech JJ, Abo C, Roman H. Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:441-451.e2. [DOI: 10.1016/j.jmig.2019.09.791] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/27/2023]
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Khazali S, Gorgin A, Mohazzab A, Kargar R, Padmehr R, Shadjoo K, Minas V. Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients. Arch Gynecol Obstet 2019; 299:1619-1626. [PMID: 30953187 DOI: 10.1007/s00404-019-05144-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE). METHODS This was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1 month following surgery. RESULTS We analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8 min (± 80.7 standard deviation, range 60-440 min) and mean hospital stay was 2.9 days (± 1.5 standard deviation, range 1-11). The conversion to laparotomy rate was 1.6%. CONCLUSIONS A combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates.
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Affiliation(s)
- Shaheen Khazali
- Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford & St. Peter's Hospital NHS Foundation Trust, Chertsey, UK. .,Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran. .,Royal Holloway-University of London, Egham, UK.
| | - Atefeh Gorgin
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Arash Mohazzab
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Roxana Kargar
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Roya Padmehr
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Khadije Shadjoo
- Avicenna Centre for Endometriosis and Minimally Invasive Gynaecology (ACEMIG), Avicenna Research Institute, ACECR, Tehran, Iran
| | - Vasilis Minas
- Centre for Endometriosis and Minimally Invasive Gynaecology (CEMIG), Ashford & St. Peter's Hospital NHS Foundation Trust, Chertsey, UK
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Bourdel N, Chauvet P, Billone V, Douridas G, Fauconnier A, Gerbaud L, Canis M. Systematic review of quality of life measures in patients with endometriosis. PLoS One 2019; 14:e0208464. [PMID: 30629598 PMCID: PMC6328109 DOI: 10.1371/journal.pone.0208464] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/16/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Endometriosis and quality of life has been the subject of much research, however, there is little consensus on how best to evaluate quality of life in endometriosis, resulting in many and diverse scales being used. In our study, we aim to identify quality of life scales used in endometriosis, to review their strengths and weaknesses and to establish what would define an ideal scale in the evaluation of endometriosis-related quality of life. MATERIALS AND METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English and French for the period from 1980 to February 2017, using the words 'endometriosis' and 'quality of life'. Publications were selected if they reported on quality of life in patients with endometriosis and specified use of a quality of life scale. A quantitative and a qualitative analysis of each scale was performed in order to establish the strengths and weaknesses for each scale (systematic registration number: PROSPERO 2014: CRD42014014210). RESULTS A total of 1538 articles publications were initially identified. After exclusion of duplicates and application of inclusion criteria, 201 studies were selected for analysis. The SF-36, a generic HRQoL measure, was found to be the most frequently used scale, followed by the EHP-30, a measure specific to endometriosis. Both perform well, when compared with other scales, with scale weaknesses offset by strengths. EHP-5 and EQ-5D also showed to be of good quality. All four were the only scales to report on MCID studied in endometriosis patients. CONCLUSION For clinical practice, routine evaluation of HRQOL in women with endometriosis is essential both for health-care providers and patients. Both SF-36 and EHP-30 perform better overall with regard to their strengths and weaknesses when compared to other scales.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Pauline Chauvet
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
| | - Valentina Billone
- Department of Mother and Child, University Hospital P. Giaccone, Palermo, Italy
| | - Giannis Douridas
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Arnaud Fauconnier
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, EA 7285 Research Unit ‘Risk and Safety in Clinical Medicine for Women and Perinatal Health’, Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Laurent Gerbaud
- Dept of Public Health, PEPRADE, Université Clermont Auvergne, CHU Clermont-Ferrand, France, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Michel Canis
- Department of Gynaecological Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Faculty of Medecine, ISIT-University of Auvergne, Clermont-Ferrand, France
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Arcoverde FVL, Andres MDP, Borrelli GM, Barbosa PDA, Abrão MS, Kho RM. Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2018; 26:266-278. [PMID: 30244153 DOI: 10.1016/j.jmig.2018.09.774] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 11/27/2022]
Abstract
Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, was conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: all types endometriosis, deep infiltrative endometriosis (DIE), and bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean differences between the 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (.21; 95% confidence interval [CI], .04-.38); significant improvement after surgical treatment for DIE in Vitality (.67; 95% CI, .41-.94), Social Functioning (.59; 95% CI, .18-.99), Role Emotional .49; 95% CI, .02-.97), Mental Health (.39; 95% CI, .03-.74), Physical Functioning (.93; 95% CI, .49-1.38), Bodily Pain (1.23; 95% CI, .47-1.99), General Health (.57; 95% CI, .02-1.12), MCS (.55; 95% CI, .10-1.00), and Physical Component Score (PCS; .73; 95% CI, .27-1.18); and significant improvement after surgery for bowel endometriosis for all 8 domains (Vitality [1.00; 95% CI, .56-1.43], Social Functioning [.97; 95% CI, .57-1.37], Role Emotional [1.17; 95% CI, .7-1.63], Mental Health [.94; 95% CI, .5-1.38], Physical Functioning [.74; 95% CI, .3-1.18], Role Physical [1.25; 95% CI, .75-1.76], Bodily Pain [1.39; 95% CI, .79-1.98], General Health [.84; 95% CI, 1.46-1.22]), MCS (.93; 95% CI, .47-1.40), PCS (.82; 95% CI, .40-1.23), and total score (1.15; 95% CI, .48-1.83). Only 1 study assessed patients with minimal disease and showed significant improvement in PCS (p = .002) and MCS (p <.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in most health domains of health-related QOL, with the greatest improvement found in the Bodily Pain domain.
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Affiliation(s)
- Fernanda Vieira Lins Arcoverde
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina de Paula Andres
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Giuliano Moysés Borrelli
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila de Almeida Barbosa
- Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Mauricio Simões Abrão
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and.
| | - Rosanne Marie Kho
- Benign Gynecology Surgery Section (Dr. Kho), Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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Vercellini P, Facchin F, Buggio L, Barbara G, Berlanda N, Frattaruolo MP, Somigliana E. Management of Endometriosis: Toward Value-Based, Cost-Effective, Affordable Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:726-749.e10. [DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
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Ballester M, Roman H. [Surgical management of deep endometriosis with colorectal involvement: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29534879 DOI: 10.1016/j.gofs.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Deep endometriosis with colorectal involvement is considered one of the most severe forms of the disease due to its impact on patients' quality of life and fertility but also by the difficulties encountered by the clinicians when proposing a therapeutic strategy. Although the literature is very rich, evidence based medicine remains poor explaining the great heterogeneity concerning the management of such patients. Surgery therefore remains a therapeutic option. It improves the intensity of gynecological, digestive and general symptoms and the quality of life. Concerning the surgical approach, it appears that laparoscopy should be the first option; the laparoscopic robot-assisted route can also be proposed. The techniques of rectal shaving, discoid resection and segmental resection are the three techniques used for surgical excision of colorectal endometriosis. The parameters taken into account for the use of either technique are: the surgeon's experience, the depth of infiltration of the lesion within the rectosigmoid wall, the lesion size and circumference, multifocality and the distance of the lesion from the anal margin. In the case of deep endometriosis with colorectal involvement, performing an incomplete surgery increases the rate of pain recurrence and decreases postoperative fertility. In case of surgery for colorectal endometriosis, pregnancy rates are similar to those obtained after ART in non-operated patients. Existing data are insufficient to formally recommend first line surgery or ART in infertile patients with colorectal endometriosis. The surgery for colorectal endometriosis exposes to a risk of postoperative complications and recurrence of which the patients should be informed preoperatively.
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Affiliation(s)
- M Ballester
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - H Roman
- Centre expert de diagnostic et prise en charge multidisciplinaire de l'endométriose, clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
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Jayot A, Nyangoh Timoh K, Bendifallah S, Ballester M, Darai E. Comparison of Laparoscopic Discoid Resection and Segmental Resection for Colorectal Endometriosis Using a Propensity Score Matching Analysis. J Minim Invasive Gynecol 2018; 25:440-446. [DOI: 10.1016/j.jmig.2017.09.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/04/2017] [Accepted: 09/24/2017] [Indexed: 02/02/2023]
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Bokor A, Lukovich P, Csibi N, D'Hooghe T, Lebovic D, Brubel R, Rigo J. Natural Orifice Specimen Extraction during Laparoscopic Bowel Resection for Colorectal Endometriosis: Technique and Outcome. J Minim Invasive Gynecol 2018; 25:1065-1074. [PMID: 29454144 DOI: 10.1016/j.jmig.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE To present a detailed description of a modified natural orifice specimen extraction (NOSE) colectomy technique. We also report the postoperative outcomes of our prospective case series when compared with conventional laparoscopic bowel resection in a relatively large series of patients. DESIGN Canadian Task Force classification II-1. SETTING A university tertiary referral center. PATIENTS The last 90 consecutive patients in our care with deep infiltrating endometriosis of the bowel are presented in this study. Patients were diagnosed at the 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary. INTERVENTIONS We performed laparoscopic bowel resection using the transrectal NOSE technique and compared the results of the new operative method (n = 30) with traditional laparoscopic bowel resection (n = 60). MEASUREMENTS AND MAIN RESULTS The median duration of surgery was 121 minutes in the control group and 96 minutes in the NOSE group (p = .005). According to the Clavien-Dindo classification, we observed a severe, grade IIIb or higher, overall complication rate of 3.3% among all 90 patients. In the control group, anastomosis insufficiency occurred in 3.3% of patients (2/60 cases), and in 1 patient with anastomotic leakage a rectovaginal fistula was observed (1.7%). There was no significant difference in the rates of severe postoperative complications (p = .55). The length of hospital stay in the control group was a median of 7 days (range, 5-13 days), whereas in the NOSE group it was 6 days (range, 3-11 days) (p < .001). CONCLUSION According to our findings, the use of NOSE colectomy offers a shorter recovery time and can eventually lead to a shorter surgery duration compared with traditional laparoscopic bowel resection.
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Affiliation(s)
- Attila Bokor
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
| | - Peter Lukovich
- Department of Surgery, St John Hospital, Budapest, Hungary
| | - Noemi Csibi
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | | | - Dan Lebovic
- Center for Reproductive Medicine, Minneapolis, Minnesota
| | - Reka Brubel
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Janos Rigo
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril 2017; 108:931-942. [PMID: 29202966 DOI: 10.1016/j.fertnstert.2017.09.006] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Abstract
Deep endometriosis (DE) remains the most difficult endometriotic entity to treat. Medical treatment for DE can reduce symptoms but does not cure the disease, and surgical removal of the lesion is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Although several surgical techniques such as laparoscopic bowel resection, disc excision, and rectal shaving have been described, there is no consensus regarding the choice of technique or the timing of surgery. Our review of publications reporting results and complications of surgery for rectovaginal DE reveals a relatively higher complication rate after bowel resection compared with shaving and disc excision, especially for rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization. Data show that shaving is feasible even in advanced disease. The risk of immediate complications after shaving and disc excision is probably lower than after colorectal resection, allowing for better functional outcomes. The presumed higher risk of recurrence related to shaving has not been demonstrated. For these reasons, surgeons should consider rectal shaving as a first-line surgical treatment of rectovaginal DE, regardless of nodule size or association with other digestive localizations. When the result of rectal shaving is unsatisfactory (rare cases), disc excision may be performed either exclusively by laparoscopy or by using transanal staplers. Segmental resection may ultimately be reserved for advanced lesions responsible for major stenosis or for several cases of multiple nodules infiltrating the rectosigmoid junction or sigmoid colon.
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Affiliation(s)
- Olivier Donnez
- Institut du sein et de Chirurgie gynécologique d'Avignon, Polyclinique Urbain V (Elsan Group), Avignon, France, and Pôle de recherche en gynécologie, IREC institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
| | - Horace Roman
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics and Research Group EA 4308 Spermatogenesis and Male Gamete Quality, Rouen University Hospital, Rouen, France
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Daraï E, Bendifallah S, Chabbert-Buffet N, Golfier F. [Creation of expert centers on endometriosis]. Presse Med 2017; 46:1218-1222. [PMID: 29169709 DOI: 10.1016/j.lpm.2017.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022] Open
Abstract
Endometriosis is a frequent pathology with a high incidence of deep infiltrating endometriosis and complex forms that can affect 20% of patients with endometriosis. The incidence of infertility associated with endometriosis can reach 50%. The complexity of care requires the creation of expert centers working in networks with general practitioners. Criteria for defining these expert centers are being drawn up, based on structural criteria (multidisciplinary consultation meeting), links with medical assistance structures for procreation and activity criteria for severe and complex forms (number of interventions per center and per surgeon).
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Affiliation(s)
- Emile Daraï
- Université Pierre et Marie Curie (UPMC), Assistance publique des hôpitaux de Paris, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de La Chine, 75020 Paris 6, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UMPC), 75020 Paris, France; UMRS-938, Paris 6, 75012, Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France.
| | - Sofiane Bendifallah
- Université Pierre et Marie Curie (UPMC), Assistance publique des hôpitaux de Paris, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de La Chine, 75020 Paris 6, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UMPC), 75020 Paris, France
| | - Nathalie Chabbert-Buffet
- Université Pierre et Marie Curie (UPMC), Assistance publique des hôpitaux de Paris, hôpital Tenon, service de gynécologie-obstétrique et reproduction humaine, 4, rue de La Chine, 75020 Paris 6, France; Hôpital Tenon, centre expert en endométriose (C3E), groupe de recherche clinique (GRC-6 UMPC), 75020 Paris, France; UMRS-938, Paris 6, 75012, Paris, France; Hôpital Tenon, centre de diagnostic en un jour de l'endométriose (CDJE), 75020 Paris, France
| | - François Golfier
- CHU de Lyon, service de gynécologie-obstétrique, 69000 Lyon, France
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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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Daraï E, Cohen J, Ballester M. Colorectal endometriosis and fertility. Eur J Obstet Gynecol Reprod Biol 2017; 209:86-94. [DOI: 10.1016/j.ejogrb.2016.05.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 02/08/2023]
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Ballester M, Roman H, Mathieu E, Touleimat S, Belghiti J, Daraï E. Prior colorectal surgery for endometriosis-associated infertility improves ICSI-IVF outcomes: results from two expert centres. Eur J Obstet Gynecol Reprod Biol 2017; 209:95-99. [DOI: 10.1016/j.ejogrb.2016.02.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Rogers PAW, Adamson GD, Al-Jefout M, Becker CM, D’Hooghe TM, Dunselman GAJ, Fazleabas A, Giudice LC, Horne AW, Hull ML, Hummelshoj L, Missmer SA, Montgomery GW, Stratton P, Taylor RN, Rombauts L, Saunders PT, Vincent K, Zondervan KT. Research Priorities for Endometriosis. Reprod Sci 2017; 24:202-226. [PMID: 27368878 PMCID: PMC5933154 DOI: 10.1177/1933719116654991] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The 3rd International Consensus Workshop on Research Priorities in Endometriosis was held in São Paulo on May 4, 2014, following the 12th World Congress on Endometriosis. The workshop was attended by 60 participants from 19 countries and was divided into 5 main sessions covering pathogenesis/pathophysiology, symptoms, diagnosis/classification/prognosis, disease/symptom management, and research policy. This research priorities consensus statement builds on earlier efforts to develop research directions for endometriosis. Of the 56 research recommendations from the 2011 meeting in Montpellier, a total of 41 remained unchanged, 13 were updated, and 2 were deemed to be completed. Fifty-three new research recommendations were made at the 2014 meeting in Sao Paulo, which in addition to the 13 updated recommendations resulted in a total of 66 new recommendations for research. The research recommendations published herein, as well as those from the 2 previous papers from international consensus workshops, are an attempt to promote high-quality research in endometriosis by identifying and agreeing on key issues that require investigation. New areas included in the 2014 recommendations include infertility, patient stratification, and research in emerging nations, in addition to an increased focus on translational research. A revised and updated set of research priorities that builds on this document will be developed at the 13th World Congress on Endometriosis to be held on May 17-20, 2017, in Vancouver, British Columbia, Canada.
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Affiliation(s)
| | - G. David Adamson
- Palo Alto Medical Foundation Fertility Physicians of Northern California,
Palo Alto, CA, USA
- World Endometriosis Research Foundation (WERF), London, United Kingdom
| | | | - Christian M. Becker
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
| | | | - Gerard A. J. Dunselman
- Department of Obstetrics & Gynaecology, Research Institute GROW,
Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Linda C. Giudice
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- University of California, San Francisco, CA, USA
- World Endometriosis Society (WES), Vancouver, Canada
| | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh,
United Kingdom
| | - M. Louise Hull
- The Robinson Institute, University of Adelaide, Adelaide, Australia
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- World Endometriosis Society (WES), Vancouver, Canada
| | - Stacey A. Missmer
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- Harvard Schools of Medicine and Public Health, Boston, MA, USA
| | | | | | - Robert N. Taylor
- World Endometriosis Society (WES), Vancouver, Canada
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Luk Rombauts
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- World Endometriosis Society (WES), Vancouver, Canada
- Monash University, Clayton, Australia
| | - Philippa T. Saunders
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh,
United Kingdom
| | - Katy Vincent
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford,
United Kingdom
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30
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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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Afors K, Centini G, Fernandes R, Murtada R, Zupi E, Akladios C, Wattiez A. Segmental and Discoid Resection are Preferential to Bowel Shaving for Medium-Term Symptomatic Relief in Patients With Bowel Endometriosis. J Minim Invasive Gynecol 2016; 23:1123-1129. [DOI: 10.1016/j.jmig.2016.08.813] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
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Thomin A, Belghiti J, David C, Marty O, Bornes M, Ballester M, Roman H, Daraï E. Maternal and neonatal outcomes in women with colorectal endometriosis. BJOG 2016; 125:711-718. [DOI: 10.1111/1471-0528.14221] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Thomin
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - J Belghiti
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - C David
- Department of Gynaecology and Obstetrics; Rouen University Hospital; Hospital-Charles Nicolle; Rouen France
| | - O Marty
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - M Bornes
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - M Ballester
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
- UMRS938; Université Pierre et Marie Curie; Paris France
| | - H Roman
- Department of Gynaecology and Obstetrics; Rouen University Hospital; Rouen France
- Research Group 4308, Spermatogenesis and Gamete Quality; IHU Rouen Normandy; IFRMP23; Reproductive Biology Laboratory; Rouen University Hospital; Rouen France
| | - E Daraï
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
- UMRS938; Université Pierre et Marie Curie; Paris France
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Increasing the Quality of Surgery for Deep Endometriosis Should Be Based on Homogenous Clinical Patient Phenotype, Surgical Experience, and Standardized Outcome Reporting in Multicenter Multisurgeon Prospective Trials. Ann Surg 2015; 262:e26-8. [DOI: 10.1097/sla.0000000000000573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Impact of Surgical Excision of Deep Infiltrating Bowel Endometriosis on Health-Related Quality of Life: Review of Current Literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2015. [DOI: 10.5301/je.5000207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The aim of this study was to systematically review the impact of surgical excision of deep infiltrating endometriosis involving the bowel, on health-related quality of life, based on the currently available literature. Methods A systematic review was completed of English-language publications in the last 10 years, which had assessed the impact of surgical excision on quality of life in patients with deep infiltrating endometriosis of the bowel using standardized, validated quality-of-life questionnaires. Results Fourteen studies were identified. Standardized questionnaires used to assess the therapeutic impact on quality of life were the SF-36, SF-12, EHP-30, EQ-5D and 15D. Overall, women with bowel endometriosis scored lower on quality-of-life measures than the general population. Regardless of which standardized, validated questionnaire was used, surgical treatment had a positive impact on health-related quality of life. Conclusions Endometriosis, in particular deep infiltrating endometriosis of the bowel, has a profound impact on the quality of life of women diagnosed with the condition. Though surgical excision has a positive short-term impact, studies are needed to assess the long-term impact on quality of life in this lifelong, chronic, recurring condition.
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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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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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Vercellini P, Consonni D, Barbara G, Buggio L, Frattaruolo MP, Somigliana E. Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod Biomed Online 2014; 28:704-13. [DOI: 10.1016/j.rbmo.2014.02.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 02/03/2023]
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Clinical outcome after radical excision of moderate-severe endometriosis with or without bowel resection and reanastomosis: a prospective cohort study. Ann Surg 2014; 259:522-31. [PMID: 23579578 DOI: 10.1097/sla.0b013e31828dfc5c] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the clinical outcome of women requiring laparoscopic excision of moderate-severe endometriosis in women with and without bowel resection and reanastomosis. METHODS Two hundred three patients with laparoscopically excised moderate (n = 67) or severe (n = 136) endometriosis (rAFS: revised endometriosis classification of the American Fertility Society) were prospectively followed during a median of 20 months (1-45 months) using a CONSORT-inspired checklist. Patients completed the EHP30 Quality-of-Life Questionnaire and visual analogue scales (VAS) for dysmenorrhea, chronic pelvic pain, and deep dyspareunia and answered questions about postoperative complications, reinterventions/recurrences, and fertility outcome 1 month before and 6, 12, 18, and 24 months after surgery. Clinical outcome was compared between women with deeply infiltrative endometriosis undergoing CO2 laser ablative surgery with bowel resection (study group, 76/203; 37%) and without bowel resection (control group, 127/203; 63%). RESULTS Both groups were similar with respect to population characteristics and clinical outcome, except for mean rAFS score [higher in study group (73 ± 31) than in control group (48 ± 26)] and minor complication rate [higher in study group (11%) than in control group (1%)]. In both groups, mean VAS and EHP30 scores improved significantly and remained stable for 24 months after surgery, with a pregnancy rate of 51%. Within 1, 2, and 3 years follow-up, the cumulative reintervention rate was 1%, 7%, and 10%, respectively, and the cumulative endometriosis recurrence rate was 1%, 6%, and 8%, respectively. CONCLUSIONS Clinical outcome after CO2 laser laparoscopic excision of moderate-severe endometriosis was comparable in women with or without bowel resection and reanastomosis, except for a higher minor complication rate occurring in women with bowel resection and reanastomosis (NCT00463398).
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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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Van den Broeck U, Meuleman C, Tomassetti C, D'Hoore A, Wolthuis A, Van Cleynenbreugel B, Vergote I, Enzlin P, D'Hooghe T. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod 2013; 28:2389-97. [PMID: 23798058 DOI: 10.1093/humrep/det260] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION Is there a difference between women with endometriosis who underwent laparoscopic surgery with bowel resection or without bowel resection regarding depressive symptoms, relational adjustment and sexual functioning? SUMMARY ANSWER Radical surgery for endometriosis in both groups improved the levels of depression and sexual functioning, but only the bowel resection patients showed improvements in relationship satisfaction. WHAT IS KNOWN ALREADY?: The frequent pain symptoms in endometriosis patients can have an impact on psychological issues, relationships and sexual functioning. There are no data available on depression and relationship adjustment after endometriosis surgery. Sexual dysfunction problems have been described after bowel resection for rectal cancer, but no data are available for endometriosis surgery. STUDY DESIGN, SIZE, DURATION This prospective cohort study included 203 consecutive women operated at the Leuven University Fertility Center (LUFC) between 1 September 2006 and 30 September 2008 for moderate (n = 67) or severe (n = 136) endometriosis. The preoperative response rate was respectively 84% in the bowel resection group and 79% in the no bowel resection group. PARTICIPANTS, SETTING, METHODS The beck depression inventory (BDI) measured depression, the dyadic adjustment scale (DAS) measured relationship satisfaction and the short sexual functioning scale (SSFS) measured sexual functioning before and 6, 12 and 18 months after women had laparoscopic surgery at the LUFC, a tertiary referral centre for fertility exploration, treatment and surgery. MAIN RESULTS AND THE ROLE OF CHANCE Both groups had better post-operative outcomes when compared with the preoperative assessments. Mean BDI and DAS levels were comparable with the normal population. Overall assessment points, the bowel resection patients had better outcomes for DAS (P < 0.05) and SSFS 'arousal' (P < 0.05) than the no bowel resection patients. At 6 months after the operation, when compared with the no bowel resection group, the bowel resection group reported lower mean levels of BDI (P < 0.05), a lower incidence of SSFS 'pain during intercourse' and 'orgasm problems' (P < 0.05), and a lower proportion of patients with severe orgasm problems (P < 0.05). The data show that radical but fertility sparing surgery, with or without bowel resection, for the treatment of endometriosis results in comparable and good psychological outcomes concerning depression levels, relationship satisfaction and sexual functioning. LIMITATIONS, REASONS FOR CAUTION Although the initial response rate was good, response dropped over time and was significantly higher for bowel resection patients compared with the no bowel resection patients (P = 0.05). A responder/non-responder analysis for the whole study population showed no significant differences concerning pain problems. This reduces the possible risk of (positive) bias in the results. WIDER IMPLICATIONS OF THE FINDINGS Endometriosis is a complex condition and the focus should not be on a one-dimensional end-organ gynaecological outcome, but should take into account the role of psychological factors in pain-related outcome. To this end, more prospective data are needed on sexual functioning and psychological outcomes.
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Affiliation(s)
- U Van den Broeck
- Department of Gynaecology and Obstetrics, University Hospital Leuven, Campus Gasthuisberg, Leuven, Belgium.
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Tomassetti C, Geysenbergh B, Meuleman C, Timmerman D, Fieuws S, D'Hooghe T. External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery. Hum Reprod 2013; 28:1280-8. [PMID: 23462390 DOI: 10.1093/humrep/det017] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION Can the ability of the endometriosis fertility index (EFI) to predict non-assisted reproductive technology (ART) pregnancy after endometriosis surgery be confirmed by an external validation study? SUMMARY ANSWER The significant relationship between the EFI score and the time to non-ART pregnancy observed in our study represents an external validation of this scoring system. WHAT IS KNOWN AND WHAT THIS PAPER ADDS The EFI was previously developed and tested prospectively in a single center, but up to now no external validation has been published. Our data provide validation of the EFI in an external fertility unit on a robust scientific basis, to identify couples with a good prognosis for spontaneous conception who can therefore defer ART treatment, regardless of their revised American Fertility Society (rAFS) endometriosis staging. DESIGN Retrospective cohort study where the EFI was calculated based on history and detailed surgical findings, and related to pregnancy outcome in 233 women attempting non-ART conception immediately after surgery; all data used for EFI calculation and analysis of reproductive outcome had been collected prospectively as part of another study. PARTICIPANTS AND SETTING The EFI score was calculated (score 0-10) for 233 women with all rAFS endometriosis stages (minimal-mild, n = 75; moderate-severe, n = 158) after endometriosis surgery (1 September 2006-30 September 2010) in a university hospital-based reproductive medicine unit with combined expertise in reproductive surgery and medically assisted reproduction. All participants attempted non-ART conception immediately after surgery by natural intercourse, ovulation induction with timed intercourse or intrauterine insemination (with or without ovulation induction or controlled ovarian stimulation). DATA ANALYSIS METHOD All analyses were performed for three different definitions of pregnancy [overall (any HCG >25 IU/l), clinical and ongoing >20 weeks]. Six groups were distinguished (EFI scores 1-3, 4, 5, 6, 7+8, 9+10), and Kaplan-Meier (K-M) estimates for cumulative pregnancy rate were calculated. Subjects were censored when they were lost to follow-up, had subsequent surgery for endometriosis, started ovarian suppression or underwent ART. As K-M estimates might overestimate the actual event rate, cumulative incidence estimates treating ART as competing event were also calculated. Cox regression analysis was used to assess the performance of EFI and constituting variables. Performance of the score (prediction, discrimination) was quantified with the following methods: mean squared error of prediction (Brier score), areas under the receiver-operating curve and global concordance index C(τ). MAIN RESULTS AND THE ROLE OF CHANCE There was a highly significant relationship between the EFI and the time to non-ART pregnancy (cumulative overall pregnancy rate, P = 0.0004), with the K-M estimate of cumulative overall pregnancy rate at 12 months after surgery equal to 45.5% [95% confidence interval (CI) 39.47-49.87]-ranging from 16.67% (95% CI 5.01-47.65) for EFI scores 0-3, to 62.55% (95% CI 55.18-69.94) for EFI scores 9-10. For each increase of 1 point in the EFI score, the relative risk of becoming pregnant increased by 31% (95% CI 16-47%; i.e. hazard ratio 1.31). The 'least function score'-which assesses the tubal/ovarian function at conclusion of surgery-was found to be the most important contributor to the total EFI score among all the other variables (age, duration of infertility, prior pregnancy, AFS endometriosis lesion and total score). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION The EFI score had a moderate performance in the prediction of the pregnancy rate. Indeed, the decrease in prediction error was rather small, as shown by the decrease in Brier score from 0.213 to 0.198, and low estimates for R² (13%) and C(τ) (0.629). GENERALIZABILITY TO OTHER POPULATIONS As the EFI was validated externally in our own European population after initial testing by Adamson and Pasta (Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010;94:1609-1615) in an American population, it appears that the EFI can be used clinically to counsel infertile endometriosis patients receiving reproductive surgery in specialized centers about their post-operative conception options. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by funds obtained via the Clinical Research Fund of the University Hospitals Leuven, Belgium, via the Ferring Chair in Reproductive Medicine and Surgery, and the Serono Chair in Reproductive Medicine granted to the Leuven University Fertility Center. The authors have no conflicts of interest to declare.
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Affiliation(s)
- C Tomassetti
- KU Leuven, Leuven University Fertility Center, University Hospitals Leuven, 49 Herestraat, Leuven 3000, Belgium.
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Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet Gynecol 2012; 24:245-52. [PMID: 22729087 DOI: 10.1097/gco.0b013e3283556285] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To present the clinical outcome after laparoscopic radical excision of deeply infiltrative endometriosis (DIE) with colorectal extension and laparoscopic segmental bowel resection. RECENT FINDINGS In three different studies including mostly patients with recurrent DIE with colorectal extension, we showed that radical reconstructive CO2 laser laparoscopic resection of DIE with colorectal extension in a multidisciplinary setting resulted in a low complication rate, a low cumulative reintervention and recurrence rate and a high cumulative pregnancy rate, also when bowel resection reanastomosis was performed. In a systematic review to assess the clinical outcome of surgical treatment of DIE with colorectal involvement, data were reported in such a way that comparison of different surgical techniques was not possible. A checklist is proposed to achieve standardized reporting of presenting symptoms, preoperative tests, inclusion criteria, preoperative and postoperative care, complications, follow-up, patient-centered assessment of pain and quality of life, fertility and recurrence corrected for postoperative use of hormonal suppression or infertility treatment. SUMMARY CO2 laser laparoscopic radical excision of DIE with colorectal extension and laparoscopic segmental bowel resection in centers of expertise is associated with good clinical outcome. To make real progress, international agreement is needed on terms and definitions used in surgical endometriosis research.
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Jia SZ, Leng JH, Shi JH, Sun PR, Lang JH. Health-related quality of life in women with endometriosis: a systematic review. J Ovarian Res 2012; 5:29. [PMID: 23078813 PMCID: PMC3507705 DOI: 10.1186/1757-2215-5-29] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/01/2012] [Indexed: 12/24/2022] Open
Abstract
Endometriosis has critical implications for women's quality of life. However, an overview of the current knowledge of this issue is limited. The objective of this systematic review was to determine the extent of endometriosis and its treatment upon women's health-related quality of life (HRQoL). PubMed, Embase, PsycoINFO, CINAHL and the Cochrane Clinical Trials were searched up to May 2012, and only studies using standardized instruments to evaluate HRQoL in women with endometriosis were selected. Our electronic searches identified 591 citations, of which 39 studies satisfied the inclusion criteria including nine qualitative studies and 30 treatment-related studies. Findings showed that endometriosis impaired women's HRQoL. Pain was strongly related to a poor HRQoL, and medical or surgical treatment could partially restore this impairment. No conclusive evidence was available on whether endometriosis imposed an additional impairment in HRQoL per se, apart from the decrease caused by chronic pelvic pain, or on the superiority of various hormonal suppression agents. The impacts of disease extent, duration and fertility status upon HRQoL were inconsistent. In summary, HRQoL was impaired in women with endometriosis, and medical or surgical treatment to alleviate pain could partially restore this impairment.
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Affiliation(s)
- Shuang-Zheng Jia
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking, Union Medical College, P, R, China.
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Current World Literature. Curr Opin Obstet Gynecol 2012; 24:265-72. [DOI: 10.1097/gco.0b013e3283564f02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deep rectovaginal endometriotic nodules: perioperative complications from a series of 3,298 patients operated on by the shaving technique. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10397-012-0759-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ballester M, d'Argent EM, Morcel K, Belaisch-Allart J, Nisolle M, Darai E. Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study. Hum Reprod 2012; 27:1043-9. [DOI: 10.1093/humrep/des012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Vercellini P, Barbara G, Buggio L, Frattaruolo MP, Somigliana E, Fedele L. Effect of patient selection on estimate of reproductive success after surgery for rectovaginal endometriosis: literature review. Reprod Biomed Online 2012; 24:389-95. [PMID: 22377155 DOI: 10.1016/j.rbmo.2012.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 01/04/2012] [Indexed: 12/19/2022]
Abstract
The effect of rectovaginal endometriosis on fertility is unclear. Several authors foster radical surgery, including colorectal resection, as a fertility-enhancing procedure. However, interpretation of data is difficult, as the baseline fertility status is often undefined and it is not always possible to discriminate between spontaneous conceptions and those resulting from IVF. A systematic literature review was performed with the aim of defining the pregnancy rate specifically in patients who were infertile before surgery and who sought spontaneous pregnancy. A PubMed search was conducted to identify English language studies published between 2005 and 2011 evaluating reproductive performance after surgery for rectovaginal and rectosigmoid endometriosis. According to the results of the 11 selected studies, the mean post-operative conception rate in all women seeking pregnancy independently of preoperative fertility status and IVF performance was 39% (95% CI 35-43%; 223/571), but dropped to 24% (95% CI 20-28%; 123/510) in infertile patients who sought spontaneous conception (odds ratio 0.50, 95% CI 0.38-0.65%). Patients' selection significantly influences the estimate of the effect of rectovaginal endometriosis excision on infertility. This should be carefully taken into consideration at preoperative counselling. Rectovaginal endometriosis usually is associated with pain symptoms, but the effect of this disease form on fertility is uncertain, as burial of foci beneath rectouterine adhesions with exclusion of the deepest part of the pelvis may limit interference with fertilization processes. Several authors foster radical surgery, including colorectal resection, as a fertility-enhancing procedure. However, interpretation of data is difficult, as the baseline fertility status is often undefined and it is not always possible to discriminate between spontaneous conceptions and those resulting from IVF. A systematic literature review was performed with the aim of defining the pregnancy rate specifically in patients who were infertile before surgery and who sought pregnancy spontaneously. A PubMed search was conducted to identify English language studies published between 2005 and 2011 evaluating reproductive performance after surgery for rectovaginal and rectosigmoid endometriosis. According to the results of the 11 selected studies, the mean post-operative conception rate in all women seeking pregnancy independently of preoperative fertility status and IVF performance was 39% (223/571), but dropped to 24% (123/510) in infertile patients who sought conception spontaneously. The 15% difference is statistically significant. Infertile patients with rectovaginal endometriosis considering surgery, should be carefully informed of the real probability of post-operative conception avoiding generic overestimations.
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Affiliation(s)
- Paolo Vercellini
- Department of Obstetrics and Gynecology, Istituto Luigi Mangiagalli, University of Milan, Milan, Italy.
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