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Guo C, Chen MZ, Chiu T, Condous G, Barto W. The appendix in endometriosis. Aust N Z J Obstet Gynaecol 2023; 63:792-796. [PMID: 37427888 DOI: 10.1111/ajo.13730] [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: 12/30/2022] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND In the most severe stage of endometriosis, Stage IV, intestinal involvement is common. The true prevalence of endometriotic disease of the appendix in this population is not well described. A macroscopically normal looking appendix may harbour endometriosis. AIMS Our study aims to assess the role of routinely performing appendicectomy in Stage IV endometriosis surgery, and the histopathological prevalence of true appendiceal endometriosis in this population. METHODS This is a retrospective study of women undergoing surgery for Stage IV endometriosis between 2018 to 2022 in a tertiary public hospital in New South Wales, Australia. Patient demographics, age and post-operative complications were retrospectively retrieved from hospital medical records. Inclusion criteria were women with Stage IV endometriosis who underwent routine appendicectomy as part of their endometriosis surgery. Exclusion criteria were women who did not have Stage IV endometriosis, those who had cancer surgery or emergency surgery for endometriosis. The primary outcome of this study was to determine the incidence of appendiceal endometriosis. Secondary outcomes included post-operative complications and length of stay. RESULTS Sixty-seven patients were included. The mean age was 36 years. All patients also underwent bowel resection for colorectal endometriosis. There were 35.8% who had confirmed appendiceal endometriosis on histopathology. Post-operative complications included port site infections, colitis, urinary tract infection and ureteric injury. There were no complications related to appendicectomy. Mean length of stay was 4.4 days. CONCLUSION Laparoscopic appendicectomy can be safely performed at time of laparoscopic surgical excision of Stage IV endometriosis and should be routinely considered in a subset of Stage IV endometriosis patients with colorectal involvement undergoing surgery.
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Affiliation(s)
- Cici Guo
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - Michelle Zhiyun Chen
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tricia Chiu
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
| | - George Condous
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Walid Barto
- Department of Colorectal Surgery, Nepean Hospital, Sydney, New South Wales, Australia
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Galaviz VD, Nguyen AD, Sticco PL, Downing KT. Appendectomy in endometriosis: an update on surgical indications and management of uncommon diseases. Curr Opin Obstet Gynecol 2023; 35:377-382. [PMID: 37144569 DOI: 10.1097/gco.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Abnormal appendiceal disease is commonly encountered following an appendectomy when performed in patients with endometriosis. Appendiceal endometriosis is the most notable finding and can affect up to 39% of patients with endometriosis. Despite this knowledge, guidelines for performing an appendectomy have not been formally established. In this article, we review the surgical indications for an appendectomy at the time of endometriosis surgery and discuss the management of other diseases that may be encountered following the histopathologic evaluation of an excised appendix. RECENT FINDINGS Removal of the appendix in patients with endometriosis contributes to optimal surgical management. Relying on abnormal appendiceal appearance for removal may leave endometriosis-affected appendices. For this reason, utilizing risk factors to guide surgical management is essential. Common appendiceal diseases are sufficiently managed with appendectomy. Uncommon diseases may require further surveillance. SUMMARY Emerging data in our field support the performance of an appendectomy at the time of endometriosis surgery. Guidelines for performing a concurrent appendectomy should be formalized to encourage preoperative counselling and management for patients with risk factors for appendiceal endometriosis. Abnormal diseases is frequently encountered after appendectomy in the setting of endometriosis surgery and further management is based on the histopathology of the specimen.
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Allahqoli L, Mazidimoradi A, Momenimovahed Z, Günther V, Ackermann J, Salehiniya H, Alkatout I. Appendiceal Endometriosis: A Comprehensive Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13111827. [PMID: 37296678 DOI: 10.3390/diagnostics13111827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Objective: the purpose of this review was to evaluate the prevalence of appendiceal endometriosis and the safety of concomitant appendectomy in women with endometriosis or pelvic pain. Materials and Methods: We searched the electronic databases Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was not subject to any limitation in terms of time or method. The primary research question was: what is the prevalence of appendiceal endometriosis? The secondary research question was: is it safe to perform appendectomy during surgery for endometriosis? Publications that reported data about appendiceal endometriosis or appendectomy in women with endometriosis were reviewed regarding the inclusion criteria. Results: We found 1418 records. After review and screening, we included 75 studies published between 1975 and 2021. With regard to the first question of the review, we found 65 eligible studies and divided these into the following two categories: (a) endometriosis of the appendix presenting as acute appendicitis, and (b) endometriosis of the appendix as an incidental finding in gynecological surgery. Forty-four case reports described appendiceal endometriosis in women who were admitted for the treatment of pain in the right-sided lower abdomen. Endometriosis of the appendix was observed in 2.67% (range, 0.36-23%) of women who were admitted due to acute appendicitis. In addition, appendiceal endometriosis was an incidental finding during gynecological surgery in 7.23% of cases (range, 1-44.3%). With regard to the second question of the review, which was the safety of appendectomy in women with endometriosis or pelvic pain, we found 11 eligible studies. Reviewed cases had no significant intraoperative or follow-up complications during the 12 weeks. Conclusion: Based on the reviewed studies, coincidental appendectomy appears reasonably safe and was associated with no complications in the cases reviewed for the present report.
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Affiliation(s)
- Leila Allahqoli
- Ministry of Health and Medical Education, Tehran 1467664961, Iran
| | - Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7134814336, Iran
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom 3716993456, Iran
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Johannes Ackermann
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Kiel School of Gynaecological Endoscopy, Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105 Kiel, Germany
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Ma L, Wen B, Wen Z. A Systematic Review and Meta-Analysis of the Efficacy of Uterine Artery Embolization in the Treatment of Endometriosis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:8966063. [PMID: 36248948 PMCID: PMC9553446 DOI: 10.1155/2022/8966063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/07/2022] [Indexed: 11/22/2022]
Abstract
Objective To compare the efficacy of uterine artery embolization (UAE) with traditional methods for treating endometriosis. Methods The randomized controlled trials of uterine artery embolization and other medical treatments for endometriosis in PubMed, Embase, Web of Science, Cochrane Library, China Journal Full-Text Database, Wanfang Database, VIP Database, and China Biomedical Literature Database were retrieved by computer. The search time was up to June 2022. The quality of articles was evaluated by Cochrane ROB 2.0, and meta-analysis was performed by Stata15.1 software. Results 7 studies were finally included. Meta-analysis showed that the serum CA125 level after uterine artery embolization was significantly lower than that in the control group (SMD = -0.85, 95%CI (-1.12, -0.59)], and the postoperative visual analogue scale (VAS) of dysmenorrhea was significantly lower than that in the control group (SMD = -1.86, 95%CI (-2.21, -1.50)) There was no significant difference in the effective rate, FSH level, E2 level, and LH level between the two groups. Conclusion UAE can effectively reduce the VAS score of dysmenorrhea and serum CA125 level for treating endometriosis. However, due to the limitation of the quality of included articles, more large sample size and high quality RCTs are needed to provide stronger evidence-based medicine evidence for clinical practice.
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Affiliation(s)
- Li Ma
- Operating Room,the First Hospital of China Medical University, Shenyang 110001, Liaoning, China
| | - Bingxin Wen
- Department of General Surgery,Jin Qiu Hospital of Liaoning, Shenyang 110016, Liaoning, China
| | - Zhenhua Wen
- Operating Room,the First Hospital of China Medical University, Shenyang 110001, Liaoning, China
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Pascoal E, Wessels JM, Aas-Eng MK, Abrao MS, Condous G, Jurkovic D, Espada M, Exacoustos C, Ferrero S, Guerriero S, Hudelist G, Malzoni M, Reid S, Tang S, Tomassetti C, Singh SS, Van den Bosch T, Leonardi M. Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:309-327. [PMID: 35229963 DOI: 10.1002/uog.24892] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State-of-the-Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold-standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Pascoal
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - J M Wessels
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- AIMA Laboratories Inc., Hamilton, Canada
| | - M K Aas-Eng
- Department of Gynecology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M S Abrao
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - G Condous
- Acute Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School, Nepean Hospital, Sydney, Australia
| | - D Jurkovic
- Institute for Women's Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - M Espada
- Department of Obstetrics and Gynaecology, Blue Mountains ANZAC Memorial Hospital, Katoomba, Australia
- Sydney Medical School, Sydney, Australia
| | - C Exacoustos
- Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Cagliari, Italy
| | - G Hudelist
- Department of Gynecology, Center for Endometriosis, St John of God Hospital, Vienna, Austria
- Scientific Endometriosis Foundation (SEF), Westerstede, Germany
| | - M Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - S Reid
- Department of Obstetrics and Gynaecology, Western Sydney University, Sydney, Australia
| | - S Tang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - C Tomassetti
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven University Fertility Centre, Leuven, Belgium
| | - S S Singh
- Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Canada
| | - T Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium
| | - M Leonardi
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
- Sydney Medical School, Sydney, Australia
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Kiyokawa T. Peritoneal Pathology Review: Mullerian, Mucinous and Mesothelial Lesions. Surg Pathol Clin 2022; 15:259-276. [PMID: 35715161 DOI: 10.1016/j.path.2022.02.005] [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] [Indexed: 06/15/2023]
Abstract
This review provides an overview of the pathology of selected benign and malignant lesions of the female peritoneum and their often-encountered differential diagnoses. It includes endometriosis and its related lesions, endosalpingiosis, pseudomyxoma peritonei (PMP) and related ovarian/appendiceal pathology, and malignant and benign mesothelial tumors. The current terminology associated with PMP is also discussed.
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Affiliation(s)
- Takako Kiyokawa
- Department of Pathology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo 105-8461, Japan.
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Villaescusa M, Andres MP, Amaral AC, Barbosa RN, Abrão MS. Endometriosis and its relation with carcinoid tumor of the appendix: a systematic review. Minerva Obstet Gynecol 2021; 73:606-613. [PMID: 33904692 DOI: 10.23736/s2724-606x.21.04792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The prevalence of appendiceal endometriosis ranges from 0.4% to 22%. The carcinoid tumor is the most common neoplasm of the appendix, with incidence ranging from 0.3% to 0.9%. Appendix lesions develop in up to 22% of women with deep infiltrative endometriosis. Even though these are most likely endometriosis, carcinoid tumors should always be considered. The aim of this review was to assess the prevalence of appendiceal carcinoid tumors and appendiceal endometriosis in patients undergoing gynecologic surgery, its association with endometriosis, and related symptoms. EVIDENCE ACQUISITION We included retrospective and prospective studies that assessed women who underwent appendicectomy in the past 20 years for appendiceal endometriosis and/or appendix carcinoid tumor confirmed by histological analysis. Results were reported as relative and absolute frequencies. Due to the heterogeneity of included studies, a statistical analysis (meta-analysis) was not performed. EVIDENCE SYNTHESIS The prevalence of appendiceal endometriosis was 15.2% in patients who underwent surgery for pelvic endometriosis and 11.4% in those who underwent benign gynecological surgery. Conversely, carcinoid tumors of the appendix were present in 2.4% of endometriosis patients and 1.3% of other benign gynecological surgeries. CONCLUSIONS The rates of carcinoid tumors in patients with endometriosis are the same as in the general population. Given the risk of a malignant appendiceal tumor, in all gynecological surgeries, especially those for endometriosis, the appendix should be inspected and removed if it has an abnormal appearance.
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Affiliation(s)
- Marina Villaescusa
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Marina P Andres
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil.,Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandre C Amaral
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Rodrigo N Barbosa
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil.,Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mauricio S Abrão
- Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil - .,Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Ross WT, Chu A, Li L, Kunselman AR, Harkins GJ, Deimling TA, Benton AS. Appendectomy in the surgical management of women with endometriosis and pelvic pain. Int J Gynaecol Obstet 2021; 154:526-531. [PMID: 33483967 DOI: 10.1002/ijgo.13614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the role of appendectomy in surgical excision of endometriosis and to assess complications associated with appendectomy. METHODS Retrospective study of women undergoing appendectomy for pelvic pain and/or endometriosis during a primary gynecologic procedure. RESULTS Record review was performed for 609 women who underwent appendectomy between 2013 and 2019 for pelvic pain (6.9%, 42/609), stage I-II endometriosis (63.7%, 388/609), or stage III-IV endometriosis (29.4%, 179/609). Appendiceal endometriosis (AppE) was present in 14.9% (91/609); 2.4% without endometriosis (1/42, reference group), 7.0% with stage I-II endometriosis (27/388, odds ratio [OR] 3.06, 95% confidence interval [CI] 0.41-23.11, P = 0.278), and 35.2% with stage III-IV endometriosis (63/179, OR 22.24, 95% CI 2.99-165.40, P = 0.002). AppE was significantly associated with endometriosis present in other locations (OR 5.27, 95% CI 2.66-10.43, P < 0.001). The predicted probability of identifying AppE ranged from 6% with 0 positive endometriosis sites to 56% when 4 or more sites were identified. There were no complications related to the performance of an appendectomy. CONCLUSION Women with chronic pelvic pain and/or endometriosis have an increased risk of AppE. Modern appendectomy at the time of gynecologic surgery is safe, with no associated complications in this study. Our findings support the consideration of appendectomy as part of the comprehensive surgical management of endometriosis.
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Affiliation(s)
- Whitney Trotter Ross
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Amanda Chu
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Linda Li
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Allen R Kunselman
- Public Health Sciences, Penn State Hershey College of Medicine, Hershey, PA, USA
| | - Gerald J Harkins
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Timothy A Deimling
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Andrea S Benton
- Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, Penn State Health Hershey Medical Center, Hershey, PA, USA
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Leonardi M, Robledo KP, Espada M, Vanza K, Condous G. SonoPODography: A new diagnostic technique for visualizing superficial endometriosis. Eur J Obstet Gynecol Reprod Biol 2020; 254:124-131. [PMID: 32961428 DOI: 10.1016/j.ejogrb.2020.08.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To perform a pilot diagnostic accuracy study of a novel transvaginal ultrasonography procedure called saline-infusion sonoPODography to predict superficial endometriosis in patients with suspected endometriosis. STUDY DESIGN A prospective single-center diagnostic accuracy study was performed from September 2019-November 2019. The index test sonoPODography was performed and the results were documented in a standardized fashion. SonoPODography was performed by installing saline into the pouch of Douglas (POD) via an intrauterine balloon catheter to create an acoustic window between the ultrasound probe and surrounding structures. The pelvis was then assessed for the presence or absence of superficial endometriosis using pre-defined features. Direct visualization at laparoscopy and histological assessment of excised endometriosis confirmed the outcome. The diagnostic performance of sonoPODography was evaluated. RESULTS 42 consecutive participants underwent sonoPODography. Superficial endometriosis was identified by sonoPODography in 24/42 (57.1 %) and in 37/42 (88.1 %) participants by direct visualization at laparoscopy. The overall diagnostic performance of sonoPODography was: accuracy 69.1 %, sensitivity 64.9 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 27.8 %. Amongst those without deep endometriosis/endometriomas/pouch of Douglas obliteration, the diagnostic performance was: accuracy 80.0 %, sensitivity 77.7 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 33.3 %. The pouch of Douglas peritoneum was the most common site of superficial endometriosis. CONCLUSIONS SonoPODography is a novel ultrasound-based procedure that permits the direct visualization of superficial with respectable diagnostic accuracy. The findings of this pilot study are promising and justify the initiation of a larger outpatient study. SonoPODography may establish new avenues for the non-invasive diagnosis and investigation of endometriosis.
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Affiliation(s)
- M Leonardi
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, 2747, Australia; The University of Sydney Nepean Clinical School, Sydney, 2747, Australia; Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.
| | - K P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - M Espada
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, 2747, Australia; The University of Sydney Nepean Clinical School, Sydney, 2747, Australia
| | - K Vanza
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, 2747, Australia; The University of Sydney Nepean Clinical School, Sydney, 2747, Australia
| | - G Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Hospital, Kingswood, 2747, Australia; The University of Sydney Nepean Clinical School, Sydney, 2747, Australia; OMNI Ultrasound & Gynaecological Care, St Leonards, Australia
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10
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Coratti F, Vannuccini S, Foppa C, Staderini F, Coratti A, Cianchi F, Petraglia F. Emergency surgery for appendectomy and incidental diagnosis of superficial peritoneal endometriosis in fertile age women. Reprod Biomed Online 2020; 41:729-733. [PMID: 32807657 DOI: 10.1016/j.rbmo.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION This study aimed to evaluate the presence of superficial peritoneal endometriosis (SUP) in women referred to emergency surgery for right iliac fossa (RIF) pain and undergoing an appendectomy, considering which factors may be useful to suspect and identify endometriosis. DESIGN An observational case-control study was conducted on a group (n = 149) of fertile age women. After surgery, Group A was selected upon the diagnosis of endometriosis (n = 34); Group B (n = 115) represented the controls. Demographics, comorbidities and clinical findings were registered and analysed. RESULTS Appendicitis of various grades of severity was diagnosed in all patients, but SUP was also identified in 23%, of which 14.7% also presented with endometriosis of the appendix. Women in Group A reported chronic pelvic pain, dysmenorrhoea, dyspareunia and oral contraceptive use more frequently. At multivariate analysis, factors associated with endometriosis were: age <40 years, autoimmune disorders, multiple allergies, abdominal chronic pain, associated gynaecological pain symptoms, Alvarado score ≤6, and inconclusive ultrasound findings. CONCLUSIONS The incidental finding of SUP in fertile age women presenting with an acute RIF pain and undergoing emergency surgery is a relevant observation. Clinical history and symptoms should guide surgeons in performing a correct diagnosis and in referring the patient to the gynaecology specialist.
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Affiliation(s)
- Francesco Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Silvia Vannuccini
- Department of Molecular and Developmental Medicine, University of Siena Siena, Italy; Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy
| | - Caterina Foppa
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Andrea Coratti
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, General and Endocrine Surgery, Careggi University Hospital Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital Florence, Italy.
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11
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Robotic treatment of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2020; 71:129-143. [PMID: 32684433 DOI: 10.1016/j.bpobgyn.2020.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/18/2022]
Abstract
Endometriosis describes a condition with the presence of ectopic endometrial glands and stroma outside the endometrial cavity that affects up to 15% of reproductive-aged women. Of women affected with endometriosis, 3.8-37% will have endometriosis involving the bowel, primarily the rectosigmoid colon. While medical management is often recommended as a first-line therapy, it is not curative, and surgery is often required as an adjunct for the management of symptoms. Minimally invasive surgery has become the standard of care for managing these patients. The use of robotic-assisted laparoscopy offers benefits that may allow surgeons to perform these challenging surgical cases using a minimally invasive technique. For lesions that affect the colon, there are three primary techniques used for removal which include: 1) rectal shaving, 2) discoid excision and 3) segmental resection. The decision to pursue one approach over another is largely dependent on the number of lesions present, a lesion's size and depth of invasion as well as the involved circumference of the bowel. The available evidence of using robotic-assisted laparoscopy in cases of bowel endometriosis is limited in the literature. In this review, we will summarize the role of robotic-assisted laparoscopy in the management of bowel endometriosis.
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