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Canis M, Abbott J, Abrao M, Al-Jefout M, Bedaiwy M, Benagiano G, Burns KA, Canis M, Carmona F, Chapron C, Critchley HO, de Ziegler D, Falcone T, Fazleabas A, Ferrero S, Garcia-Velasco JA, Gargett C, Greaves E, Griffith LG, Guo SW, Habiba M, Harada T, Hull ML, Johnson NP, Kaufman Y, Issacson KB, Khan KN, Kim MR, Koninckx PA, Lessey BA, Martin D, Matsuzaki S, Mishra G, Osuga Y, Petraglia F, Popov A, Roman H, Romano A, Saunders P, Seckin T, Somigliana E, Taylor HS, Taylor RN, Vercellini P, Vigano P. A Call for New Theories on the Pathogenesis and Pathophysiology of Endometriosis. J Minim Invasive Gynecol 2024; 31:371-377. [PMID: 38365066 DOI: 10.1016/j.jmig.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
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Asencio FDA, Fins RJP, Mitie CK, Ussia A, Wattiez A, Ribeiro HS, Ribeiro PA, Koninckx PR. Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain. Clin Pract 2023; 13:780-790. [PMID: 37489420 PMCID: PMC10366930 DOI: 10.3390/clinpract13040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023] Open
Abstract
Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.
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Affiliation(s)
| | | | - Carolina Kami Mitie
- Medicine College, University of Santa Casa de São Paulo, São Paulo 01224-001, Brazil
| | - Anastasia Ussia
- Gemelli Hospital, Universtità Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Arnauld Wattiez
- Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
| | | | - Paulo Ayrosa Ribeiro
- Department of Gynaecology Endoscopy, Santa Casa de São Paulo Hospital, São Paulo 01221-010, Brazil
| | - Philippe Robert Koninckx
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, 3000 Leuven, Belgium
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Martin DC. Regarding "Intraoperative Detection of Rectosigmoid Endometriosis". J Minim Invasive Gynecol 2023; 30:513. [PMID: 37031856 DOI: 10.1016/j.jmig.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Daniel C Martin
- University of Tennessee Health Science Center, Memphis, Tennessee
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Roman H, Dennis T, Forestier D, François MO, Assenat V, Tuech JJ, Hennetier C, Merlot B. Disk Excision Using End-to-End Anastomosis Circular Stapler for Deep Endometriosis of the Rectum: A 492-Patient Continuous Prospective Series. J Minim Invasive Gynecol 2023; 30:122-130. [PMID: 36334913 DOI: 10.1016/j.jmig.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To report a large series including women managed by disk excision using end-to-end anastomosis (EEA) circular transanal stapler to assess the feasibility of the technique, the features of nodules suitable for removal by disk excision, and the rate of major early complications. DESIGN Retrospective study on data prospectively recorded in 2 databases. SETTING Two tertiary referral centers. PATIENTS A total of 492 patients undergoing surgery for rectal endometriosis from May 2011 to June 2022. INTERVENTIONS Rectal disk excision using the EEA stapler. MEASUREMENT AND MAIN RESULTS Disk excision using EEA was performed in 492 patients (24.2%) of 2,029 women receiving surgery for deep endometriosis infiltrating the rectum during the 11-year study period. Deep endometriosis involved low rectum in 11% and mid rectum in 55.3%. The diameter of rectal nodules exceeded 3 cm in 65.9%. Mean operative time was 2 hours, mean diameter of rectal patches removed was 41 ± 11 mm, and the mean rectal suture height was 9.2 ± 5.5 cm. The presence of microscopic foci on the edges of rectal patches was identified in 30.2% of cases. Rectal fistula was recorded in 20 patients (4%). The distance from the anal verge was significantly lower in patients with fistula than women with no fistula (5.9 ± 2 cm vs 9.2 ± 5.6 cm, p = .027). Follow-up ranged from 1 to 120 months, with a median value of 36 months. Magnetic resonance imaging in 3 patients during follow-up revealed a recurrent nodule infiltrating the previous stapled line (0.6%) after a postoperative delay of, respectively, 36, 48, and 84 months. CONCLUSION Disk excision using the EEA stapler is suitable in nodules >3 cm if surgeons ensure deep shaving of the rectum, to allow complete inclusion of the shaved area into the stapler jaws. Postoperative rectal recurrences seem incidental, whereas bowel leakage rate is comparable with that after colorectal resection. This technique is suitable in almost a quarter of patients managed for rectal endometriosis nodules and is therefore a valuable technique that warrants more widespread use.
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Affiliation(s)
- Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot); Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark (Dr. Roman, Dr. Tuech, Dr. Hennetier).
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Damien Forestier
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Marc Olivier François
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Vincent Assenat
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
| | - Jean Jacques Tuech
- Department of Surgery, Rouen University Hospital, Rouen, France (Dr. Tuech)
| | - Clotilde Hennetier
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France (Dr. Hennetier)
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France (Drs. Roman, Dennis, Forestier, François, Assenat, and Merlot)
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Limbachiya D, Tiwari R, Kumari R, Agrawal M. Bowel Endometriosis Management by Colorectal Resection: Laparoscopic Surgical Technique & Outcome. JSLS 2023; 27:JSLS.2022.00075. [PMID: 36741688 PMCID: PMC9859653 DOI: 10.4293/jsls.2022.00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background and Objectives Bowel deep infiltrating endometriosis (DIE) management by colorectal resection is a complex procedure. The purpose of the present study is to delineate a meticulous approach to the assessment of the patient, step-wise surgical technique, pre, and postoperative care, and its short-term and long-term outcomes. Methods This is a single-center retrospective study done on patients of bowel DIE managed by colorectal resection between January 1, 2019 to June 30, 2021. Results There was a significant improvement in the symptomatology of patients post-surgery. Our surgical technique is feasible with acceptable short-term and long-term outcomes. Conclusion Bowel DIE management can be proficiently executed with a proper diagnostic approach, appropriate surgical expertise with exhaustive pelvic anatomy knowledge especially concerning autonomic nerve plexus.
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Affiliation(s)
- Dipak Limbachiya
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
| | - Rajnish Tiwari
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
| | - Rashmi Kumari
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
| | - Manoj Agrawal
- Department of Gynaecological Endoscopy, Eva Women's Hospital, Ahmedabad, India
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Grigoriadis G, Dennis T, Merlot B, Forestier D, Noailles M, François MO, Hajdinák A, Roman H. Natural Orifice Specimen Extraction (NOSE) colorectal resection for deep endometriosis: A 50 case series: NOSE resection for DIE: 50 cases. J Minim Invasive Gynecol 2022; 29:1054-1062. [PMID: 35595229 DOI: 10.1016/j.jmig.2022.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To describe our experience with the use of Natural Orifice Specimen Extraction (NOSE) technique for segmental bowel resection in patients with colorectal endometriosis. DESIGN Retrospective, observational study. SETTING Single tertiary referral centre PATIENTS: 50 consecutive patients undergoing NOSE colectomy for colorectal endometriosis in our centre, between March 2021 and November 2021. INTERVENTIONS NOSE colectomy for colorectal endometriosis with removal of the excised colorectal specimen through the vagina or the anus. MEASUREMENT AND MAIN RESULTS 45 procedures were performed laparoscopically and 5 procedures were carried out robotically. All interventions were carried out by 3 endometriosis surgeons in a multi-disciplinary fashion, with involvement of a colorectal surgeon. There were no cases of conversion to laparotomy. Concomitant surgical procedures were performed in all cases. 11 patients had concomitant interventions on the digestive tract. 5 patients had concomitant interventions on the sacral plexus or sciatic nerve. All anastomoses were latero-terminal. The mean height of colorectal anastomosis was 12 centimetres (SD= +/- 4), and the mean length of the excised colorectal specimen was 9 centimetres (SD= +/- 4). In 29 cases, the specimen was extracted through the vagina and in 21 cases through the anus. 5 patients required a re-operation in the early post-operative period: We identified 1 case of anastomotic leak, 1 case of post-operative bowel obstruction, 1 case of haemorrhage and 2 cases of pelvic collection (no macroscopic evidence of pus). No patient received blood transfusion. The mean operative time was 158 minutes (SD=+/- 70) and mean hospital stay was 4 days (SD=+/- 1). CONCLUSION NOSE colectomy is a reproducible surgical technique for the management of colorectal endometriosis. The complication rate appears comparable with the conventional (mini-laparotomy) surgical approach. In experienced hands, this technique has a short learning curve, both in laparoscopy as well as in robotic surgery.
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Affiliation(s)
| | - Thomas Dennis
- IFEMEndo Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, 33000, France
| | - Benjamin Merlot
- IFEMEndo Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, 33000, France
| | - Damien Forestier
- IFEMEndo Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, 33000, France
| | - Myriam Noailles
- IFEMEndo Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, 33000, France
| | | | - Adrienn Hajdinák
- IFEMEndo Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, 33000, France
| | - Horace Roman
- IFEMEndo Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux, 33000, France.
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