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Santullo F, De Cicco Nardone A, El Halabieh MA, Lodoli C, Abatini C, Ferracci F, Campolo F, Benvenga G, Scambia G, Pacelli F, Ianieri MM. Totally intracorporeal colorectal anastomosis (TICA) after segmental colorectal resection for deep endometriosis: technical notes and case series. Arch Gynecol Obstet 2025:10.1007/s00404-025-08040-4. [PMID: 40327066 DOI: 10.1007/s00404-025-08040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Accepted: 04/21/2025] [Indexed: 05/07/2025]
Abstract
PURPOSE The aim of this study was to evaluate the safety and feasibility of totally intracorporeal colorectal anastomosis (TICA) in patients undergoing colorectal resection for the treatment of deep endometriosis (DE) affecting the bowel. METHODS Between January 2021 and August 2024, 33 consecutive patients with DE treated with segmental colorectal resection were enrolled. In 30 patients, TICA was performed. Demographic, operative, and postoperative data were collected retrospectively. RESULTS The mean distance between the endometriotic nodule and the anal verge was 11.5 (7-18) cm. The mean operative time was 282.83 (190-512) minutes. No major intraoperative complications occurred. Three (10%) patients developed a minor (Clavien‒Dindo grade I/II) postoperative complication. CONCLUSION TICA is a safe and feasible technique and represents a valid alternative reconstruction method after colorectal resection for DE.
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Affiliation(s)
- Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Alessandra De Cicco Nardone
- Unit of Oncological Gynaecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Miriam Attalla El Halabieh
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Claudio Lodoli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Carlo Abatini
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Federica Ferracci
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Unit of Oncological Gynaecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Campolo
- Unit of Oncological Gynaecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Greta Benvenga
- Unit of Oncological Gynaecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Giovanni Scambia
- Unit of Oncological Gynaecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Fabio Pacelli
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Manuel Maria Ianieri
- Unit of Oncological Gynaecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Crestani A, Merlot B, Denost Q, Francois MO, Assenat V, Lacheray IC, Dennis T, Roman H. [Colorectal endometriosis surgery: Technical and technological innovations in service of a complex surgery]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2025:S2468-7189(25)00088-1. [PMID: 40157501 DOI: 10.1016/j.gofs.2025.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2025] [Accepted: 03/27/2025] [Indexed: 04/01/2025]
Abstract
INTRODUCTION Digestive endometriosis represents the most common form of deep endometriosis, significantly impacting patients' quality of life. The optimization of its surgical management has been marked by major technological advances. This review explores the evolution of colorectal endometriosis surgery, highlighting the progress in laparoscopy, the contribution of robotics, the shift towards organ preservation, and the optimization of postoperative care. METHODS A systematic literature search was conducted in the PubMed and Embase databases, focusing on clinical studies, meta-analyses, and international guidelines published between 1980 and 2025. Articles were selected based on their relevance to technical advancements and clinical outcomes. RESULTS Laparoscopy has replaced laparotomy, leading to a reduction in complications and an improvement in postoperative quality of life. Robotics, while not a groundbreaking revolution, provides advantages in precision and surgeon comfort. Conservative procedures have emerged as safe alternatives to systematic extensive segmental resection. Indication criteria have evolved to favor strategies tailored to the depth and extent of lesions while minimizing complication risks and preserving digestive function and quality of life. The standardization of procedures, the abandonment of systematic protective ileostomy, and enhanced recovery protocols have contributed to reducing surgical morbidity and improving patients' quality of life. CONCLUSION Technical and technological advancements have transformed colorectal endometriosis surgery. Surgical strategies are shifting towards personalized approaches, integrating minimally invasive surgery and optimized multidisciplinary management. The future lies in the continuous improvement of techniques and the better standardization of surgical indications.
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Affiliation(s)
- Adrien Crestani
- Institut franco-européen multidisciplinaire de l'endométriose, clinique Tivoli-Ducos, Bordeaux, France.
| | - Benjamin Merlot
- Institut franco-européen multidisciplinaire de l'endométriose, clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, Émirats arabes unis.
| | - Quentin Denost
- Service de chirurgie colorectale, Bordeaux Colorectal Institute, clinique Tivoli, Bordeaux, France.
| | - Marc Olivier Francois
- Service de chirurgie colorectale, Bordeaux Colorectal Institute, clinique Tivoli, Bordeaux, France.
| | - Vincent Assenat
- Service de chirurgie colorectale, Bordeaux Colorectal Institute, clinique Tivoli, Bordeaux, France.
| | | | - Thomas Dennis
- Institut franco-européen multidisciplinaire de l'endométriose, clinique Tivoli-Ducos, Bordeaux, France.
| | - Horace Roman
- Institut franco-européen multidisciplinaire de l'endométriose, clinique Tivoli-Ducos, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, Émirats arabes unis; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, Émirats arabes unis; Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Danemark.
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Tsuei A, Nezhat F, Amirlatifi N, Najmi Z, Nezhat A, Nezhat C. Comprehensive Management of Bowel Endometriosis: Surgical Techniques, Outcomes, and Best Practices. J Clin Med 2025; 14:977. [PMID: 39941647 PMCID: PMC11818743 DOI: 10.3390/jcm14030977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/20/2025] [Accepted: 01/26/2025] [Indexed: 02/16/2025] Open
Abstract
Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity.
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Affiliation(s)
- Angie Tsuei
- Camran Nezhat Institute Center for Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA; (A.T.); (N.A.); (Z.N.); (A.N.)
| | - Farr Nezhat
- Weill Cornell Medical College, Cornell University, New York, NY 10065, USA;
- Gynecology/Oncology, NYU Long Island School of Medicine, Mineola, NY 11501, USA
| | - Nikki Amirlatifi
- Camran Nezhat Institute Center for Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA; (A.T.); (N.A.); (Z.N.); (A.N.)
| | - Zahra Najmi
- Camran Nezhat Institute Center for Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA; (A.T.); (N.A.); (Z.N.); (A.N.)
| | - Azadeh Nezhat
- Camran Nezhat Institute Center for Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA; (A.T.); (N.A.); (Z.N.); (A.N.)
- Stanford University Medical Center, Palo Alto, CA 94305, USA
| | - Camran Nezhat
- Camran Nezhat Institute Center for Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA; (A.T.); (N.A.); (Z.N.); (A.N.)
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco, San Francisco, CA 94143, USA
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Nasseri Y, Ma R, Fani N, La K, Solis-Pazmino P, Xu V, Siedhoff MT, Wright KN, Schneyer R, Hamilton KM, Barnajian M, Meyer R. The impact of surgeon speciality on surgical outcomes following colorectal resection for endometriosis. Colorectal Dis 2025; 27:e70028. [PMID: 39949080 DOI: 10.1111/codi.70028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 01/21/2025] [Accepted: 01/27/2025] [Indexed: 05/09/2025]
Abstract
AIM An estimated 5%-25% of women with endometriosis have colorectal involvement. Colorectal resection is the most suitable surgical management for cases with large bowel infiltration. However, this method is also associated with the highest rate of postoperative complications. Data focusing on surgeon speciality and surgical outcomes are currently limited. The aim of this work was to evaluate the surgical characteristics and short-term postoperative outcomes following colorectal resection for endometriosis according to surgeon speciality. METHOD Using the National Surgical Quality Improvement Program (NSQIP) database, we included women who underwent colorectal resection for endometriosis between 2012 and 2020. Surgeries by general/colorectal surgeons were compared with those by gynaecological surgeons. The primary outcome was major complications according to the Clavien-Dindo classification. RESULTS Among 745 colorectal resections, 82.3% were performed by general/colorectal surgeons and 17.7% by gynaecologists. Racial and ethnic characteristics differed between groups, but other baseline characteristics were comparable. General/colorectal surgeons performed fewer minimally invasive surgeries (29.9% vs. 58.3%, p < 0.001). General/colorectal surgery cases had lower rates of any postoperative complications and minor complications (14.8% vs. 29.5%, p < 0.001; 10.1% vs. 23.5%, p < 0.001), while major complication rates were similar. Multivariable regression showed no association between major complications and surgical speciality. In a propensity score-matched analysis, no significant differences were found between the two cohorts. CONCLUSION Most colorectal resections are performed by general/colorectal surgeons while a minimally invasive approach is more common among gynaecologists. There were no significant differences in outcomes between the two groups after adjusting for confounding variables. This suggests considering a multidisciplinary or dual surgery team approach to deep infiltrative endometriosis requiring bowel resection.
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Affiliation(s)
- Yosef Nasseri
- Surgery Group Los Angeles, Los Angeles, California, USA
| | - Rachel Ma
- Surgery Group Los Angeles, Los Angeles, California, USA
| | - Negin Fani
- Medical University of Warsaw, Warsaw, Poland
| | - Kristina La
- Surgery Group Los Angeles, Los Angeles, California, USA
| | - Paola Solis-Pazmino
- Surgery Group Los Angeles, Los Angeles, California, USA
- Surgery Department, Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- CaTaLiNA-Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Vincent Xu
- Surgery Group Los Angeles, Los Angeles, California, USA
| | - Matthew T Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Rebecca Schneyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Kacey M Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | | | - Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology, Cedars Sinai Medical Center, Los Angeles, California, USA
- Tel-Aviv University, Tel-Aviv, Israel
- The Dr Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
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Villiger AS, Hoehn D, Ruggeri G, Vaineau C, Nirgianakis K, Imboden S, Kuhn A, Mueller MD. Lower Urinary Tract Dysfunction Among Patients Undergoing Surgery for Deep Infiltrating Endometriosis: A Prospective Cohort Study. J Clin Med 2024; 13:7367. [PMID: 39685825 DOI: 10.3390/jcm13237367] [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: 11/06/2024] [Revised: 11/28/2024] [Accepted: 11/29/2024] [Indexed: 12/18/2024] Open
Abstract
Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study is to evaluate the efficacy of preoperative and postoperative multichannel urodynamic testing (UD) in identifying pre-existing or surgically induced LUTD among patients with DIE. Methods: Women with suspected DIE and planned surgical resection of DIE at the Department of Obstetrics and Gynecology at the University Hospital of Bern from September 2015 to October 2022 were invited to participate in this prospective cohort study. UD was performed before and 6 weeks after surgery. The primary outcome was the maximum flow rate (uroflow), an indicator of LUTD. Secondary outcomes were further urodynamic observations of cystometry and pressure flow studies, lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS), and pain as assessed by the visual analog scale (VAS). Results: A total of 51 patients requiring surgery for DIE were enrolled in this study. All patients underwent surgical excision of the DIE. The cohort demonstrated a uroflow of 22.1 mL/s prior to surgery, which decreased postoperatively to 21.5 mL/s (p = 0.56, 95%CI -1.5-2.71). The mean bladder contractility index (BCI) exhibited a notable decline from 130.4 preoperatively to 116.6 postoperatively (p = 0.046, 95%CI 0.23-27.27). Significant improvements were observed in the prevalence of dysmenorrhea, abdominal pain, dyspareunia, and dyschezia following surgical intervention (p = <0.001). The IPSS score was within the lower moderate range both pre- and postoperatively (mean 8.37 vs. 8.51, p = 0.893, 95%CI -2.35-2.05). Subgroup analysis identified previous endometriosis surgery as a significant preoperative risk factor for elevated post-void residual (43.6 mL, p = 0.026, 95%CI 13.89-73.37). The postoperative post-void residual increased among participants with DIE on the rectum to 54.39 mL (p = 0.078, 95%CI 24.06-84.71). Participants who underwent hysterectomy exhibited a significantly decreased uroflow (16.4 mL/s, p = 0.014, 95%CI 12-20) and BCI (75.1, p = 0.036, 95%CI 34.9-115.38). Conclusions: Nerve-respecting laparoscopy for DIE may alter bladder function. UD is not advisable before surgery, but the measurement may detect patients with LUTD.
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Affiliation(s)
- Anna-Sophie Villiger
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Diana Hoehn
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Giovanni Ruggeri
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Cloé Vaineau
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Annette Kuhn
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Michael David Mueller
- Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Lindheim SR, Johnson N, Eickman K, Kohl-Thomas B, Flyckt R. What's Now and What's Next for Surgical Endometriosis Management in the Infertile Patient? An Evidence-Based Review for the General OB/GYN. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102645. [PMID: 39299369 DOI: 10.1016/j.jogc.2024.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/30/2024] [Accepted: 07/31/2024] [Indexed: 09/22/2024]
Abstract
Endometriosis is a significant contributor to female infertility, and its complex nature and varied phenotypes lead to questions regarding the value of surgical management. In this manuscript, we summarize current evidence and recommendations regarding surgical treatment for infertility in peritoneal disease, endometriomas, adenomyosis, and deep endometriosis, and highlight recent evidence regarding perinatal outcomes in women with endometriosis. Our purpose is to provide a concise "user's guide" for decisions regarding the surgical management of endometriosis in patients with infertility and generate awareness of recent perinatal outcome data.
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Affiliation(s)
- Steven R Lindheim
- University of Central Florida College of Medicine, Orlando, FL; Baylor Scott & White Department of Obstetrics & Gynecology, Temple, TX; Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.
| | - Nicolas Johnson
- Division of Reproductive Endocrinology and Infertility, University Hospitals, Cleveland Medical Center, Cleveland, OH
| | - Kira Eickman
- University of Central Florida College of Medicine, Orlando, FL
| | | | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals, Cleveland Medical Center, Cleveland, OH
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Volodarsky-Perel A, Roman H, Francois MO, Jehaes C, Dennis T, Kade S, Forestier D, Assenat V, Merlot B, Denost Q. Low rectal resection for low rectal endometriosis and rectal adenocarcinoma: Are we discussing the same risks? Int J Gynaecol Obstet 2024; 167:823-830. [PMID: 38752586 DOI: 10.1002/ijgo.15691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 10/19/2024]
Abstract
OBJECTIVE To evaluate the rate and risk factors for anastomosis leakage in patients undergoing colorectal resection with low anastomosis for rectal endometriosis and rectal adenocarcinoma. METHODS A retrospective cohort study evaluating prospectively collected data was conducted. Patients undergoing colorectal resection for rectal endometriosis and rectal adenocarcinoma with low anastomosis (<7 cm from the anal verge [AV]) from September 2018 to January 2023 were included in the analysis. The main outcome was the rate of anastomosis leakage. A multivariate logistic regression was conducted to evaluate risk factors for anastomosis leakage in both groups. RESULTS A total of 159 patients underwent colorectal resection with low anastomosis due to rectal endometriosis (n = 99) and rectal adenocarcinoma (n = 60). Patients with endometriosis were significantly younger than those with adenocarcinoma (35.7 ± 5.1 vs 63.7 ± 12.6; P = 0.001). The leakage rate was similar between the endometriosis (n = 12, 12.1%) and adenocarcinoma (n = 9, 15.0%) patients (P = 0.621). The anastomosis height less than 5 cm from the AV (adjusted odds ratio [aOR] 12.12, 95% confidence interval [CI] 2.24-23.54) was significantly associated with the anastomosis leakage. Protective stoma was associated with the decrease of the leakage risk (aOR 0.12, 95% CI 0.01-0.72). The type of disease (rectal endometriosis or adenocarcinoma) was not associated with the anastomosis leakage (aOR 2.87, 95% CI 0.34-21.23). CONCLUSIONS Despite the different pathogenesis, the risk of anastomotic leakage was found to be similar between patients with low rectal endometriosis and those with rectal adenocarcinoma. These results must be considered by the gynecologist and colorectal surgeon to deliver proper information before rectal surgery for endometriosis.
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Affiliation(s)
- Alexander Volodarsky-Perel
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Sheba Medical Center affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Abu Dhabi, UAE
| | | | - Constance Jehaes
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Sandesh Kade
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Abu Dhabi, UAE
| | - Damien Forestier
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
| | - Vincent Assenat
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Abu Dhabi, UAE
| | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
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Khazali S, Bachi A, Mondelli B, Fleischer K, Adamczyk M, Delanerolle G, Shi JQ, Yang X, Nisar P, Bearn P. Intra-operative and post-operative complications of endometriosis excision using the SOSURE approach - A single- surgeon retrospective series of 1116 procedures over 8 years. Facts Views Vis Obgyn 2024; 16:325-336. [PMID: 39357864 PMCID: PMC11569428 DOI: 10.52054/fvvo.16.3.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024] Open
Abstract
Background Endometriosis surgery outcomes have been widely studied, yet heterogeneity in terminology and techniques persist. Objectives This study focuses on the perioperative outcomes of a single surgeon using the same structured approach (SOSURE: Survey & Sigmoid mobilisation, Ovarian mobilisation, Suspension of uterus and ovaries, Ureterolysis, Rectovaginal and pararectal space development, Excision of all visible disease) and adheres to the recent standardised terminology proposed by international gynaecological and endometriosis societies. Materials and Methods A quality improvement study was conducted retrospectively from January 2015 to January 2023. Data collection involved two databases: the National British Society for Gynaecological Endoscopy (BSGE) database and a more comprehensive locally kept database. The methodology also integrated four endometriosis staging systems. Main outcome measures Intra-operative and post-operative complication rates. Results Between 2015 and 2023, 1047 women underwent 1116 endometriosis procedures in various UK hospitals with S.K. as primary surgeon. Exclusions totalled 20 due to missing records and specific surgical criteria. The rate of major post-operative complications (Clavien-Dindo grade 3a and 3b) was 1.5% and minor post-operative complications (Clavien-Dindo grade 1 and 2) were seen in 13.8%. No Clavien-Dindo grade 4 or 5 complications were noted. Conclusion Our study has shown a low complication rate in endometriosis surgery, despite increasing complexity of surgical cases. This is likely attributed to the surgeon's learning curve, high surgical volume and adherence to a structured approach. What's new? Our study demonstrates the learning curve of a surgeon over the course of 8 years. This series involved more than 1000 patients and to our knowledge, is the first to report the complexity of the casemix using four different endometriosis staging systems.
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Barchi LC, Callado GY, Machado RB, Chico MA, Damico DC, Lacerda DP, Ricciardi R, Leite RMDA. INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1806. [PMID: 38958344 PMCID: PMC11216408 DOI: 10.1590/0102-6720202400013e1806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Deep penetrating endometriosis (DE) can affect abdominal and pelvic organs like the bowel and bladder, requiring treatment to alleviate symptoms. AIMS To study and investigate clinical and surgical outcomes in patients diagnosed with DE involving the intestines, aiming to analyze the effectiveness of surgical treatments. METHODS All cases treated from January 2021 to July 2023 were included, focusing on patients aged 18 years or older with the disease affecting the intestines. Patients without intestinal involvement and those with less than six months of post-surgery follow-up were excluded. Intestinal involvement was defined as direct invasion of the intestinal wall or requiring adhesion lysis for complete resection. Primary outcomes were adhesion lysis, rectal shaving, disc excision (no-colectomy group), and segmental resection (colectomy group) along with surgical complications like anastomotic leak and fistulas, monitored for up to 30 days. RESULTS Out of 169 patients with DE surgically treated, 76 met the inclusion criteria. No colectomy treatment was selected for 50 (65.7%) patients, while 26 (34.2%) underwent rectosigmoidectomy (RTS). Diarrhea during menstruation was the most prevalent symptom in the RTS group (19.2 vs. 6%, p<0.001). Surgical outcomes indicated longer operative times and hospital stays for the segmental resection group, respectively 186.5 vs. 104 min (p<0.001) and 4 vs. 2 days, (p<0.001). Severe complications (Clavien-Dindo ≥3) had an overall prevalence of 6 (7.9%) cases, without any difference between the groups. There was no mortality reported. Larger lesions and specific symptoms like dyschezia and rectal bleeding were associated with a higher likelihood of RTS. Bayesian regression highlighted diarrhea close to menstruation as a strong predictor of segmental resection. CONCLUSIONS In patients with DE involving the intestines, symptoms such as dyschezia, rectal bleeding, and menstrual period-related diarrhea predict RTS. However, severe complication rates did not differ significantly between the segmental resection group and no-colectomy group.
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Affiliation(s)
- Leandro Cardoso Barchi
- São Leopoldo Mandic, Faculty of Medicine, Campinas (SP), Brazil
- Gastromed Instituto Zilberstein, São Paulo (SP), Brazil
- São Luiz Rede D'or, Hospital Osasco Endometriosis Centre, São Paulo (SP), Brazil
| | - Gustavo Yano Callado
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
| | | | | | | | | | - Rocco Ricciardi
- Harvard Medical School, Massachusetts General Hospital, Boston (MA), USA
| | - Rodrigo Moises de Almeida Leite
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
- Harvard Medical School, Massachusetts General Hospital, Boston (MA), USA
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10
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Meyer R, Nasseri YY, Barnajian M, Siedhoff MT, Wright KN, Hamilton KM, Levin G, Truong MD. Risk factors for major complications following colorectal resections for endometriosis in the USA. Int J Colorectal Dis 2023; 39:1. [PMID: 38055072 PMCID: PMC10700479 DOI: 10.1007/s00384-023-04577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE We aimed to describe the incidence and identify risk factors for the occurrence of short-term major posto-perative complications following colorectal resection for endometriosis. METHODS A cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2020. We included patients with a primary diagnosis of endometriosis who underwent colon or rectal resections for endometriosis. RESULTS Of 755 women who underwent colorectal resection, 495 (65.6%) had laparoscopic surgery and 260 (34.4%) had open surgery. The major complication rate was 13.5% (n = 102). Women who underwent open surgery had a higher proportion of major complications (n = 53, 20.4% vs. n = 49, 9.9%, p < 0.001). In a multivariable regression analysis, Black race (aOR 95%CI 2.81 (1.60-4.92), p < 0.001), Hispanic ethnicity (aOR 95%CI 3.02 (1.42-6.43), p = 0.004), hypertension (aOR 95%CI 1.89 (1.08-3.30), p = 0.025), laparotomy (aOR 95%CI 1.64 (1.03-3.30), p = 0.025), concomitant enterotomy (aOR 95%CI 3.02 (1.26-7.21), p = 0.013), and hysterectomy (aOR 95%CI 2.59 (1.62-4.15), p < 0.001) were independently associated with major post-operative complications. In a subanalysis of laparoscopies only, Hispanic ethnicity, chronic hypertension, lysis of bowel adhesions, and hysterectomy were independently associated with major complications. In a subanalysis of laparotomies only, Black race and hysterectomy were independently positively associated with the occurrence of major complications. CONCLUSION This study provides a current population-based estimate of short-term complications after surgery for colorectal endometriosis in the USA. The identified risk factors for complications can assist during preoperative shared decision-making and informed consent process.
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Affiliation(s)
- Raanan Meyer
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Ramat-Gan, Israel.
| | - Yosef Y Nasseri
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Moshe Barnajian
- Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew T Siedhoff
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kelly N Wright
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kacey M Hamilton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gabriel Levin
- Lady Davis Institute for Cancer Research, Jewish General Hospital, McGill University, Quebec, Canada
| | - Mireille D Truong
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Volodarsky-Perel A, Merlot B, Denost Q, Dennis T, Chanavaz-Lacheray I, Roman H. Robotic-assisted versus conventional laparoscopic approach in patients with large rectal endometriotic nodule: the evaluation of safety and complications. Colorectal Dis 2023; 25:2233-2242. [PMID: 37849058 DOI: 10.1111/codi.16785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023]
Abstract
AIM The aim was to compare postoperative complications in patients undergoing the excision of a rectal endometriotic nodule over 3 cm by a robotic-assisted versus a conventional laparoscopic approach. METHODS We conducted a retrospective cohort study evaluating prospectively collected data. The main interventions included rectal shaving, disc excision or colorectal resection. All the surgeries were performed in one endometriosis reference institute. To evaluate factors significantly associated with the risk of anastomosis leakage or fistula and bladder atony, we conducted a multivariate logistic regression model. RESULTS A total of 548 patients with rectal endometriotic nodule over 3 cm in diameter (#ENZIAN C3) were included in the final analysis. The demography and clinical characteristics of women managed by the robotic-assisted (n = 97) approach were similar to those of patients who underwent conventional laparoscopy (n = 451). The multivariate logistic regression demonstrated that the surgical approach (robotic-assisted vs. laparoscopic) was not associated with the rate of anastomosis leakage or fistula (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.3-4.0) and bladder dysfunction (aOR 0.5, 95% CI 0.1-1.8). A rectal nodule located lower than 6 cm from the anal verge was significantly associated with anastomosis leakage (aOR 4.1, 95% CI 1.4-10.8) and bladder atony (aOR 4.3, 95% CI 1.5-12.3). Anastomosis leakage was also associated with smoking (aOR 3.2, 95% CI 1.4-7.4), significant vaginal infiltration (aOR 2.7, 95% CI 1.2-6.7) and excision of nodules involving sacral roots (aOR 5.6, 95% CI 1.7-15.5). CONCLUSION The robotic-assisted approach was not associated with increased risk of main postoperative complications compared to conventional laparoscopy for the treatment of large rectal endometriotic nodules.
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Affiliation(s)
- Alexander Volodarsky-Perel
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli-Ducos, Bordeaux, France
| | - Thomas Dennis
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Isabella Chanavaz-Lacheray
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, Bordeaux, France
- Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates
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12
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Chaggar P, Tellum T, Cohen A, Jurkovic D. Intra- and interobserver reproducibility of transvaginal ultrasound for the detection and measurement of endometriotic lesions of the bowel. Acta Obstet Gynecol Scand 2023; 102:1306-1315. [PMID: 37641421 PMCID: PMC10541154 DOI: 10.1111/aogs.14660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The number and invasion depth of endometriotic bowel lesions, total length of bowel affected by endometriosis, lesion-to-anal verge distance, and extent of pouch of Douglas obliteration are important factors in preoperatively determining risk and complexity of endometriosis surgery. The intra- and interobserver reproducibility of transvaginal ultrasound in the evaluation of many of these parameters has not yet been investigated. Our study aimed to assess the intra- and interobserver reproducibility of transvaginal ultrasound between an experienced and less experienced examiner for all of these parameters. MATERIAL AND METHODS This prospective observational cross-sectional study was conducted between July 2019 and November 2020. Fifty consecutive premenopausal women who underwent transvaginal ultrasound examination in our clinic for the first time, were examined by the same two operators during the same attendance. Outcomes of interest were the inter-rater reproducibility of transvaginal ultrasound for detecting the presence, number, depth and size of bowel endometriotic nodules, lesion-to-anal-verge distance, total length of bowel affected, and pouch of Douglas obliteration. The intraobserver reproducibility was assessed for the continuous parameters. Cohen's kappa (κ) statistic, Cohen's weighted kappa (κ), proportions of agreement, intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement were used to assess the reproducibility of the parameters. RESULTS The inter-rater agreement and reliability were very good for identifying bowel endometriosis, the number and invasion depth of bowel nodules, determining whether the maximum nodule length was <3 cm, and lesion-to-anal-verge distance <8 cm (proportion of agreement 0.92, 0.94, 0.97, 0.94, 0.96; κ 0.92, 0.91, 0.92, 0.82, 0.89). The inter-rater agreement and reliability were good for assessing pouch of Douglas obliteration (proportion of agreement 0.86, κ 0.80). The intra-rater reliability for the mean nodule diameter (ICC 0.93 and 0.97) and total length of bowel affected (ICC 0.94 and 0.91) were excellent for operators A and B, respectively. The inter-rater reliability for the mean nodule diameter was good (ICC 0.80), and moderate for the total length of bowel affected (ICC 0.70). The Bland-Altman limits of agreement demonstrated clinically acceptable ranges for these two parameters. CONCLUSIONS This study demonstrated a high intra- and inter-rater reproducibility of transvaginal ultrasound in the diagnosis of bowel endometriosis and measurement of its various components.
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Affiliation(s)
- Prubpreet Chaggar
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Tina Tellum
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Department of GynecologyOslo University HospitalOsloNorway
| | - Abigail Cohen
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Davor Jurkovic
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
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13
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Pontrelli G, Huscher C, Scioscia M, Brusca F, Tedeschi U, Greco P, Mancarella M, Biglia N, Novara L. End-to-end versus side-to-end anastomosis after bowel resection for deep infiltrating endometriosis: A retrospective study. J Gynecol Obstet Hum Reprod 2022; 51:102472. [DOI: 10.1016/j.jogoh.2022.102472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
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Darici E, Salama M, Bokor A, Oral E, Dauser B, Hudelist G. Different segmental resection techniques and postoperative complications in patients with colorectal endometriosis: A systematic review. Acta Obstet Gynecol Scand 2022; 101:705-718. [PMID: 35661342 DOI: 10.1111/aogs.14379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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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Xu P, Wang J, Zhang Y, Zhu L, Zhang X. Factors Affecting the Postoperative Bowel Function and Recurrence of Surgery for Intestinal Deep Endometriosis. Front Surg 2022; 9:914661. [PMID: 35774384 PMCID: PMC9239406 DOI: 10.3389/fsurg.2022.914661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to evaluate the factors associated with complications and long-term results in the surgical treatment of intestinal deep endometriosis and to figure out the optimized treatment measures for bowel endometriosis.MethodsA retrospective study was performed in a single center in China. Medical charts were reviewed from 61 women undergoing surgical treatment for bowel endometriosis between January 2013 and August 2019 in the Department of General Gynecology, Women’s Hospital School of Medicine Zhejiang University. Multivariate regression analysis was utilized to investigate the impact of the stages of endometriosis and surgical steps (independent risk factors) on complications (and postoperative bowel dysfunction). The clinical characters, surgical procedures, postoperative treatment, complications, and recurrence rate were summarized and analyzed by using Lasso regression.ResultsSurgery type was the most important independent risk factor related to postoperative abnormal defecation in intestinal deep endometriosis patients (P < 0.05, OR = 34.133). Infection is the most important independent risk factor related to both postoperative complications (OR = 96.931) and recurrences after conservative surgery (OR = 4.667). Surgery type and age were significantly related to recurrences after conservative surgery.ConclusionsWe recommended conservative operation especially full-thickness disc excision to improve the quality of life of intestinal deep endometriosis patients. In addition, prevention of infection is very important to reduce the postoperative complications rate and the recurrence rate.
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16
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Raffone A, Raimondo D, Oliviero A, Raspollini A, Travaglino A, Torella M, Riemma G, La Verde M, De Franciscis P, Casadio P, Seracchioli R, Mollo A. The Use of near Infra-Red Radiation Imaging after Injection of Indocyanine Green (NIR-ICG) during Laparoscopic Treatment of Benign Gynecologic Conditions: Towards Minimalized Surgery. A Systematic Review of Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:792. [PMID: 35744056 PMCID: PMC9231050 DOI: 10.3390/medicina58060792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: To assess the use of near infrared radiation imaging after injection of indocyanine green (NIR-ICG) during laparoscopic treatment of benign gynecologic conditions. Materials and Methods: A systematic review of the literature was performed searching 7 electronic databases from their inception to March 2022 for all studies which assessed the use of NIR-ICG during laparoscopic treatment of benign gynecological conditions. Results: 16 studies (1 randomized within subject clinical trial and 15 observational studies) with 416 women were included. Thirteen studies assessed patients with endometriosis, and 3 studies assessed non-endometriosis patients. In endometriosis patients, NIR-ICG use appeared to be a safe tool for improving the visualization of endometriotic lesions and ureters, the surgical decision-making process with the assessment of ureteral perfusion after conservative surgery and the intraoperative assessment of bowel perfusion during recto-sigmoid endometriosis nodule surgery. In non-endometriosis patients, NIR-ICG use appeared to be a safe tool for evaluating vascular perfusion of the vaginal cuff during total laparoscopic hysterectomy (TLH) and robotic-assisted total laparoscopic hysterectomy (RATLH), and intraoperative assessment of ovarian perfusion in adnexal torsion. Conclusions: NIR-ICG appeared to be a useful tool for enhancing laparoscopic treatment of some benign gynecologic conditions and for moving from minimally invasive surgery to minimalized surgery. In particular, it might improve treatment of endometriosis (with particular regard to deep infiltrating endometriosis), benign diseases requiring TLH and RATLH and adnexal torsion. However, although preliminary findings appear promising, further investigation with well-designed larger studies is needed.
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Affiliation(s)
- Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), Univertity of Bologna, 40138 Bologna, Italy; (A.R.); (A.R.); (R.S.)
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessia Oliviero
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry Schola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (A.O.); (A.M.)
| | - Arianna Raspollini
- Department of Medical and Surgical Sciences (DIMEC), Univertity of Bologna, 40138 Bologna, Italy; (A.R.); (A.R.); (R.S.)
| | - Antonio Travaglino
- Unità di Ginecopatologia e Patologia Mammaria, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80128 Naples, Italy; (M.T.); (G.R.); (M.L.V.); (P.D.F.)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80128 Naples, Italy; (M.T.); (G.R.); (M.L.V.); (P.D.F.)
| | - Marco La Verde
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80128 Naples, Italy; (M.T.); (G.R.); (M.L.V.); (P.D.F.)
| | - Pasquale De Franciscis
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80128 Naples, Italy; (M.T.); (G.R.); (M.L.V.); (P.D.F.)
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (DIMEC), Univertity of Bologna, 40138 Bologna, Italy; (A.R.); (A.R.); (R.S.)
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry Schola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (A.O.); (A.M.)
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Casas SGDL, Spagnolo E, Saverio SD, Álvarez-Gallego M, Carrasco AL, López MC, Cobos ST, Campo CF, Gutiérrez AH, Miguelañez IP. Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases. Ann Coloproctol 2022:ac.2021.00829.0118. [PMID: 35255203 DOI: 10.3393/ac.2021.00829.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/06/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose The surgical management of deep infiltrative endometriosis (DE) involving the rectum remains a challenge. The objective of this study was to assess the outcomes from a single tertiary center over a decade with an emphasis on the role of a protective loop ileostomy (PI). Methods A retrospective review of outcomes for 168 patients managed between 2008 and 2018 is presented including 57 rectal shaves, 23 discoid excisions, and 88 segmental rectal resections. Results The nodule size (mean±standard deviation) in the segmental resection group was 32.7±11.2 mm, 23.4±10.5 mm for discoid excision, and 18.8±6.0 mm for rectal shaves. A PI was performed in 19 elective cases (11.3%) usually for an ultra-low anastomosis <5 cm from the anal verge. All Clavien-Dindo grade III/IV complications occurred after segmental resections and included 5 anastomotic leaks, 6 rectovaginal fistulas, 2 ureteric fistulas, and 1 ureteric stenosis. Of 26 stomas (15.5%), there were 19 PIs, 3 secondary ileostomies (after complications), and 4 end colostomies. The median time to PI closure was 5.8 months (range, 0.4-16.7 months) in uncomplicated disease compared with 9.2 months (range, 4.7-18.4 months) when initial postoperative complications were recorded (P=0.019). Only 1 patient with a recurrent rectovaginal fistula had a permanent colostomy. Conclusion In patients with DE and rectal involvement a PI is selectively used for low anastomoses and complex pelvic reconstructions. Protective stomas and those used in the definitive management of a major postoperative complication can usually be reversed.
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Affiliation(s)
| | - Emanuela Spagnolo
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
| | - Salomone Di Saverio
- Department of General Surgery, Hospital of San Benedetto del Tronto (AP), San Benedetto, Italy
| | | | - Ana López Carrasco
- Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain
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Scioscia M, Huscher CGS, Brusca F, Marchegiani F, Cannone R, Brasile O, Greco P, Scutiero G, Anania G, Pontrelli G. Preservation of the inferior mesenteric artery in laparoscopic nerve-sparing colorectal surgery for endometriosis. Sci Rep 2022; 12:3146. [PMID: 35210558 PMCID: PMC8873484 DOI: 10.1038/s41598-022-07237-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.
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Affiliation(s)
- Marco Scioscia
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Cristiano G S Huscher
- Department of Surgical Oncology, Robotics and New Technologies, Policlinico Hospital, Abano Terme, Padua, Italy
| | - Federica Brusca
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Francesco Marchegiani
- First Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Rossella Cannone
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy
| | - Orsola Brasile
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Pantaleo Greco
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy.
| | - Gennaro Scutiero
- Department of Medical Science, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Via Aldo Moro 8, 44124, Cona, FE, Italy
| | - Gabriele Anania
- Department of Medical Science, Section of General Surgery, University of Ferrara, Azienda Ospedaliero-Universitaria S.Anna, Cona, Ferrara, Italy
| | - Giovanni Pontrelli
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
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Mège D, Bernard C, Pivano A, Nho RLH, Aubert M, Duclos J, Agostini A, Pirro N. Morbidity of diverting stoma during colorectal surgery for deep infiltrating endometriosis – an observational study. J Gynecol Obstet Hum Reprod 2022; 51:102347. [DOI: 10.1016/j.jogoh.2022.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/28/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
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20
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Spagnolo E, Marí-Alexandre J, Di Saverio S, Gilabert-Estellés J, Agababyan C, Garcia-Casarrubios P, López A, González-Cantó E, Pascual I, Hernández A. Feasibility and safety of transvaginal specimen extraction in deep endometriosis colorectal resectional surgery and analysis of risk factors for postoperative complications. Tech Coloproctol 2022; 26:261-270. [PMID: 35091790 DOI: 10.1007/s10151-021-02565-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of the present study was to demonstrate that transvaginal specimen extraction is a feasible and safe approach in colorectal resection for deep endometriosis (DE) and to assess the risk factors for postoperative complications. METHODS This retrospective cohort study included all the consecutive patients undergoing segmental bowel resection for symptomatic endometriosis at "La Paz" University Hospital (Madrid, Spain) and at "Hospital General Universitario de Valencia" (Valencia, Spain) from January 2014 to December to 2017. Patients were grouped according to specimen extraction approach into those who had transvaginal extraction (Group I) and those who had suprapubic extraction (Group II). Clinic-demographical, surgical and post-surgical data were recorded. Intra- and postoperative complications were classified according to Clavien-Dindo criteria. Postoperative data were compared between groups. Risk factors associated with surgery were investigated. RESULTS Out of 99 female patients included (average age 36.91 ± 5.36 years), 23 patients (23.2%) had transvaginal and 76 (76.8%) had suprapubic specimen extraction. The groups were comparable regarding operative time, nodule size, level of anastomosis, hospital stay and intraoperative complications. We observed no statistically significant differences in postoperative complications and rectovaginal fistula rate between the groups. Binary logistic regression analyses determined that vaginal endometriosis is an independent risk factor for postoperative complications (OR: 2.63, 95% CI [1.10-6.48], p = 0.03). CONCLUSIONS Transvaginal specimen extraction is a safe and feasible technique in DE colorectal surgery and should be taken into consideration whenever vaginal endometriosis exists. Nevertheless, vaginal endometriosis can be an independent risk factor for postoperative complications in DE surgery.
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Affiliation(s)
- E Spagnolo
- Department of Obstetrics and Gynecology, "La Paz" University Hospital, Madrid, Spain
| | - J Marí-Alexandre
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain
| | - S Di Saverio
- General Surgery One, University of Insubria, University Hospital of Varese, Viale Luigi Borri, 57, 21100, Varese, VA, Italy.
| | - J Gilabert-Estellés
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain.,Comprehensive Multidisciplinary Endometriosis Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.,Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain
| | - C Agababyan
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain.,Comprehensive Multidisciplinary Endometriosis Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - P Garcia-Casarrubios
- Department of Obstetrics and Gynecology, "La Paz" University Hospital, Madrid, Spain
| | - A López
- Department of Obstetrics and Gynecology, "La Paz" University Hospital, Madrid, Spain
| | - E González-Cantó
- Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain
| | - I Pascual
- Department of General Surgery, "La Paz" University Hospital, Madrid, Spain
| | - A Hernández
- Department of Obstetrics and Gynecology, "La Paz" University Hospital, Madrid, Spain.,Department of Obstetrics and Gynaecology, Universidad Autónoma de Madrid, Madrid, Spain
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21
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Borghese G, Coppola F, Raimondo D, Raffone A, Travaglino A, Bortolani B, Lo Monaco S, Cercenelli L, Maletta M, Cattabriga A, Casadio P, Mollo A, Golfieri R, Paradisi R, Marcelli E, Seracchioli R. 3D Patient-Specific Virtual Models for Presurgical Planning in Patients with Recto-Sigmoid Endometriosis Nodules: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:86. [PMID: 35056394 PMCID: PMC8777715 DOI: 10.3390/medicina58010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
Background and Objective: In recent years, 3D printing has been used to support surgical planning or to guide intraoperative procedures in various surgical specialties. An improvement in surgical planning for recto-sigmoid endometriosis (RSE) excision might reduce the high complication rate related to this challenging surgery. The aim of this study was to build novel presurgical 3D models of RSE nodules from magnetic resonance imaging (MRI) and compare them with intraoperative findings. Materials and Methods: A single-center, observational, prospective, cohort, pilot study was performed by enrolling consecutive symptomatic women scheduled for minimally invasive surgery for RSE between November 2019 and June 2020 at our institution. Preoperative MRI were used for building 3D models of RSE nodules and surrounding pelvic organs. 3D models were examined during multi-disciplinary preoperative planning, focusing especially on three domains: degree of bowel stenosis, nodule's circumferential extension, and bowel angulation induced by the RSE nodule. After surgery, the surgeon was asked to subjectively evaluate the correlation of the 3D model with the intra-operative findings and to express his evaluation as "no correlation", "low correlation", or "high correlation" referring to the three described domains. Results: seven women were enrolled and 3D anatomical virtual models of RSE nodules and surrounding pelvic organs were generated. In all cases, surgeons reported a subjective "high correlation" with the surgical findings. Conclusion: Presurgical 3D models could be a feasible and useful tool to support surgical planning in women with recto-sigmoidal endometriotic involvement, appearing closely related to intraoperative findings.
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Affiliation(s)
- Giulia Borghese
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Francesca Coppola
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
| | - Antonio Travaglino
- Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, 80138 Naples, Italy;
| | - Barbara Bortolani
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (B.B.); (L.C.); (E.M.)
| | - Silvia Lo Monaco
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Laura Cercenelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (B.B.); (L.C.); (E.M.)
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Arrigo Cattabriga
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy;
| | - Rita Golfieri
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (F.C.); (S.L.M.); (A.C.); (R.G.)
| | - Roberto Paradisi
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
| | - Emanuela Marcelli
- eDIMES Lab-Laboratory of Bioengineering, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40126 Bologna, Italy; (B.B.); (L.C.); (E.M.)
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Azienda Ospedaliero-Univeristaria di Bologna, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (G.B.); (M.M.); (P.C.); (R.P.); (R.S.)
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22
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Hiltunen J, Eloranta ML, Lindgren A, Keski-Nisula L, Anttila M, Sallinen H. Robotic-assisted laparoscopy is a feasible method for resection of deep infiltrating endometriosis, especially in the rectosigmoid area. J Int Med Res 2021; 49:3000605211032788. [PMID: 34407685 PMCID: PMC8381426 DOI: 10.1177/03000605211032788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare outcomes of mini-invasive surgical treatment of endometriosis, especially conventional laparoscopy with robotic-assisted laparoscopy, and to evaluate the quality of life. METHODS One hundred three consecutive patients with endometriosis who had surgery from 2014 to 2017 owing to an indication of pain were enrolled in this retrospective study. The majority (n = 77, 75%) of patients underwent conventional laparoscopy and 18 (17%) had robotic-assisted laparoscopy. The quality of life was postoperatively assessed with a questionnaire. RESULTS The rates of parametrectomy (76% vs. 45%,) and rectovaginal resection (28% vs. 4%) were significantly higher in robotic-assisted laparoscopy than in laparoscopy. Additionally, the rate of bowel operations (50% vs. 17%), especially the shaving technique, was higher in robotic-assisted laparoscopy surgery than in laparoscopy (39% vs. 8%). There was no difference in the rate of postoperative complications between laparoscopy and robotic-assisted laparoscopy. Most (91%) of the patients who answered the questionnaire felt that surgical treatment had relieved their pain. In the laparoscopic and robotic-assisted groups, 88% of respondents felt that their quality of life had improved after surgery. CONCLUSIONS This study suggests that robotic-assisted laparoscopy is a feasible method to resect deep infiltrating endometriosis, especially in the rectosigmoid area.
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Affiliation(s)
- Janika Hiltunen
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.,Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Marja-Liisa Eloranta
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Auni Lindgren
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland.,Department of Health Sciences, Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Maarit Anttila
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Sallinen
- Department of Gynecology and Obstetrics, 60650Kuopio University Hospital, Kuopio University Hospital, Kuopio, Finland
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23
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Fan J, McDonnell R, Jacques A, Fender L, Lo G. MRI sliding sign: Using MRI to assess rectouterine mobility in pelvic endometriosis. J Med Imaging Radiat Oncol 2021; 66:54-59. [PMID: 34241976 DOI: 10.1111/1754-9485.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgical excision of deep infiltrating endometriosis (DIE) is complex and associated with morbidity. Diagnostic imaging plays an important role in the preoperative workup. We sought to determine the utility of single sagittal T2-weighted MRI motion sequence in the preoperative assessment of pelvic mobility in patients with endometriosis. METHODS An observational study at a single tertiary public referral centre in Australia. Eighty-one MRI studies from 1 May 2019 to 3 December 2019, were enrolled. Studies were included if they were performed to stage endometriosis, including a T2-weighted motion series, adequately covering a uterus, cervix and rectum. Fifty-seven studies met inclusion criteria. The reference standard was a contemporaneous transvaginal ultrasound (TVUS) reporting on pelvic organ mobility. Three subspecialist radiologists were then blindly asked to identify, on the cine loop: rectouterine immobility, superficial endometriosis (pelvic bowel adhesions), rectosigmoid Deep Infiltrating Endometriosis (DIE). Fleiss' Kappa assessed interobserver agreement. Consensus MRI sensitivity and specificity were estimated against the reference standard (TVUS). RESULTS Median age was 35 years (range 19-51). Forty-three cases had a contemporaneous TVUS; 14 reporting a sliding sign, 29 with fixed pelves. Interobserver agreement was 'substantial' (k = 0.79) for absent MRI sliding sign and 'almost perfect' (k = 0.90) for absence of DIE. Consensus MRI had 90% sensitivity (95% CI 73-98%) for pelvic immobility at TVUS (absent sliding sign). Interobserver agreement and consensus MRI sensitivity were higher for adhesions and immobility than normal findings. CONCLUSION An MRI motion sequence can identify patients with pelvic adhesions and immobility, helping determine surgical difficulty when TVUS is not diagnostic.
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Affiliation(s)
- Jim Fan
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Rose McDonnell
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Laura Fender
- King Edward Memorial Hospital, Perth, Western Australia, Australia.,Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Glen Lo
- King Edward Memorial Hospital, Perth, Western Australia, Australia.,Department of Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,BreastScreen WA, Perth, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia.,Curtin University, Perth, Western Australia, Australia
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24
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Flaxman TE, Cooke CM, Miguel OX, Sheikh AM, Singh SS. A review and guide to creating patient specific 3D printed anatomical models from MRI for benign gynecologic surgery. 3D Print Med 2021; 7:17. [PMID: 34224043 PMCID: PMC8256564 DOI: 10.1186/s41205-021-00107-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patient specific three-dimensional (3D) models can be derived from two-dimensional medical images, such as magnetic resonance (MR) images. 3D models have been shown to improve anatomical comprehension by providing more accurate assessments of anatomical volumes and better perspectives of structural orientations relative to adjacent structures. The clinical benefit of using patient specific 3D printed models have been highlighted in the fields of orthopaedics, cardiothoracics, and neurosurgery for the purpose of pre-surgical planning. However, reports on the clinical use of 3D printed models in the field of gynecology are limited. Main text This article aims to provide a brief overview of the principles of 3D printing and the steps required to derive patient-specific, anatomically accurate 3D printed models of gynecologic anatomy from MR images. Examples of 3D printed models for uterine fibroids and endometriosis are presented as well as a discussion on the barriers to clinical uptake and the future directions for 3D printing in the field of gynecological surgery. Conclusion Successful gynecologic surgery requires a thorough understanding of the patient’s anatomy and burden of disease. Future use of patient specific 3D printed models is encouraged so the clinical benefit can be better understood and evidence to support their use in standard of care can be provided.
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Affiliation(s)
- Teresa E Flaxman
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada. .,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Carly M Cooke
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Olivier X Miguel
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Adnan M Sheikh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sukhbir S Singh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
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25
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Roman H, Bridoux V, Merlot B, Resch B, Chati R, Coget J, Forestier D, Tuech JJ. Risk of bowel fistula following surgical management of deep endometriosis of the rectosigmoid: a series of 1102 cases. Hum Reprod 2021; 35:1601-1611. [PMID: 32619233 PMCID: PMC7368398 DOI: 10.1093/humrep/deaa131] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
STUDY QUESTION What are the risk factors and prevalence of bowel fistula following surgical management of deep endometriosis infiltrating the rectosigmoid and how can it be managed? SUMMARY ANSWER In patients managed for deep endometriosis of the rectosigmoid, risk of fistula is increased by bowel opening during both segmental colorectal resection and disc excision and rectovaginal fistula repair is more challenging than for bowel leakage. WHAT IS KNOWN ALREADY Bowel fistula is known to be a severe complication of colorectal endometriosis surgery; however, there is little available data on its prevalence in large series or on specific management. STUDY DESIGN, SIZE, DURATION A retrospective study employing data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis (CIRENDO) from June 2009 to May 2019, in three tertiary referral centres. PARTICIPANTS/MATERIALS, SETTING, METHODS One thousand one hundred and two patients presenting with deep endometriosis infiltrating the rectosigmoid, who were managed by shaving, disc excision or colorectal resection. The prevalence of bowel fistula was assessed, and factors related to the complication and its surgical management. MAIN RESULTS AND THE ROLE OF CHANCE Of 1102 patients enrolled in the study, 52.5% had a past history of gynaecological surgery and 52.7% had unsuccessfully attempted to conceive for over 12 months. Digestive tract subocclusion/occlusion was recorded in 12.7%, hydronephrosis in 4.5% and baseline severe bladder dysfunction in 1.5%. An exclusive laparoscopic approach was carried out in 96.8% of patients. Rectal shaving was performed in 31.9%, disc excision in 23.1%, colorectal resection in 35.8% and combined disc excision and sigmoid colon resection in 2.9%. For various reasons, the nodule was not completely removed in 6.4%, while in 7.2% of cases complementary procedures on the ileum, caecum and right colon were required. Parametrium excision was performed in 7.8%, dissection and excision of sacral roots in 4%, and surgery for ureteral endometriosis in 11.9%. Diverting stoma was performed in 21.8%. Thirty-seven patients presented with bowel fistulae (3.4%) of whom 23 (62.2%) were found to have rectovaginal fistulae and 14 (37.8%) leakage. Logistic regression model showed rectal lumen opening to increase risk of fistula when compared with shaving, regardless of nodule size: adjusted odds ratio (95% CI) for disc excision, colorectal resection and association of disc excision + segmental resection was 6.8 (1.9–23.8), 4.8 (1.4–16.9) and 11 (2.1–58.6), respectively. Repair of 23 rectovaginal fistulae required 1, 2, 3 or 4 additional surgical procedures in 12 (52.2%), 8 (34.8%), 2 (8.7%) and 1 patient (4.3%), respectively. Repair of leakage in 14 patients required 1 procedure (stoma) in 12 cases (85.7%) and a second procedure (colorectal resection) in 2 cases (14.3%). All patients, excepted five women managed by delayed coloanal anastomosis, underwent a supplementary surgical procedure for stoma repair. The period of time required for diverting stoma following repair of rectovaginal fistulae was significantly longer than for repair of leakages (median values 10 and 5 months, respectively, P = 0.008) LIMITATIONS, REASONS FOR CAUTION The main limits relate to the heterogeneity of techniques used in removal of rectosigmoid nodules and repairing fistulae, the lack of accurate information about the level of nodules, the small number of centres and that a majority of patients were managed by one surgeon. WIDER IMPLICATIONS OF THE FINDINGS Deep endometriosis infiltrating the rectosigmoid can be managed laparoscopically with a relatively low risk of bowel fistula. When the type of bowel procedure can be chosen, performance of shaving instead of disc excision or colorectal resection is suggested considering the lower risk of bowel fistula. Rectovaginal fistula repair is more challenging than for bowel leakage and may require up to four additional surgical procedures. STUDY FUNDING/COMPETING INTEREST(S) CIRENDO is financed by the G4 Group (The University Hospitals of Rouen, Lille, Amiens and Caen) and the ROUENDOMETRIOSE Association. No financial support was received for this study. H.R. reports personal fees from ETHICON, Plasma Surgical, Olympus and Nordic Pharma outside the submitted work. The other authors declare no conflict of interests related to this topic.
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Affiliation(s)
- Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France.,Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Valérie Bridoux
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Benjamin Merlot
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
| | - Benoit Resch
- Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.,Clinique Mathilde, Rouen, France
| | - Rachid Chati
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Julien Coget
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | | | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
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26
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Casals G, Carrera M, Domínguez JA, Abrão MS, Carmona F. Impact of Surgery for Deep Infiltrative Endometriosis before In Vitro Fertilization: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1303-1312.e5. [PMID: 33582380 DOI: 10.1016/j.jmig.2021.02.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of this systematic review and meta-analysis were to compare reproductive outcomes in patients who underwent surgery for deep infiltrative endometriosis (DIE) before in vitro fertilization (IVF) with those in patients who underwent IVF without a previous surgery for DIE, to analyze data according to different types of surgery (complete or incomplete) or subgroups of patients (DIE with or without bowel involvement), and to assess surgical and IVF complications and data regarding safety concerns. DATA SOURCES A systematic literature search from January 1980 to November 2019 with no language restriction was performed in PubMed, MEDLINE, Embase, and Web of Science. The search strategy used the following Medical Subject Headings terms: "in vitro," "fertilization," "IVF," "assisted reproduction," "colorectal," "endometriosis," "deep," "infiltrating," "deep infiltrative endometriosis," "intestinal," "bowel," "rectovaginal," "uterosacral," "vaginal," and "bladder." METHODS OF STUDY SELECTION We included studies that compared reproductive outcomes in women with infertility with DIE who received IVF with or without a previous surgery for DIE lesions. Meta-analysis was performed using Review Manager (RevMan v.5.3; Cochrane Training, London, United Kingdom). The risk of bias of the included studies was assessed using the method recommended by Cochrane Collaboration. TABULATION, INTEGRATION, AND RESULTS The systematic search retrieved 150 articles; 98 studies were potentially eligible, and their full texts were reviewed. Of these, 12 studies met our inclusion criteria, and 5 presented data suitable for inclusion in a meta-analysis; however, 2 of the studies provided overlapping data, and only the larger study was finally included. No randomized controlled trials (RCTs) were found. The pregnancy rate per patient was 1.84 (95% confidence interval [CI], 1.28-2.64), the pregnancy rate per cycle was 1.84 (95% CI, 1.26-2.70), and the live birth rate per patient was 2.22 (95% CI, 1.42-3.46) times more likely for operated patients than for nonoperated ones. The addition of data from the incomplete surgery groups also showed a higher pregnancy rate per patient for surgery before IVF (odds ratio [OR] 1.63; 95% CI, 1.16-2.28). The results favor previous surgery in DIE with digestive involvement (OR 2.43; 95% CI, 1.13-5.22) and also in DIE without digestive involvement (OR 1.55; 95% CI, 0.61-3.95). A qualitative analysis of the complications of surgery and IVF showed a partial or complete lack of information on these issues as well as high heterogeneity in the reported data. None of these studies is an RCT; therefore, all have a high risk of selection and allocation bias, except for 1 study that statistically controlled the latter risk by using propensity scores. Funnel plots showed no asymmetry. CONCLUSION The results were very consistent for all the studied outcomes, showing a statistically significant benefit for surgery before IVF, although they should be confirmed with RCTs. In addition to the reproductive outcomes, safety data should also be reported to obtain a complete assessment of the risks and benefits.
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Affiliation(s)
- Gemma Casals
- Department of Gynecology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona (Drs. Casals and Carmona), Barcelona
| | - María Carrera
- Assisted Reproduction Unit, Hospital Universitario Doce de Octubre (Dr. Carrera), Madrid
| | - José Antonio Domínguez
- Instituto Extremeño de Reproducción Asistida (IERA Badajoz-Lisboa), Centro de Cirugía de Mínima Invasión Jesús Uson (Dr. Domínguez), Cáceres, Spain
| | - Mauricio Simões Abrão
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (Dr. Abrão), São Paulo, Brazil
| | - Francisco Carmona
- Department of Gynecology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona (Drs. Casals and Carmona), Barcelona.
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Quality of life in patients with deep endometriosis and laparoscopic colorectal resection. GINECOLOGIA.RO 2021. [DOI: 10.26416/gine.32.2.2021.5001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bassi MA, Andres MP, Bassi CM, Neto JS, Kho RM, Abrão MS. Postoperative Bowel Symptoms Improve over Time after Rectosigmoidectomy for Endometriosis. J Minim Invasive Gynecol 2020; 27:1316-1323. [DOI: 10.1016/j.jmig.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 01/31/2023]
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Rousset P, Buisson G, Lega JC, Charlot M, Gallice C, Cotte E, Milot L, Golfier F. Rectal endometriosis: predictive MRI signs for segmental bowel resection. Eur Radiol 2020; 31:884-894. [PMID: 32851441 DOI: 10.1007/s00330-020-07170-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/31/2020] [Accepted: 08/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To retrospectively determine the accuracy of MRI rectal and pararectal signs in predicting the necessity for segmental resection in the case of lesions located in the rectum. METHODS MR images of consecutive patients treated for rectal endometriosis over a 5-year period were reviewed in consensus by two blinded readers. A systematic analysis of 7 rectal (lesion length, transverse axis, thickness and circumference, and presence of a convex base, submucosal oedema and hyperintense cystic areas) and 4 pararectal (posterior vaginal fornix, parametrial, ureteral and sacro-recto-genital septum involvements) signs was performed for each lesion. MRI results were compared to the surgical procedure performed (shaving versus segmental resection). RESULTS Among 61 patients studied, 32 received a segmental resection and 29, a shaving. Receiver operating characteristic curve analysis allowed determining cut-off values for length (≥ 32 mm), transverse axis (≥ 22 mm), thickness (≥ 14 mm) and circumference (≥ 3/8 radii). The 7 rectal signs, and only the sacro-recto-genital septum pararectal sign, were significantly associated with segmental resection in univariate analysis, nodular thickness ≥ 14 mm and circumference ≥ 3/8 radii being the most predictive signs (odds ratio 94.5 and 60.4, respectively). These 2 signs remained positively associated with segmental resection in multivariate analysis and, when combined, were predictive of segmental resection with an accuracy of 90.2%. CONCLUSION Assessing MRI rectal and pararectal signs may accurately predict the need for segmental resection versus a more conservative approach such as shaving for rectal lesion management. KEY POINTS • MRI analysis of rectal endometriosis, taking into account rectal and pararectal signs, may assist surgeons in the decision-making process, in counselling patients regarding the surgical procedure and in adequately allocating resources. • Among rectal signs, nodular thickness ≥ 14 mm and a circumference ≥ 38% were the most predictive signs of segmental resection. • Among pararectal signs, only the sacro-recto-genital septum involvement was significantly associated with segmental resection.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude Bernard University, Villeurbanne, France. .,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France.
| | - Guillaume Buisson
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Jean-Christophe Lega
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Internal and Vascular Medicine Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Mathilde Charlot
- Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Colin Gallice
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Gynecological Oncological and Obstetrics Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Eddy Cotte
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Oncologic and General Surgery Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Laurent Milot
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - François Golfier
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Gynecological Oncological and Obstetrics Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, 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: 66] [Impact Index Per Article: 13.2] [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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Agnello M, Vottero M, Bertapelle P. Sacral neuromodulation to treat voiding dysfunction in patients with previous pelvic surgery for deep infiltrating endometriosis: our centre's experience. Int Urogynecol J 2020; 32:1499-1504. [PMID: 32803341 PMCID: PMC8203508 DOI: 10.1007/s00192-020-04478-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/27/2020] [Indexed: 12/04/2022]
Abstract
Introduction and hypothesis Voiding symptoms/dysfunctions (VS/Ds) after surgery for deep-infiltrating endometriosis (DIE) are frequent (20% of patients) and, together with bowel dysfunctions, may represent a de novo disorder due to surgical damage of the pelvic plexus or a worsening of pre-existent functional damage. Sacral neuromodulation (SNM) might improve voiding symptoms by treating dysfunctional voiding. The aim of this study is to report our experience with SNM in patients treated with surgery for DIE. Methods We retrospectively enrolled 13 patients with VS/Ds after surgery for DIE. All patients were investigated with urodynamic studies (UDS) and agreed to undergo SNM. Pre-existing VS/Ds, bowel disorders and pelvic pain, DIE surgical procedures, UDS and SNM test results were recorded. Results After surgery for DIE, functional bladder outflow obstruction and detrusor acontractility were observed in nine and four patients, respectively. Chronic pelvic pain was present in seven cases. Twelve patients developed constipation, whilst one patient had de novo faecal incontinence. After the SNM testing period, nine patients (69.2%) experienced a significant improvement of symptoms that led to definitive implant. Four patients (30.8%) had no symptom relief and the system was removed. Conclusions Functional bladder outflow obstruction and urinary retention are the most common VS/Ds after surgery for DIE. SNM may be an effective option for these patients, probably due to its action in improving the dysfunctional voiding, which was likely to be already present as part of the “endometriotic syndrome” and got worse after pelvic surgery. Results for pelvic pain control and gastrointestinal disorders should not be underestimated.
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Affiliation(s)
- Marco Agnello
- Università degli Studi di Torino, Torino, Italy. .,SC Urologia U, A.O.U. Città della Salute e della Scienza, Molinette Hospital (Corso Bramante 88, Torino - CAP 10126), Torino, Italy.
| | - Mario Vottero
- SC Neuro-Urologia, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Paola Bertapelle
- SC Neuro-Urologia, A.O.U. Città della Salute e della Scienza, Torino, Italy
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Vesale E, Roman H, Moawad G, Benoit L, Touboul C, Darai E, Bendifallah S. Voiding Dysfunction after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1490-1502.e3. [PMID: 32730989 DOI: 10.1016/j.jmig.2020.07.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Surgical management of deep endometriosis is associated with a high incidence of lower urinary tract dysfunction. The aim of the current systematic review and meta-analysis was to assess the rates of voiding dysfunction according to colorectal shaving, discoid excision, and segmental resection for deep endometriosis. DATA SOURCES We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. Medical Subject Headings terms for colorectal endometriosis and voiding dysfunction were combined and restricted to the French and English languages. The final search was performed on August 28, 2019. The outcome measured was the occurrence of postoperative voiding dysfunction. METHODS OF STUDY SELECTION Study Quality Assessment Tools were used to assess the quality of included studies. Studies rated as good and fair were included. Two reviewers independently assessed the quality of each included study, discrepancies were discussed; if consensus was not reached, a third reviewer was consulted. TABULATION, INTEGRATION AND RESULTS Out of 201 relevant published reports, 51 studies were ultimately reviewed systematically and 13 were included in the meta-analysis. Rectal shaving was statistically less associated with postoperative voiding dysfunction than segmental colorectal resection (Odds ratio [OR] 0.34; 95% confidence intervals [CI], 0.18-0.63; I2 = 0%; p <.001) or discoid excision (OR 0.22; 95% CI, 0.09-0.51; I2 = 0%; p <.001). No significant difference was noted when comparing discoid excision and segmental colorectal resection (OR 0.74; 95% CI, 0.32-1.69; I2 = 29%; p = .47). Similarly, rectal shaving was associated with a lower risk of self-catheterization >1 month than segmental colorectal resection (OR 0.3; 95% CI, 0.14-0.66; I2 = 0%; p = .003). This outcome was no longer significant when comparing discoid excision and segmental colorectal resection (OR 0.72; 95% CI, 0.4-1.31; I2 = 63%; p = .28). CONCLUSION Colorectal surgery for endometriosis has a significant impact on urinary function regardless of the technique. However, rectal shaving causes less postoperative voiding dysfunction than discoid excision or segmental resection.
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Affiliation(s)
- Elie Vesale
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); Department of Gynecology and Obstetrics, Medical Center of the Sud-Francilien, (Dr Vesale), Corbeil-Essonne, France
| | - Horace Roman
- Clinique Tivoli-Ducos, Bordeaux (Dr. Roman), France
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, (Dr. Moawad), Washington, District of Columbia
| | - Louise Benoit
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris.
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
| | - Emile Darai
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
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Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb). Arch Gynecol Obstet 2020; 302:983-993. [PMID: 32676859 DOI: 10.1007/s00404-020-05694-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. METHODS All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. RESULTS Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. CONCLUSIONS Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
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Ferrero S, Stabilini C, Barra F, Clarizia R, Roviglione G, Ceccaroni M. Bowel resection for intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol 2020; 71:114-128. [PMID: 32665125 DOI: 10.1016/j.bpobgyn.2020.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/12/2023]
Abstract
Over the last twenty years, segmental resection (SR) has been the technique most frequently used to treat bowel endometriosis. Nowadays, it is most commonly performed by laparoscopy; however, there is evidence that it can be safely performed by robotic-assisted laparoscopic surgery. Rectovaginal fistula and anastomotic leakage are the two major complications of SR; other complications include pelvic abscess, postoperative bleeding, ureteral damage, and anastomotic stricture. Several studies showed that SR causes improvement in pain and intestinal symptoms; nerve-sparing SR may improve the functional outcomes. The rates of postoperative recurrence of bowel endometriosis vary across the studies, possibly because of the different definitions of recurrence.
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Affiliation(s)
- Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, Genoa, 16132, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Cesare Stabilini
- Department of Surgical Science, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, Genoa, 16132, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, Genoa, 16132, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Via Don A. Sempreboni 5, Negrar, 37024, Verona, Italy
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Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis. Arch Gynecol Obstet 2020; 302:957-967. [PMID: 32661754 PMCID: PMC7471187 DOI: 10.1007/s00404-020-05686-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
Abstract
Introduction Deep infiltrating endometriosis (DIE) affects between 3.8% and 37% of all endometriosis patients, mostly affecting rectovaginal septum or retrocervical space and characterized by the severe endometriosis-related complaints. Nowadays, generally managed with surgery. However, this is associated with a risk of postoperative complications. To better evaluate intra- and postoperative complications and outcomes for rectovaginal (RVE) and retrocervical endometriosis (RCE), the preoperative management should be accurately described and compared. Methodology This is a cohort retrospective study performed at the Endometriosis Centre of Charité-University Clinic, Berlin. 34 patients were investigated in their reproductive age, n = 19 with RVE and n = 15 RCE, operated between 2011 and 2015. The surgical approach was divergent in both groups. Single laparoscopy was performed in RCE patients (RCEP) and vaginal assisted laparoscopy in RVE patients (RVEP). Long-term postoperative outcome included complications, fertility rate and recurrence rate. Results The median follow-up time was three years (y). Symptom-free status was revealed in n = 12 RVEP and n = 9 RCEP. Postoperatively, endometriosis-related complaints were presented in n = 7 RVEP and n = 6 RCEP, but with significant pain relief. From n = 8 RVE patients seeking fertility, pregnancy occurred in n = 7 and from n = 9 RCEP pregnancy appeared in n = 5 patients in the meantime of 6 months. Postoperative complications were reported in n = 1 RVEP with early postoperative bleeding, after ureter leakage and n = 1 RCEP with postoperative anastomotic insufficiency. The postoperative recurrence rate was equivalent to zero. Conclusion The appropriate surgical approach for each group, preserving anatomy and functionality of the organs, seems to be very essential and efficient.
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Jago CA, Nguyen DB, Flaxman TE, Singh SS. Bowel surgery for endometriosis: A practical look at short- and long-term complications. Best Pract Res Clin Obstet Gynaecol 2020; 71:144-160. [PMID: 32680784 DOI: 10.1016/j.bpobgyn.2020.06.003] [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: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Endometriosis involving the bowel requires a thorough evaluation prior to deciding upon surgical treatment. Patient symptoms, treatment goals, extent and location of disease, surgeon experience, and anticipated risks all play a part in the preoperative decision-making process. Short- and long-term complications after bowel surgery for endometriosis are the focus of this article. Unfortunately, the literature to date has inherent limitations that prevent generalizability. Most studies are retrospective or prospective single-center case series. Publication bias is unavoidable with mainly large volume experts sharing their experience. As a result, there is a need for high-quality prospective studies that standardize inclusion criteria and outcome measures among various centers with an aim to present long-term outcomes. In the meantime, care for those with endometriosis involving the bowel requires a thorough preoperative plan to minimize risks and a need for early diagnosis and management of complications unique to bowel surgery.
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Affiliation(s)
- Caitlin Anne Jago
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada
| | - Dong Bach Nguyen
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada
| | - Teresa E Flaxman
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, 1053 Carling Ave, K1Y 4E9, Ottawa ON Canada
| | - Sukhbir S Singh
- Minimally Invasive Gynecology Research Group, Department of Ob/Gyn and Newborn Care, University of Ottawa & the Ottawa Hospital, 501 Smyth Rd, K1H 8L6, Ottawa ON Canada; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, 1053 Carling Ave, K1Y 4E9, Ottawa ON Canada.
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Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC WOMENS HEALTH 2020; 20:111. [PMID: 32434535 PMCID: PMC7240912 DOI: 10.1186/s12905-020-00974-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Background To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
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Affiliation(s)
- Hungling Kwok
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hongye Jiang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Tian Li
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huan Yang
- Department of Gynecology, Shenzhen Second People's Hospital/ the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Hui Fei
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Cheng
- Department of Obstetrics and Gynecology, the Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Shuzhong Yao
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China
| | - Shuqin Chen
- Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510000, China.
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Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, Nisolle M, Roman H, Saridogan E, Tanos V, Tomassetti C, Ulrich UA, Vermeulen N, De Wilde RL. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020; 2020:hoaa002. [PMID: 32064361 PMCID: PMC7013143 DOI: 10.1093/hropen/hoaa002] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
STUDY QUESTION How should surgery for endometriosis be performed? SUMMARY ANSWER This document provides recommendations covering technical aspects of different methods of surgery for deep endometriosis in women of reproductive age. WHAT IS KNOWN ALREADY Endometriosis is highly prevalent and often associated with severe symptoms. Yet compared to equally prevalent conditions, it is poorly understood and a challenge to manage. Previously published guidelines have provided recommendations for (surgical) treatment of deep endometriosis, based on the best available evidence, but without technical information and details on how to best perform such treatment in order to be effective and safe. STUDY DESIGN SIZE DURATION A working group of the European Society for Gynaecological Endoscopy (ESGE), ESHRE and the World Endometriosis Society (WES) collaborated on writing recommendations on the practical aspects of surgery for treatment of deep endometriosis. PARTICIPANTS/MATERIALS SETTING METHODS This document focused on surgery for deep endometriosis and is complementary to a previous document in this series focusing on endometrioma surgery. MAIN RESULTS AND THE ROLE OF CHANCE The document presents general recommendations for surgery for deep endometriosis, starting from preoperative assessments and first steps of surgery. Different approaches for surgical treatment are discussed and are respective of location and extent of disease; uterosacral ligaments and rectovaginal septum with or without involvement of the rectum, urinary tract or extrapelvic endometriosis. In addition, recommendations are provided on the treatment of frozen pelvis and on hysterectomy as a treatment for deep endometriosis. LIMITATIONS REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical expertise. Where available, references of relevant studies were added. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on management of endometriosis and the recommendations for surgical treatment of ovarian endometrioma. STUDY FUNDING/COMPETING INTERESTS The meetings of the working group were funded by ESGE, ESHRE and WES. Dr Roman reports personal fees from ETHICON, PLASMASURGICAL, OLYMPUS and NORDIC PHARMA, outside the submitted work; Dr Becker reports grants from Bayer AG, Volition Rx, MDNA Life Sciences and Roche Diagnostics Inc. and other relationships or activities from AbbVie Inc., and Myriad Inc, during the conduct of the study; Dr Tomassetti reports non-financial support from ESHRE, during the conduct of the study; and non-financial support and other were from Lumenis, Gedeon-Richter, Ferring Pharmaceuticals and Merck SA, outside the submitted work. The other authors had nothing to disclose. TRIAL REGISTRATION NUMBER na.
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Affiliation(s)
| | - Joerg Keckstein
- Endometriosis Centre Dres. Keckstein, Richard-Wagner Strasse 18, 9500 Villach, Austria
| | - Christian M Becker
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital Womens Centre, OX3 9DU Oxford, UK
| | - Michel Canis
- Department of Gynaecological Surgery, University Clermont Auvergne CHU, Estaing 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR Fribourg Hopital cantonal, 1708 Fribourg, Switzerland
| | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623 Thessaloniki, Greece
| | | | - Michelle Nisolle
- Hôpital de la Citadelle, Department of Obstetrics & Gynecology, 4000 Liège, Belgium
| | - Horace Roman
- Endometriosis Centre, Clinic Tivoli-Ducos, Bordeaux, France
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ertan Saridogan
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing Institute for Women’s Health, University College Hospital, NW1 2BU London, UK
| | - Vasilios Tanos
- Department of Obstetrics and Gynecology, Aretaeio Hospital, 2024 Nicosia, Cyprus
| | - Carla Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, 3000 Leuven, Belgium
| | - Uwe A Ulrich
- Department of Obstetrics and Gynaecology, Martin Luther Hospital, 14193 Berlin, Germany
| | | | - Rudy Leon De Wilde
- University Hospital for Gynecology, Carl von Ossietzky Universitat Oldenburg, 26129 Oldenburg, Germany
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Preoperative Ultrasound Indications Determine Excision Technique for Bowel Surgery for Deep Infiltrating Endometriosis: A Single, High-Volume Center. J Minim Invasive Gynecol 2020; 27:1141-1147. [PMID: 32007640 DOI: 10.1016/j.jmig.2019.08.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/07/2019] [Accepted: 08/31/2019] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVE To identify bowel nodule features of deep infiltrating endometriosis (DIE) measured through preoperative ultrasound scanning that influence laparoscopic surgical strategy. DESIGN A retrospective study. SETTING Malzoni Clinic-Endoscopica Malzoni Department, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy. PATIENTS Patients undergoing laparoscopic surgery between January 1, 2014, and December 31, 2018, for clinically suspected DIE with previous ultrasound evaluation ≤1 month before intervention. INTERVENTION Use of sonographic measurements to determine laparoscopic excision technique (segmental bowel resection, discoid resection, shaving) for DIE with bowel involvement.``` MEASUREMENTS AND MAIN RESULTS: Of 5051 DIE surgeries, 4983 were included; 1494 (29.9%) bowel resections (512 bowel segmental resections and 982 nodulectomies [967 shaving and 15 discoid resections]) were performed, accounting for 34.3% and 65.7% of all bowel procedures, respectively. Preoperative sonographic findings and surgical reports were collected. Sensitivity and specificity of preoperative ultrasound evaluation for all types of DIE lesions were calculated, and sonographic measurements of bowel nodules and different surgical techniques were compared. According to preoperative sonographic measurements, most nodules excised by segmental resection had a longitudinal diameter of 3 to 7 cm, none were <3 cm; all nodules excised by nodulectomy (shaving or discoid resection) had a longitudinal diameter <3 cm. Mean thickness (maximum depth of muscular layer infiltration) of identified bowel nodules estimated through ultrasound scanning was 13.4 mm ± 4.8 mm (mean ± standard deviation) and 5.8 mm ± 2.7 mm for lesions removed by segmental resection and nodulectomy, respectively, and there was a statistically significant difference between them (p <.05). Of the 512 segmental resected bowel nodules, 143 (28%) had a maximum depth ≥9 mm, 354 (69%) had 7 to 9 mm, and 15 (3%) had <7 mm (6 mm, with length >4 cm). All shaved nodules had thickness ≤7 mm. The 15 nodules excised by discoid resection (1.5% of nodulectomies) were <25 mm, but thickness ranged from 7 to 9 mm. CONCLUSION The need for segmental resection in DIE with bowel-infiltrating nodules depends on the degree of muscular layer infiltration and corresponding thickness (muscularis rule) in addition to nodule length and can be accurately identified by preoperative ultrasound evaluation.
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Nicolaus K, Zschauer S, Bräuer D, Jimenez-Cruz J, Lehmann T, Rengsberger M, Diebolder H, Runnebaum IB. Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 2020; 301:699-706. [PMID: 31989287 DOI: 10.1007/s00404-019-05425-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to assess post-operative complications based on the Clavien-Dindo classification system following routine laparoscopic treatment of all stages of endometriosis. METHODS A retrospective cohort study was carried out to identify women who underwent laparoscopic complete resection of newly diagnosed endometriosis between 2013 and 2016. 401 patients were identified using hospital database search software, and electronic files were reviewed. The stages of endometriosis had been classified according to the revised score of the American Society of Reproductive Medicine (rASRM) and the Enzian classification in cases of deep infiltrating endometriosis. Post-operative complications were recorded based on the Clavien-Dindo classification. Multivariate regression analysis was used to investigate the impact of the stages of endometriosis and surgical steps on complications. RESULTS Grade III complications requiring surgical, endoscopic, or radiological intervention occurred in only 1.7% of patients and were significantly associated with rASRM stage IV (OR 1.8). Grade II complications (blood transfusion, total parenteral nutrition) occurred in 18.7% of patients. rASRM stage IV (OR 2.0), hysterectomy (OR 3.2), conversion to laparotomy (OR 11.1), and bowel resection (OR 27.6) were significantly associated with increased risk of grade II complications. rASRM stages I-III did not show an effect on post-operative complications or hospital stay. CONCLUSIONS Clavien-Dindo complication grading was readily applicable to laparoscopic removal of endometriosis of all stages. Higher Clavien-Dindo grades correctly reflected clinically relevant complications and were associated with deep infiltrating endometriosis, stage IV endometriosis, bowel surgery, or hysterectomy. Clavien-Dindo classification can be recommended for evaluation of laparoscopic endometriosis surgery outcome.
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Affiliation(s)
- Kristin Nicolaus
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Stefan Zschauer
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Dominik Bräuer
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Jorge Jimenez-Cruz
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
- Department of Obstetrics and Prenatal Medicine, University Women's Hospital Bonn, Bonn, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Rengsberger
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Herbert Diebolder
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Ingo B Runnebaum
- Department of Gynecology and Reproductive Medicine, University Women's Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany.
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Nevo A, Haidar AM, Navaratnam A, Humphreys M. Urinary Retention Following Non-urologic Surgery. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00518-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Hernández Gutiérrez A, Spagnolo E, Zapardiel I, Garcia-Abadillo Seivane R, López Carrasco A, Salas Bolívar P, Pascual Miguelañez I. Post-operative complications and recurrence rate after treatment of bowel endometriosis: Comparison of three techniques. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100083. [PMID: 31517307 PMCID: PMC6728789 DOI: 10.1016/j.eurox.2019.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/10/2019] [Accepted: 07/06/2019] [Indexed: 01/30/2023] Open
Abstract
Objective The aim of the present study was to compare post-operative complications and recurrence of three surgical techniques: segmental resection, discoid excision and nodule shaving. Study design From January 2014 to December 2017, 143 patients who underwent segmental bowel resections for endometriosis at “La Paz” University Hospital, were enrolled and grouped by different techniques. We compared post-operative complications and recurrence rate in three groups: 76 (53%) patients underwent segmental resection (group I), 20 (14%) patients underwent discoid resection (group II) and 47 (33%) patients underwent rectal shaving (group III). Qualitative data was defined by absolute values and percentages, and quantitative data by mean and standard deviation. Qualitative variables between groups were compared using Chi- squared test. While quantitative data between groups was performed by means of t-test and ANOVA test. For all statistical tests a value of p < 0.05 will be considered statistically significant. Result Segmental resection was associated with higher rate of severe post-operative complications in comparison with discoid resection or shaving technique (23.5% versus 5% versus 0% respectively) (p = 0.005). We showed statistical differences among the three study groups for nodule size (p < 0.001) and localization (p = 0.02). Our analysis showed statistical differences among the three groups in term of additional procedures performed at the same time of bowel surgery, in particular in case of endometriosis of the ureter (p = 0.001) and the parametrium (p = 0.04). After a long follow-up (46.4 ± 0.5 months for the group I, 42.2 ± 1.6 months for the group II, 39.7 ± 1.8 months for the group III), the shaving group was associated to higher recurrence rate (12.7%) in comparison with the discoid group (5%) and the segmental resection group (1.3%) (p = 0.01). Conclusion We showed that segmental resection is associated with high rate of postoperative complications. Conversely, this strategy should avoid the need of further interventions in young patients. Conservative surgery, such as discoid resection and shaving, revealed a higher recurrence rate and could be more appropriate in women approximating menopause because of the lower possibility of recurrence.
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Affiliation(s)
| | | | - Ignacio Zapardiel
- Department of Obstetrics and Gynecology, "La Paz" University Hospital, Madrid, Spain
| | | | - Ana López Carrasco
- Department of Obstetrics and Gynecology, "La Paz" University Hospital, Madrid, Spain
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Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol 2019; 239:21-29. [PMID: 31163353 DOI: 10.1016/j.ejogrb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/20/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
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Affiliation(s)
- Johannes Lermann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
| | - Nalan Topal
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany; Department of Obstetrics and Gynecology, Klinikverbund Südwest, Klinikum Sindelfingen-Böblingen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefanie Burghaus
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Felix Heindl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
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Ceccaroni M, Ceccarello M, Caleffi G, Clarizia R, Scarperi S, Pastorello M, Molinari A, Ruffo G, Cavalleri S. Total Laparoscopic Ureteroneocystostomy for Ureteral Endometriosis: A Single-Center Experience of 160 Consecutive Patients. J Minim Invasive Gynecol 2019; 26:78-86. [DOI: 10.1016/j.jmig.2018.03.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/14/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
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Raffaelli R, Garzon S, Baggio S, Genna M, Pomini P, Laganà AS, Ghezzi F, Franchi M. Mesenteric vascular and nerve sparing surgery in laparoscopic segmental intestinal resection for deep infiltrating endometriosis. Eur J Obstet Gynecol Reprod Biol 2018; 231:214-219. [PMID: 30415128 DOI: 10.1016/j.ejogrb.2018.10.057] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE(S) To investigate Mesenteric vascular and nerve Sparing Surgery (MSS) as surgical laparoscopic technique to perform segmental intestinal resection for deep infiltrating endometriosis (DIE). STUDY DESIGN Prospective cohort study between January 2013 and December 2016. Consecutive patients with suspected intestinal DIE underwent clinical and imaging evaluation to confirm intestinal involvement. Indications for radical surgery and surgical technique (intestinal resection versus shaving) were consistent with Abrão algorithm. Surgeons aimed to perform MSS in all the consecutive patients that required intestinal resection. MSS consists in mesenteric artery, branching arteries, and surrounding nerve fibers preservation by dissecting mesentery adherent to the intestinal wall. Data about history, preoperative and post-operative evaluation, surgery and complications were recorded. Symptoms were evaluated before and 30-60 days after surgery with numeric rating scale for pain. Constipation was evaluated with the Constipation Assessment Scale (CAS). Patients with diagnosis of irritable bowel syndrome, inflammatory bowel diseases, diverticulitis, and previous segmental intestinal resection were excluded. RESULTS Sixty-two out of 75 (82.7%) consecutive women with intestinal endometriosis underwent laparoscopic segmental intestinal resection performed with MSS. Major complications that required repeated operation occurred in 4 cases (6.5%). Anastomotic leakage occurred in only 1 case (1.6%). Dysmenorrhea (p < .001; r = -0.86), dyspareunia (p < .001; r = -0.80), dyschezia (p < .001; r = -0.86) and dysuria (p < .001; r = -0.56) were significantly improved after surgery. After an average of 33.1 months from surgery, severe constipation was reported only by two patients (3.6%) (CAS: 13-16). The median time from surgery to intestinal function recovery (flatus or stool passage) was one day. Logistic regression analysis showed constipation related to the distance from anal verge and time since surgery. CONCLUSION(S) MSS in laparoscopic intestinal resection for DIE may be reproducible, safe and effective. MSS could be combined with pelvic nerve-sparing surgery as an effective approach to improve intestinal symptoms after radical surgery for DIE that requires segmental intestinal resection.
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Affiliation(s)
- Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Silvia Baggio
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Michele Genna
- Department of General Surgery, AOUI Verona, Verona, Italy
| | - Paola Pomini
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Hudelist G, Aas-Eng MK, Birsan T, Berger F, Sevelda U, Kirchner L, Salama M, Dauser B. Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis-A prospective cohort study. Acta Obstet Gynecol Scand 2018; 97:1438-1446. [DOI: 10.1111/aogs.13436] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/12/2018] [Accepted: 07/21/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Gernot Hudelist
- Department of Gynecology; Hospital St. John of God; Vienna Austria
| | | | - Tudor Birsan
- Department of General Surgery; Hospital St. John of God; Vienna Austria
| | - Franz Berger
- Department of General Surgery; Wilhelminen Hospital; Vienna Austria
| | - Ursula Sevelda
- Department of Gynecology; Hospital St. John of God; Vienna Austria
| | - Lisa Kirchner
- Department of Gynecology; Hospital St. John of God; Vienna Austria
| | - Mohamad Salama
- Department of Thoracic Surgery; Otto Wagner Hospital; Vienna Austria
| | - Bernhard Dauser
- Department of General Surgery; Hospital St. John of God; Vienna Austria
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47
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Fang J, Piessens S. A step-by-step guide to sonographic evaluation of deep infiltrating endometriosis. SONOGRAPHY 2018. [DOI: 10.1002/sono.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Fang
- Monash Health; Moorabbin Hospital; VIC Australia
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48
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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. [PMID: 28988744 DOI: 10.1016/j.jogc.2017.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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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49
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Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, Mihailide C, Bamford H, DiFrancesco L, Tazuke S, Ghanouni P, Rivas H, Nezhat A, Nezhat C, Nezhat F. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol 2018; 218:549-562. [PMID: 29032051 DOI: 10.1016/j.ajog.2017.09.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/19/2017] [Accepted: 09/27/2017] [Indexed: 12/29/2022]
Abstract
The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.
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50
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Bertocchi E, Barugola G, Benini M, Bocus P, Rossini R, Ceccaroni M, Ruffo G. Colorectal Anastomotic Stenosis: Lessons Learned after 1643 Colorectal Resections for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2018; 26:100-104. [PMID: 29678755 DOI: 10.1016/j.jmig.2018.03.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To evaluate the incidence, risk factors, and treatment of colorectal anastomotic stenosis in patients who undergo rectosigmoid resection for deep infiltrating endometriosis (DIE). DESIGN Retrospective analysis of a prospective database (Canadian Task Force classification III). SETTING Public medical center. PATIENTS All women who underwent laparoscopic rectosigmoid resections for DIE at our hospital between January 2002 and December 2016. INTERVENTION All patients were evaluated clinically and endoscopically at 1 month and 3 months after bowel resection. Stenosis was defined as a lack of passage through the anastomosis of a 12-mm proctoscope. Symptomatic stenosis was defined as the presence of endoscopically confirmed stricture accompanied by at least 2 of the following symptoms: constipation, need to push, tenesmus, and ribbon stools. Only patients with symptomatic stenosis were studied. Demographic data, surgical techniques, and postoperative complications were recorded prospectively. Treatments and outcomes of anastomotic symptomatic strictures were analyzed. MEASUREMENTS AND MAIN RESULTS A total of 1643 patients underwent laparoscopic rectosigmoid resection at our hospital between January 2002 and December 2016. Among these, 104 patients (6.3%) presented with symptomatic anastomotic stenosis. The median patient age was 27 years (range, 23-44 years), and the median interval between diagnosis and the onset of symptomatic stenosis was 57 days (range, 21-64 days). The only statistically significant predictors of anastomotic stenosis were the presence of ileostomy (p = .01) and previous pelvic surgery (p = .002). Treatment of choice was always conservative. Of the 104 patients in the study cohort, 90 (86.5%) underwent 3 endoscopic dilatations. No patient required reoperation. CONCLUSION The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication.
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Affiliation(s)
- Elisa Bertocchi
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy.
| | - Giuliano Barugola
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Marco Benini
- Department of Gastroenterology and Endoscopy, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Paolo Bocus
- Department of Gastroenterology and Endoscopy, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Roberto Rossini
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Gynecology, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
| | - Giacomo Ruffo
- Department of Surgery, Sacred Heart-Don Calabria Hospital, Negrar, Verona, Italy
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