73: Endometriosis of the rectus muscle: A single center experience

Abstract

There is limited data to inform physician’s counseling for endometriosis infiltrating the rectus muscle. The objective of this study was to review patient characteristics, preoperative and intraoperative findings for excised cases of rectus muscle endometriosis. In this IRB approved retrospective case series, we identified all women undergoing surgical resection of endometriosis with confirmed rectus muscle endometriosis on pathology report at a single academic hospital between January 2009 and January 2019. Subjects were excluded if pathologic specimens did not include the muscle or endometriosis was not present histologically. Demographics and perioperative data were extracted from the electronic medical record. Descriptive statistics were performed. Twenty-two patients were included in the analysis. The women were predominantly white, with a median age of 34 years (25 – 42 years) and median BMI of 31.28 kg/m2, (17.79 – 48.65 kg/m2). Twenty-one (95%) patients had at least one prior cesarean section and 5 (22%) had a prior excision of abdominal wall endometriosis. The chief complaint for all patients was pelvic or abdominal pain, and 75% reported cyclic pain. Only one quarter complained of a mass or lump however 54% had a palpable nodule on exam. Forty percent of women attempted medical therapy prior to surgery and all but one had preoperative imaging, the majority (81%) of which were MRI. Fourteen (64%) patients had a laparoscopic procedure and in 71% of those, the endometriosis was removed laparoscopically with 4 (21%) patients having a combined laparoscopic and abdominal procedure. Concurrent pelvic endometriosis was present in 10 (71%) patients who underwent laparoscopy, with the most common location being the bladder (60%). All cases of laparoscopic excision of rectus endometriosis were performed by a minimally invasive gynecologic surgeon (MIGS). Endometriosis nodules excised were on average 4.62 cm and 6 patients required mesh placement, 4 placed open by general surgery and the other 2 were placed laparoscopically by MIGS surgeons. There were no intraoperative complications. Eighteen (82%) of patients were discharged on the day of surgery including all 10 (100%) who had a laparoscopic excision of rectus endometriosis. Three patients in the laparotomy group had 30-day wound complications, with two requiring hospital admission for IV antibiotics. There was one hernia which was repaired 18 months following laparoscopic resection of rectus endometriosis. 94% of patients experienced complete pain relief at their postoperative visit. This case series describes the preoperative and intraoperative characteristics of rectus muscle endometriosis. Both abdominal and laparoscopic resection are effective in eliminating patients’ pain. Even when open excision is planned, laparoscopic evaluation of the pelvis should be considered due to the high incidence of concurrent pelvic endometriosis.