7692 An Approach to Imaging and Surgical Excision of Abdominal Wall Endometriosis

Abstract

<h3>Study Objective</h3> To demonstrate an approach to the imaging and surgical management of abdominal wall endometriosis (AWE) including the surgical repair of abdominal wall defects. <h3>Design</h3> Video case presentation. <h3>Setting</h3> Pre-operative imaging suite and operating room. <h3>Patients or Participants</h3> To illustrate our approach, we present two surgical cases. The first is of a patient who was referred with catamenial pain in the left lower abdominal wall. She has a history of 2 previous cesarean sections and a lesion, consistent with abdominal wall endometriosis was demonstrated on ultrasound, adjacent to her previous cesarean section scar. The second case is a patient with peri-umbilical abdominal wall endometriosis. <h3>Interventions</h3> In both cases, we demonstrate our technique for resection of abdominal wall endometriosis. We discuss a 3-step approach: 1. Landmarking and incision making 2. Dissection and excision 3. Fascial repair. Larger fascial defects may require fascial mobilization off surrounding tissue to allow for a tension-free closure or mesh placement in the abdominal wall. These techniques may be performed together in consultation with a general surgeon and are further described within this video. <h3>Measurements and Main Results</h3> Pre-operative ultrasound accurately predicted abdominal wall endometriosis and surgical excision results in symptom relief. <h3>Conclusion</h3> Ultrasound is the first line diagnostic test to confirm clinical suspicion of abdominal wall endometriosis. MRI can be used to further characterize lesion extent and structures involved. Surgical excision of abdominal wall endometriosis can be safely performed by the gynecologic surgeon in conjunction with general surgery if resection results in a large abdominal wall defect.