8811 Diaphragmatic Endometriosis: Anatomopathology and Correlation with Surgical Technique in 230 Patients Treated in a Referral Center

Abstract

<h3>Study Objective</h3> To define a decision-making algorithm for Diaphragmatic Endometriosis (DE) surgical treatment correlating laparoscopic appearance of endometriotic implants with their histopatological counterpart. <h3>Design</h3> All the cases of DE surgically treated in Our Department, from January 2004 to January 2021, were analyzed in a retrospective chart review. <h3>Setting</h3> DE lesions were correlated to intraoperative findings (morphology, localization, side of the diaphragm, diameter, depth of infiltration and number) and classified according to their histopathological features as: •"Foci": bidimensional superficial peritoneal lesions, generally ≤ 1 cm diameter. •"Plaques": thin fibrotic lesions, thickening the diaphragmatic peritoneum with no muscular infiltration, > 1cm diameter. •"Nodules": solid, tridimensional implants, associated with partial or full-thickness infiltration of underneath muscle layers and generally > 1cm diameter. <h3>Patients or Participants</h3> Two hundred -thirty patients were collected. <h3>Interventions</h3> The histopathologic revision of all the specimens enabled us to select a different laparoscopic surgical approach, for each lesion, as the following: <h3>Measurements and Main Results</h3> •Argon Beam Coagulator (ABC) and/or Diathermocoagulation (DTC) for diaphragmatic foci; •Diaphragmatic stripping is indicated for endometriotic plaques •Nodulectomy is the right choice for endometriotic nodules, with the need of partial or full-thickness diaphragmatic resection according to the entity of muscular involvement. <h3>Conclusion</h3> A safe eradication of the implants requires a standardization of the surgical technique based on the knowledge of laparoscopic and histopathologic characteristics of lesions, thus avoiding intra- and post-operative morbidities.