Comparison of ultrasound-guided high-intensity focused ultrasound ablation and surgery for abdominal wall endometriosis

Ling Zhao,Youlin Deng,Qing Wei,Jinyun Chen,Chunquan Zhao

doi:10.1080/02656736.2018.1511836

Ling Zhao, Youlin Deng + Show 3 more

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https://doi.org/10.1080/02656736.2018.1511836

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Abstract

Background: Surgery constitutes the standard approach for abdominal wall endometriosis (AWE), but is invasive. High-intensity focused ultrasound (HIFU) ablation is effective and safe for the treatment of AWE, but no study has compared HIFU and surgery.Objective: To report our experience about the benefits and adverse events of surgery compared to HIFU for the treatment of AWE.Methods: This was a retrospective study of 54 consecutive Chinese women with AWE after cesarean section treated at the First Affiliated Hospital of Chongqing Medical University (China) between January 2012 and December 2014. The patients underwent surgery (n = 29) or HIFU (n = 25). The technical success rate, adverse events, and recurrence were assessed.Results: The technical success rate was 100% in both groups. The complete remission rate was 92.0% (23/25) in the HIFU group, and 100% (29/29) in the surgery group. Numeric rating scale (NRS) scores after HIFU were significantly improved from 6.9 to 0.3.During the median follow-up period of 32 months (range, 19–46 months), the durations of pain relief were 29.7 ± 12.6 months and 25.0 ± 13.5 months in the surgery and HIFU groups, respectively (p = .337). Three patients (10.7%) experienced pain recurrence in the surgery group, and two (8.0%) in the HIFU group. Major adverse events occurred in four (13.8%) and one (4.0%) patients in the surgery and HIFU groups, respectively (p > .05).Conclusions: HIFU appears to be beneficial for the treatment of AWE, and may reduce adverse events. Compared with surgery, HIFU does not induce blood loss or tissue defects.

Highlights

Surgery is the first choice for the management of abdominal wall endometriosis (AWE) [1,2]
The diagnostic criteria for AWE were [2,7]: (1) women of reproductive age with a history of abdominal surgery such as cesarean section, endometriosis, etc.; (2) masses or nodules around the abdominal incision; (3) masses or nodules accompanied with pain and/or tenderness during menstrual cycles; (4) mass size varying with the menstrual cycle, often large before menstruation and reduced thereafter; and (5) ultrasound showing hypoechoic irregular nodules near the scar
Major adverse events attributable to treatment occurred in one (4.0%) patient in the High-intensity focused ultrasound (HIFU) group and four (13.8%) in the surgery group

Summary

Introduction

Surgery is the first choice for the management of abdominal wall endometriosis (AWE) [1,2]. Surgery constitutes the standard approach for abdominal wall endometriosis (AWE), but is invasive. High-intensity focused ultrasound (HIFU) ablation is effective and safe for the treatment of AWE, but no study has compared HIFU and surgery. Objective: To report our experience about the benefits and adverse events of surgery compared to HIFU for the treatment of AWE. The technical success rate, adverse events, and recurrence were assessed. Three patients (10.7%) experienced pain recurrence in the surgery group, and two (8.0%) in the HIFU group. Major adverse events occurred in four (13.8%) and one (4.0%) patients in the surgery and HIFU groups, respectively (p > .05). HIFU does not induce blood loss or tissue defects

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