Surgery For Deep Infiltrating Endometriosis Research Articles

Enhanced recovery after surgery (ERAS) for deep infiltrating endometriosis surgery: Experience of a French center

ObjectiveThe objective of the study was to evaluate the implementation of an ERAS programme for deep pelvic endometriosis (DPE) surgery in terms of length of stay (LOS), postoperative complications (POC) and rehospitalisation rate. MethodsThis was a comparative retrospective monocentric study in the Gynaecologic Department of the La Conception Hospital in Marseille, France. We compared a ‘conventional’ group, with classic perioperative management corresponding to patients undergoing DPE surgery between April 8, 2014 and January 23, 2018, and an ‘ERAS’ group after setting up the ERAS protocol from February 6, 2018 to March 6, 2020. ResultsA total of 101 patients with DPE surgery were included, with 39 in the conventional group and 53 in the ERAS group. The LOS decreased by 1.91 days (p < 0.001). During the 45 postoperative days, no difference was found in rehospitalised rate (p = 1). The POC rate was 15/39 (38.5 %) in the conventional group and 12/53 (22.6 %) in the ERAS group (p = 0.1). ConclusionThe implementation of an ERAS programme for DPE surgery is an effective strategy because it can reduce the LOS without increasing the POC rate.

Persistent urinary retention after deep infiltrating endometriosis surgery: to consider modification in patient selection or modification in surgical approach and extent? - An ethical challenge

Persistent urinary retention after deep infiltrating endometriosis surgery: to consider modification in patient selection or modification in surgical approach and extent? - An ethical challenge

Double trouble: Bilateral ureteral duplication incidentally diagnosed during deep infiltrating endometriosis surgery

Double trouble: Bilateral ureteral duplication incidentally diagnosed during deep infiltrating endometriosis surgery

Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery

Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery

Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery

Laparoscopic near-infrared technology with indocyanine green in deep infiltrating endometriosis surgery

Qualitative ICG Imaging to Assess Rectal Anastomotic Perfusion in Deep Infiltrating Endometriosis Surgery

Study Objective To present a practical approach to assess bowel perfusion at anastomotic site using ICG Imaging during Deep Infiltrating Endometriosis (DIE) surgery. Design Case report. Setting OR. Use of ICG imaging after segmental resection for DIE. Test results prompted a second resection/Anastomosis. Patients or Participants 43-year-old-woman, G1P1A0, Partial right oophorectomy (open surgery), 8 years before. Seven years of progressive dysmenorrhea (8/10), dyspareunia (7/10) and Dyschezia (9/10) with occasional hematochezia. After imaging and colonoscopy, posterior compartment and biparametrial DIE was diagnosed, including a 4 cm rectal nodule with submucosal involvement. Interventions Video shows surgical procedure in which after colorectal anastomosis, there was a vascular impairment detected by ICG imaging, that prompted the team to perform a further colonic resection with a new anastomosis. Measurements and Main Results Uneventful postoperative course. Discharged on POD 3. No bladder voiding or defecatory disfunctions. After two years follow up the symptoms have not reappeared. Conclusion ICG imaging, in the context of colorectal anastomosis, is a valuable tool which probably reduces the rate of anastomotic leakage detecting microvascular impairment in the anastomotic site. To present a practical approach to assess bowel perfusion at anastomotic site using ICG Imaging during Deep Infiltrating Endometriosis (DIE) surgery. Case report. OR. Use of ICG imaging after segmental resection for DIE. Test results prompted a second resection/Anastomosis. 43-year-old-woman, G1P1A0, Partial right oophorectomy (open surgery), 8 years before. Seven years of progressive dysmenorrhea (8/10), dyspareunia (7/10) and Dyschezia (9/10) with occasional hematochezia. After imaging and colonoscopy, posterior compartment and biparametrial DIE was diagnosed, including a 4 cm rectal nodule with submucosal involvement. Video shows surgical procedure in which after colorectal anastomosis, there was a vascular impairment detected by ICG imaging, that prompted the team to perform a further colonic resection with a new anastomosis. Uneventful postoperative course. Discharged on POD 3. No bladder voiding or defecatory disfunctions. After two years follow up the symptoms have not reappeared. ICG imaging, in the context of colorectal anastomosis, is a valuable tool which probably reduces the rate of anastomotic leakage detecting microvascular impairment in the anastomotic site.

Does the Presence of Adenomyosis Affect the Results of DEEP Infiltrating Endometriosis Surgery?

<h3>Study Objective</h3> To evaluate the impact of adenomyosis on surgical outcomes in women with deep infiltrating endometriosis (DIE) undergoing laparoscopic surgery. <h3>Design</h3> Retrospective study including women undergoing DIE surgery during a 3-year period. <h3>Setting</h3> Referral tertiary university hospital. <h3>Patients or Participants</h3> 157 women with DIE undergoing surgery. <h3>Interventions</h3> Two expert sonographers preoperatively diagnosed DIE and adenomyosis. DIE was defined according to the criteria of the International Deep Endometriosis Analysis group, and adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DIE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien-Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. <h3>Measurements and Main Results</h3> 157 DIE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. There were no differences between groups regarding demographic characteristics, current treatment, symptoms, r-ASRM classification or type of surgery. The mean operating time was higher in the A group (237min±98.4) compared to noA group (188min±79.3) (p=0.017). The mean hospital stay was also higher in the A group compared to noA group (3.62±4.3 vs 2.55±1.79 days, p<0.05). Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.5% (noA group) (p<0.001). There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p<0.001). <h3>Conclusion</h3> Adenomyosis seems to play a detrimental role in DIE surgical procedures. It increases the risk of presenting complications in DIE surgery after controlling for demographic, clinical and surgical factors. Adenomyosis should be considered an independent preoperative risk factor of surgical complications.

The effect of new cross linked hyaluronan gel on quality of life of patients after deep infiltrating endometriosis surgery: a randomized controlled pilot study

In this prospective randomised placebo-controlled study, we aimed to evaluate the effect of New Cross linked Hyaluronan Gel (NCH gel) on the quality of life of patients who underwent laparoscopic surgery due to Deep Infiltrating Endometriosis (DIE). The intervention group received 40 mL of NCH gel, and the control group had a 40 mL sterile saline solution instilled into the peritoneal cavity following standard laparoscopic procedures. The patients were called in the third and sixth postoperative months and requested to fill the Visual Analogue Scale (VAS), Endometriosis Health Profile (EHP-5), and Short Form for Mental and Physical Health (SF-12) questionnaires. There was a significant reduction in dysmenorrhoea, dyschezia, dyspareunia VAS scores at 3rd, and 6th-month visits in NCH gel group. The postoperative 6th-month EHP-5 scores were significantly lower (1.16 ± 1.51, p-value: .02) in NCH gel group. Besides, NCH gel group had higher SF-12 mental and SF-12 physical scores. Clinical Trials registration number: NCT04023383 IMPACT STATEMENT What is already known on this subject? Application of solid or liquid physical barriers is believed to be a promising strategy to reduce adhesions after laparoscopic endometriosis surgery. However, comparable data regarding the effects of adhesion barriers are still lacking. What the results of this study add? We revealed that there was a significantly higher decrease in VAS and EHP-5 scores and an increase in SF-12 physical-mental ratings after surgery in NCH gel group. What are the implications of these findings for clinical practice and/or further research? Using NHC gel in addition to standard surgical procedure improves postoperative VAS scores, and provides better quality of life scores.

New Cross Linked Hyaluronan Gel After Deep Infiltrating Endometriosis Surgery

New Cross Linked Hyaluronan Gel After Deep Infiltrating Endometriosis Surgery

Prospective Evaluation of Near-infrared Fluorescence Imaging Use as a Supportive Tool in Deep Infiltrating Endometriosis Surgery

Prospective Evaluation of Near-infrared Fluorescence Imaging Use as a Supportive Tool in Deep Infiltrating Endometriosis Surgery