Deeply Infiltrating Endometriosis Research Articles

10255 A Sustainable Approach for Navigating Complex Endometriosis: Bladder Peritonectomy of Deeply Infiltrative Endometriosis (DIE)

10255 A Sustainable Approach for Navigating Complex Endometriosis: Bladder Peritonectomy of Deeply Infiltrative Endometriosis (DIE)

Diagnostic Accuracy of Transvaginal Sonography for Deeply Infiltrating Endometriosis and Pouch of Douglas Obliteration in the Presence or Absence of Ovarian Endometrioma

Background: Endometriosis is one of the most common gynecological diseases worldwide. Significant attention has been drawn to this multiorgan and often painful disorder. Objectives: This study aimed to examine the accuracy of transvaginal sonography (TVS) in the diagnosis of deeply infiltrating endometriosis (DIE) with respect to the presence or absence of ovarian endometrioma (OE). Patients and Methods: This cross-sectional study was performed on all patients undergoing TVS before gynecological laparoscopy. With pathological confirmation as the standard reference, the diagnostic accuracy of TVS for DIE and pouch of Douglas (POD) obliteration was compared with that of laparoscopy in the anterior and posterior pelvic compartments with respect to the presence or absence of OE. Agreement between TVS and laparoscopy was evaluated for each case, and Cohen’s kappa statistic was measured for each site of involvement. Moreover, sensitivity, specificity, negative and positive predictive values, and likelihood ratios of TVS were calculated, with laparoscopy as the reference test. Results: A total of 110 patients, with a mean age of 37.20 ± 7.16 years, were recruited in this study. The accuracy, sensitivity, and negative predictive value of TVS for the diagnosis of DIE and POD obliteration were estimated at 89.5%, 58.3%, and 88.9% in the anterior pelvic compartment and 93.3%, 92%, and 70.6% in the posterior pelvic compartment, respectively. Nevertheless, TVS showed lower sensitivity for detecting pelvic adhesions and peritoneal cysts compared to laparoscopy. The presence of OE did not significantly increase the accuracy of TVS for the diagnosis of DIE or POD obliteration (P > 0.05). Conclusion: The present study showed that TVS is an adequately accurate and non-invasive diagnostic tool for the detection and mapping of DIE and POD obliteration, regardless of the presence of OE. TVS may waive the need for exploratory laparoscopy in DIE or at least facilitate precise pre-procedural DIE mapping.

Fertility Outcomes after Surgical Management of Colorectal Endometriosis: A Single-center Retrospective Study

To assess the pregnancy rate after surgery for colorectal endometriosis. A retrospective, single-centre study performed from January 2014 to December 2019. A university tertiary referral centre. Patients with the intention to get pregnant under the age of 43 years, with or without a history of infertility and who were surgically managed for colorectal endometriosis. Complete excision of deeply infiltrating endometriosis (DIE). The postoperative pregnancy rate was assessed. Seventy-seven patients had surgery; their mean age was 32.5 ± 4.4 years. Preoperative documented infertility was present in 77.9% (n = 60) of patients. The mean length of history of infertility was 36.2 ± 24.9 months. The procedure was performed by laparoscopic surgery in 92.2% (n = 71) of patients. Non-conservative, conservative and mixed treatment were performed in 66.2% (n = 51), 29.9% (n = 23) and 3.9% (n = 3) of patients, respectively. According to the Clavien-Dindo classification, the 3B complication rate was 6.5% (n = 5). The mean follow-up was 46.7 ± 20.6 months. Clinical pregnancies were defined by the presence of intra-uterine pregnancy with an embryo with cardiac activity. The postoperative pregnancy rate was 62.3% (n = 48), and 54.2% (n = 26) were spontaneous. The mean number of pregnancies was 1.2 ± 0.4 per patient. In addition, 18.7% (n = 9) of patients got pregnant twice. The mean time from surgery to pregnancy was 13.8 ± 13.1 months. The live birth rate was 89.1% (n = 41). There were no significant differences concerning the prognostic criteria reported in the literature (anti-Müllerian hormone level, age, presence of adenomyosis). There were no predictive criteria for live births. According to this study, surgery for colorectal endometriosis results in a high postoperative pregnancy rate. Studies with a high level of evidence are needed to determine good candidates for this type of surgery.

A More Diverse Cervical Microbiome Associates with Better Clinical Outcomes in Patients with Endometriosis: A Pilot Study.

Infection-induced chronic inflammation is common in patients with endometriosis. Although microbial communities in the reproductive tracts of patients have been reported, little was known about their dynamic profiles during disease progression and complication development. Microbial communities in cervical mucus were collected by cervical swabs from 10 healthy women and 23 patients, and analyzed by 16S rRNA amplicon sequencing. The abundance, ecological relationships and functional networks of microbiota were characterized according to their prevalence, clinical stages, and clinical features including deeply infiltrating endometriosis (DIE), CA125, pain score and infertility. Cervical microbiome can be altered during endometriosis development and progression with a tendency of increased Firmicutes and decreased Actinobacteria and Bacteroidetes. Distinct from vaginal microbiome, upregulation of Lactobacillus, in combination with increased Streptococcus and decreased Dialister, was frequently associated with advanced endometriosis stages, DIE, higher CA125 levels, severe pain, and infertility. Significantly, reduced richness and diversity of cervical microbiome were detected in patients with more severe clinical symptoms. Clinical treatments against infertility can partially reverse the ecological balance of microbes through remodeling nutrition metabolism and transport and cell-cell/cell-matrix interaction. This study provides a new understanding on endometriosis development and a more diverse cervical microbiome may be beneficial for patients to have better clinical outcomes.

Parametrial Endometriosis: Assessing the Efficacy of the Laparoscopic Nerve-Sparing Ultralateral Resection (LaNSURe) Technique

<h3>Study Objective</h3> Parametrial endometriosis (PE) is specific presentation of deeply infiltrating endometriosis (DIE) that infiltrates the parametria laterally toward the pelvic sidewall. It can affect the levator ani muscles, obturator internus, sacral nerve roots, pudendal and/or the sciatic nerve. These structures are innervated by somatic nerves; therefore, their infiltration produces somatic-type pain, as opposed to the viscaeral pain classically seen in DIE and demands a different surgical strategy. The objective of this study is to characterize the clinical presentation of patients with PE and assess the outcomes of the LaNSURe treatment strategy. <h3>Design</h3> Retrospective-prospective cohort study of patients undergoing a surgical intervention (Canadian Task Force II-3). <h3>Setting</h3> Tertiary Academic Referral Center. <h3>Patients or Participants</h3> Thirty-seven patients who underwent a LaNSURe for treatment of PE. <h3>Interventions</h3> Radical treatment of PE using the LaNSURe technique. <h3>Measurements and Main Results</h3> Visual Analog Scale (VAS) was used to assess minimum, average, and maximum pain. The primary outcome was pain level change from before surgery to the last follow up visit available. Mean follow-up time was 10.05±3.28 months. Secondary outcomes were the scores of the four validated specific health-related quality of life questionnaires Pain VAS scores significantly reduced (p<.001) from preoperative to postoperative follow up: average pain from 5.75±1.94 to 2.89±2.53; maximum pain from 7.93±2.16 to 4.50±3.34; and minimum pain from 3.79±2.66 to 1.54±1.79. McGill Pain Questionnaire improved from 32.08±19.83 to 18.44±15.15 (p=0.01), Pain Catastrophizing Scale from 26.58±14.35 to 13.77±14.91 (p=0.0027), and Pelvic Floor Distress Inventory from 157.81±44.11 to 129.72±37.70 (p=0.017). Twenty eight out of 37 (75.7%) patients had undergone one or more previous excision surgery, with 67.6% done by an endometriosis specialist, and experienced persistent PE symptoms. <h3>Conclusion</h3> The LaNSURe technique is effective at improving overall pain and quality of life while preserving nerve function in the pelvic floor.

Application of robotic single-site surgery with optional additional port for endometriosis: a single institution's experience.

To evaluate the safety and feasibility of treating stage I-IV endometriosis patients with robotic single-site surgery (RSSS). A retrospective chart review was conducted on 334 patients with endometriosis treated by a single surgeon at a university hospital from January 2015 to November 2019. Surgeries were performed in a single institution between 2015 and 2019. All patients presented with pelvic pain and underwent surgical resection of the lesion. American Society of Reproductive Medicine (ASRM) standards were used to classify endometriosis. The primary goal of this study isto investigate thefeasibility and safetyof RSSS for surgical resection of stage I-IV endometriosis patients.We will comparepatient characteristics and surgical parameters, such as blood loss, operating time, and postoperative complications, acrossdifferent endometriosis stages to evaluate the effectiveness of this novel technique. RSSS was used for all cases, with no conversions to laparotomy or traditional laparoscopy. One to two additional ports were placed in 41 patients with deeply infiltrating endometriosis (DIE) involving the colorectal and urinary tract and/or extensive pelvic adhesions. Across patient groups, there were no significant differences in age, BMI, fertility history, abdominal surgery history, and hysterectomy ratio (P > 0.05). The median operation time was 140.25min (range: 85.50-260.00min,P < 0.05) and median blood loss was 31.25mL (range: 15-100mL,P < 0.05). Histopathology supported the diagnosis in 259/334 patients. The undiagnosed patients were associated with lower ASRM scores. For 83.3% of patients (295/334), the length of hospital stay was < 24h. The postoperative complication rate was 6.0% (20/334), although only two cases were severe. Our results indicate that RSSS is an alternative, safe, and acceptable platform for the surgical treatment of all stages of endometriosis.

Management of Recurrent Colorectal Endometriosis with Segmental Resection

Study Objective To present a unique case of the workup and management of recurrent colorectal endometriosis utilizing a multidisciplinary team approach. Design Case Report. Setting Community teaching hospital. Collaborative robotic surgical team including a minimally invasive gynecologic surgeon and colorectal surgeon utilizing the Da Vinci Xi platform. Patients or Participants 38-year-old gravida 3, para 1 with a history of deeply-infiltrating endometriosis status post excisional surgery including shave excision of a colorectal implant six months prior. She presents with recurrent rectal pain and bleeding due to confirmed recurrent colorectal endometriosis. Interventions Following a multi-disciplinary case conference, colorectal surgery performed a robotic-assisted low anterior bowel resection with primary colorectal anastomosis and flexible sigmoidoscopy. Gynecology was present to confirm all endometriosis excised and fertility was optimized for future planned frozen embryo transfer. Measurements and Main Results Complete excision of colorectal endometriosis with resolution of patient's rectal pain and bleeding. Pathology showed transmural colorectal endometriosis including a rectal lymph node involved with endometriosis. Conclusion Unusual case of recurrent colorectal endometriosis following shave excision, managed with segmental colorectal resection. Endometriosis involving a lymph node shows the disease's ability to be locally invasive however this phenomenon is not thought to lead to higher recurrence rates.

Incidence of deeply infiltrating endometriosis among 240 cases of pelvic endometriosis and analysis of its clinical and pathological characteristics

Objective: To evaluate the incidence of deeply infiltrating endometriosis (DIE) among patients of pelvic endometriosis confirmed by pathology and to make analysis of its clinical and pathological characteristics. Methods: From January 1, 2018 to December 31, 2018, clinical data of 240 cases of pelvic endometriosis diagnosed by laparoscopy and pathology hospitalized in Peking University First Hospital were analyzed retrospectively for the characteristics of symptoms, pelvic examination and anatomic distribution of endometriosis foci. Results: (1) Among 240 cases of pelvic endometriosis, 94 were diagnosed with DIE with an incidence of 39.2% (94/240); of them the diagnosis were made preoperatively in 44 cases (46.8%, 44/94). (2) Compared with those without DIE, patients with DIE had higher rates of secondary dysmenorrhea [53.2% (50/94) versus 38.4% (56/146), P=0.033], anal pain [43.6% (41/94) versus 28.1% (41/146), P=0.013], dyspareunea [39.4% (37/94) versus 18.5% (27/146), P=0.001] and frequent bowel movement [33.0% (31/94) versus 15.8%(23/146), P=0.002]. (3) Patients with DIE had higher rates of bad movement of uterus [21.3% (20/94) versus 6.8% (10/146), P=0.001], painful nodularity on uterosacral ligaments [26.6% (25/94) versus 6.2% (9/146), P<0.01], painful nodularity of posterior fornix [19.1% (18/94) versus 4.8% (7/146), P<0.01], blue nodule in vaginal wall [6.4% (6/94) versus 0 (0/146), P=0.003] by pelvic examination compared with those without DIE. (4) Ninety-four patients with DIE had a total of 162 nodules, of those 88 (54.3%, 88/162) located in uterosacral ligaments, 14 (8.6%, 14/162) in the rectum, 7 (4.3%, 7/162) in vaginal wall, 6 (3.7%, 6/162) in ureter, 4 in bladder (2.5%, 4/162), 2 (1.2%, 2/162) in Douglas pouch. Forty-three DIE patients (45.7%, 43/94) had more than one nodules. Patients with DIE had concomitant ovarian endometriosis in 69 cases (73.4%, 69/94), with a total of 103 endometrial cysts. (5) Patients with DIE had a higher rate of obliterated Douglas pouch [76.6% (72/94) versus 19.2% (28/146), P<0.01]. Conclusions: More than one third of patients with pelvic endometriosis have concomitant DIE with a lower rate of preoperative diagnosis. Pelvic pains, bad movement of uterus and painful nodulirity around cervix suggest the presence of DIE.

Rectal disc resection improves stool frequency in patients with deep infiltrating endometriosis: A prospective study.

Gastrointestinal symptoms occur with deeply infiltrating endometriosis (DIE) of the rectum. To explore the medium-term gastrointestinal functional outcomes after rectal disc resection for endometriosis. All women undergoing laparoscopy for stage IV endometriosis at a tertiary referral hospital between November 2016 and January 2018 and had evidence of DIE of the rectum were included. Low anterior resection syndrome (LARS) score was measured using a validated questionnaire. Thirty-six women formed the cohort of the study. The mean age was 37years (range 20-72years). All women underwent a laparoscopic anterior rectal disc resection for DIE. The response rate was 100%. There was an increase in the percentage of patients having no LARS postoperatively compared to preoperatively (an increase of 78-83%). There was a reduction in LARS scores postoperatively observed in 18 patients (50%) and the prevalence of major LARS decreased postoperatively from 10% to 1%. Comparison of individual symptoms revealed a significant improvement in postoperative stool frequency scores (P=0.02). Multivariate analysis using logistic regression analysis demonstrated that reduction in postoperative stool frequency scores remained an independent factor (P=0.008). Rectal disc resection is feasible and safe, achieving observable improvements in stool frequency in patients with rectal DIE.

AB018. Surgical outcomes for laparoscopic resection of stage III–IV endometriosis in our unit

Background: Endometriosis is an oestrogen-dependent inflammatory process caused by the presence of endometrial tissue outside the uterine cavity. It can lead to infertility and chronic pain, which can be severely debilitating. Deeply infiltrating endometriosis (DIE) can lead to significant bowel and bladder symptoms. Management is two-fold—hormonal suppression and surgical excision.

Postoperative imaging findings after laparoscopic surgery for deeply infiltrating endometriosis.

Deeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may cause anatomical changes and a variable spectrum of postoperative findings. Residual disease and complications can be also evaluated and are of great importance to estimate pain relief and fertility prognosis. The most common imaging findings following radical surgery for DIE are fibrotic scars in the retrocervical space and bowel anastomosis, absence of the posterior vaginal fornix and loculated fluid in the pararectal spaces. Ovaries are the most frequent site of early recurrence. Complications include infection, hemorrhage, urinary/evacuatory voiding dysfunctions as well as bowel and ureteral stenosis. The purpose of this article is to review the surgical techniques currently used to treat endometriosis in the retrocervical space, vagina, bladder, bowel, ureters, and ovaries and to describe the most common imaging findings including normal aspects, residual disease, complications, and recurrence.

Partial Cystectomy for Deeply Infiltrating Endometriosis of the Bladder with Cystotomy Repair

Video Objective To demonstrate safe surgical technique and management of partial bladder cystectomy and simple cystotomy repair due to deeply infiltrating endometriosis (DIE) using the Xi DaVinci robot. Setting A 32yo patient with dysmenorrhea and dyspareunia found to have DIE of the bladder undergoing surgical management at a large academic center. Interventions The bladder lesion was initially found on preoperative MRI and confirmed during robotic assisted surgery. The lesion was felt to be full thickness and required partial bladder cystectomy for adequate excision of the implant. The DaVinci robot was used to remove the lesion with good margins. The resulting cystotomy repair was repaired, with good seal noted when the bladder was backfilled and on cystoscopy. A foley catheter was maintained for 7 days postoperatively and removed after a cystogram showing adequate bladder recovery. Conclusion Deeply infiltrating endometriosis of the bladder is rare but can be safely managed with laparoscopic partial bladder cystectomy and cystotomy repair. Adequate preoperative planning and thorough inspection of the lesion during surgery can assist with full removal of the lesion, which improves patient symptoms and decreases incidence of recurrence.

Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection

ObjectiveTo analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. Study designPatients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann–Whitney U test, and Fisher’s exact test. ResultsEighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21–58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. ConclusionsPatients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.

Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients.

To examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE). This was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1month following surgery. We analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8min (± 80.7 standard deviation, range 60-440min) and mean hospital stay was 2.9days (± 1.5 standard deviation, range 1-11). The conversion to laparotomy rate was 1.6%. A combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates.

Effects of human recombinant type I IFNs (IFN-α2b and IFN-β1a) on growth and migration of primary endometrial stromal cells from women with deeply infiltrating endometriosis: A preliminary study

Objective(s)Endometriosis is a major cause of infertility and disability for women, caused by the presence of inflammatory endometrial implants in extrauterine locations. Among the constituents involved in the immune response during the development of endometriosis, several chemokines, including interferons (IFNs) may have a role in the pathogenesis of this disease. The aim of this preliminary study was to investigate the anti-proliferative and anti-migratory activities of type I IFNs (IFN-α2b and IFN-β1a) in primary endometrial stromal cells (ESCs) isolated from women with deeply infiltrating endometriosis (DIE). Study DesignThe study subjects included 7 women ranged in the age from 27 to 37 years with diagnosis of DIE (Stage III and IV). Collected primary ESC monolayers, isolated from endometriotic nodules, were incubated with various concentrations (from 1 to 1000 IU/ml) of IFN-α2b or IFN-β1a. Result(s)IFN-β1a had a significantly higher activity in hampering the proliferation of cells compared to IFN-α2b. This effect could be related to the induction of apoptosis and cell cycle arrest in S phase, observed in ESCs during incubation with IFN-β1a. Moreover, IFN-β1a was more potent than IFN-α2b in inhibiting migration and EGF-induced ERK activity of primary ESCs. Conclusion(s)The inhibitory in vitro effect on ESC proliferation and migration of IFN-β1a was much more potent than IFN-α2b. These preliminary data offer the rationale for future preclinical and clinical trials using IFN-β1a as a new tool for the therapy and tertiary prevention in patients with DIE.

Postoperative Hormonal Suppression for Prevention of Deeply Infiltrative Endometriosis Recurrence After Surgery

Purpose of Review The long-term management of deeply infiltrative endometriosis (DIE) remains debatable. Surgical excision improves pain and fertility in patients with endometriosis, however recurrence is common. In this article, we present an evidence-based approach of recurrence and postoperative hormonal suppression in DIE.

Evonik maintains confidence in its R&D

Endometriosis is a major cause of infertility and disability for women, caused by the presence of inflammatory endometrial implants in extrauterine locations. Among the constituents involved in the immune response during the development of endometriosis, several chemokines, including interferons (IFNs) may have a role in the pathogenesis of this disease. The aim of this preliminary study was to investigate the anti-proliferative and anti-migratory activities of type I IFNs (IFN-α2b and IFN-β1a) in primary endometrial stromal cells (ESCs) isolated from women with deeply infiltrating endometriosis (DIE).The study subjects included 7 women ranged in the age from 27 to 37 years with diagnosis of DIE (Stage III and IV). Collected primary ESC monolayers, isolated from endometriotic nodules, were incubated with various concentrations (from 1 to 1000 IU/ml) of IFN-α2b or IFN-β1a.IFN-β1a had a significantly higher activity in hampering the proliferation of cells compared to IFN-α2b. This effect could be related to the induction of apoptosis and cell cycle arrest in S phase, observed in ESCs during incubation with IFN-β1a. Moreover, IFN-β1a was more potent than IFN-α2b in inhibiting migration and EGF-induced ERK activity of primary ESCs.The inhibitory in vitro effect on ESC proliferation and migration of IFN-β1a was much more potent than IFN-α2b. These preliminary data offer the rationale for future preclinical and clinical trials using IFN-β1a as a new tool for the therapy and tertiary prevention in patients with DIE.

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Endometriosis is a major cause of infertility and disability for women, caused by the presence of inflammatory endometrial implants in extrauterine locations. Among the constituents involved in the immune response during the development of endometriosis, several chemokines, including interferons (IFNs) may have a role in the pathogenesis of this disease. The aim of this preliminary study was to investigate the anti-proliferative and anti-migratory activities of type I IFNs (IFN-α2b and IFN-β1a) in primary endometrial stromal cells (ESCs) isolated from women with deeply infiltrating endometriosis (DIE).The study subjects included 7 women ranged in the age from 27 to 37 years with diagnosis of DIE (Stage III and IV). Collected primary ESC monolayers, isolated from endometriotic nodules, were incubated with various concentrations (from 1 to 1000 IU/ml) of IFN-α2b or IFN-β1a.IFN-β1a had a significantly higher activity in hampering the proliferation of cells compared to IFN-α2b. This effect could be related to the induction of apoptosis and cell cycle arrest in S phase, observed in ESCs during incubation with IFN-β1a. Moreover, IFN-β1a was more potent than IFN-α2b in inhibiting migration and EGF-induced ERK activity of primary ESCs.The inhibitory in vitro effect on ESC proliferation and migration of IFN-β1a was much more potent than IFN-α2b. These preliminary data offer the rationale for future preclinical and clinical trials using IFN-β1a as a new tool for the therapy and tertiary prevention in patients with DIE.

Outcomes after rectosigmoid resection for endometriosis: a systematic literature review.

"Endometriosis" is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis. We performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: "rectal resection" AND "endometriosis" and "rectosigmoid resection" AND "endometriosis." The search revealed 380 papers of which 78 were fully analyzed. Thirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 ± 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 ± 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 ± 3.71days. Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.

The Role of Magnetic Resonance Imaging–Diffusion Tensor Imaging in Predicting Pain Related to Endometriosis: A Preliminary Study

ObjectivesTo evaluate the sacral nerve root features by the means of magnetic resonance imaging–diffusion tensor imaging (MRI-DTI) tractography in women with endometriosis and/or adenomyosis, and to analyze the correlations among DTI abnormalities, pain symptoms, and endometriotic lesions found at surgery. DesignA cross-sectional, observational study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsWomen (n = 76) with clinical suspicion of endometriosis. InterventionsBefore surgery, dysmenorrhea, deep dyspareunia, and noncyclic pelvic pain (NCPP) were assessed using a 10-point visual analog scale. MRI enabled a 3-dimensional reconstruction of S1, S2, and S3. Fractional anisotropy was calculated for each root. Laparoscopic treatment of endometriosis was performed in 56 patients. Measurements and Main ResultsOur findings revealed correlations among sacral root reconstruction by MRI-DTI, pain symptoms, and laparoscopic findings. DTI of sacral roots revealed a regular and homogeneous appearance in 17 patients (25.8%) and abnormalities in microstructure reconstruction, with fiber irregularities and disorganization and loss of the simple unidirectional course, in 44 patients (66.7%). At laparoscopy, ovarian endometriomas were found in 82.1% of the patients, and deeply infiltrating endometriosis (DIE) were found in 57.1%. Endometriosis was staged according to the revised American Society for Reproductive Medicine classification. Pathological DTI findings were significantly associated with the severity of dysmenorrhea and NCPP, pain duration, presence of tubo-ovarian and cul-de-sac adhesions, and DIE. ConclusionThe presence of pathological DTI findings of the sacral nerve roots correlates with the type of pain, adhesions, and DIE. At present, DTI can be useful for providing a better understanding of pain; however, DTI could become a useful tool in therapeutic planning for patients with endometriosis.