Surgery For Pelvic Endometriosis Research Articles

Nomogram for Predicting a Complex Ureteral Procedure in Pelvic Endometriosis Surgery

To develop a nomogram for predicting the type of ureteral procedure in pelvic deep endometriosis (DE) surgery (1) and to describe the factors and complications associated with the ureteral procedure (2). Retrospective monocentric study of 920 patients who underwent surgery for pelvic DE between June 2009 and March 2020 in the gynecologic surgery department of the Versailles Hospital Center. The main criterion was evaluation of the ureteral procedure, classified as simple (isolation of the ureter) or complex (dissection of the ureter, segmental ureteral resection, or nephroureterectomy). Postoperative complications, including ureteral stenosis and fistula formation, were tabulated. Tertiary referral hospital and expert center in endometriosis. A total of 920 patients with DE. Ureteral procedure during surgery for DE. In total, 724 patients (79%) underwent a ureteral procedure, of which 307 (33%) were complex, including 17 (1.8%) segmental ureteral resections. In multivariate analysis, the predictive variables for a complex ureteral procedure were age (p=.036), a previous surgery for endometriosis (p <.01), and ureteral dilatation on magnetic resonance imaging (p <.001). The area under the curve for the model predicting a complex ureteral procedure was 0.68 (95% confidence interval, 0.60-0.71). A complex ureteral procedure was associated with a 3.5% rate of ureteral fistula (n=15). Age, a previous surgery for endometriosis, a rectovaginal nodule size ≥30 mm, endometriotic involvement of the rectum or sigmoid, and ureteral dilatation are significantly associated with a complex ureteral procedure. Our results allowed us to build a nomogram that can be used to better inform patients, anticipate the therapeutic strategy, and optimize the modalities of postoperative surveillance.

Minimally invasive treatment of diaphragmatic endometriosis: a 15-year single referral center's experience on 215 patients.

Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guidelines about its treatment. We describe a consecutive series of patients with DE managed by laparoscopy and videothoracoscopy (VATS) in our referral center in a period of 15years. We developed a flow-chart classifying DE implants in foci, plaques and nodules and proposing an algorithm with the aim of standardizing the surgical approach. 215 patients were treated for DE. Lesions were almost always localized on the right hemidiaphragm (91%), and the endometriotic implants were distributed as: foci in 133 (62%), plaques in 24 (11%) and nodules in 58 patients (27%), respectively. In all cases of isolated pleural involvement, concomitant diaphragmatic hernia or lesions of the thoracic side of the diaphragm VATS was performed, alone or combined with laparoscopy, resulting in a total of 26 procedures. Following the proposed algorithm, specific surgical techniques were identified as the better approaches for the different types of the lesion, such as Argon Beam Coagulation and diathermocoagulation for diaphragmatic foci, peritoneal stripping for plaques, and nodulectomy or full-thickness resection of diaphragm for nodules. It is crucial to standardize the surgical approach of DE, according to the type of lesion, thus reducing the rate of under- or over-treatments and intra or postoperative complications. This kind of surgery should be performed in a Referral Center by a gynecologic surgeon with oncogynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist.

Rapports anatomiques des nerfs végétatifs constituant la fosse para rectale, application à la chirurgie de l’endométriose rectale

ObjectivesThe objective of the study was to describe the inferior hypogastric plexus and nerves constituting the para-rectal fossa in order to study the importance of anatomical knowledge in rectal endometriosis surgery. MethodsIn order to discover the complete anatomy of the study area, we carried out a review of the literature and relied on dissection of a female cadaver and operative dissections in patients treated for rectal endometriosis. ResultsThe inferior hypogastric plexus, the hypogastric nerve and the pelvic splanchnic nerves are the nervous elements component the para-rectal fossa. These nerves were important urinary, digestive and sexual functions. The dissection of the Okabayashi and the Latzko spaces within the para-rectal fossa and sparing nerve within this zone is more important for the prevention of traumatic nervous sequelae during rectal endometriosis surgery. The pelvic anatomy can be by attraction and sheathing nerve structures by endometriosis lesions which can complicate preservation techniques. ConclusionLesions of pelvic vegetative nerves running through the para-rectal fossa can be responsible for urinary, digestive and sexual disorders that can affect patients quality of life. There is currently only one standardized “nerve sparing” technique in pelvic endometriosis surgery. Knowledge of the anatomy of the nerves making up the para-rectal fossa helps to orient the operative dissection and prevent postoperative nerve complications after surgery for rectal endometriosis.

Adenomyosis of the Extrapelvic Portion of the Round Ligament

Abstract Background: Adenomyosis is a disease of the uterus characterized by invasion of endometrial cells within the myometrium. Adenomyosis is typically confined to the uterus, with no distant localizations. This article reports on a case of adenomyosis of the distal extrapelvic portion of the round ligament. Case: The patient, a 49-year-old woman, had previously undergone surgery for pelvic endometriosis. This prior surgery included removal of uterus, fallopian tubes, and a portion of the sigmorectal intestine. She then presented with a nodule on the right side of her pubis. The nodule was close to the upper part of her right labia majora. She was experiencing cyclic pain, nodule enlargement, and edema on the right side of her pubis. The entire round ligament, from the internal inguinal canal to its distal end above the pubis, was removed. Histology testing revealed that the distal nodule was a myomalike neoformation containing endometrial tissue; this was definable as adenomyosis. Results: After the s...

Laparoscopy and Body Mass Index: Feasibility and Outcome in Obese Patients Treated for Gynecologic Diseases

Study Objective To compare feasibility and surgical outcome of laparoscopic gynecologic surgery between obese, overweight, normal-weight, and underweight women. Design Retrospective case control study (Canadian Task Force classification II-3). Setting Surgery Unit of Minimally Invasive Gynaecology. Patients A total of 503 women who underwent laparoscopic procedures for both benign disease and malignancies. Interventions Four main categories of gynecologic disease were identified: uterine fibroids, benign adnexal masses, endometriosis, and endometrial cancer (stage I). For each category patients were divided into 4 groups: underweight (BMI <18.5 kg/m 2), normal-weight (BMI 18.5–24.9 kg/m 2), overweight (BMI 25–29.9 kg/m 2), and obese (BMI ≥30 kg/m 2). Measurements and Main Results Selected outcomes were duration of surgery, rate of laparotomy conversion, intraoperative and postoperative complications, and duration of hospital stay. No statistical difference regarding demographic data, surgical and medical history, and intraoperative findings was present between groups. No laparotomy conversion occurred. Regarding duration of surgery, we found no statistical difference among the BMI groups with regard to benign diseases, whereas pelvic lymphadenectomy in obese patients with endometrial cancer had a statistically significant longer duration than in the control group (122 ± 47min vs 65 ± 21 min, p <.001). The postoperative complication rate was 0.01%: 3 cases of blood transfusion and 1 case of hemoperitoneum among myomectomies; 1 ureteral fistula in surgery for pelvic endometriosis; and 1 case of postoperative lymphocele in endometrial cancer group. No statistically significant difference was found in duration of hospital stay among the BMI groups in any of the categories of disease. For each category we conducted an analysis to identify any possible risk factors other than BMI in the surgical outcomes. Conclusion Laparoscopic approach in the various applications of gynecologic surgery does not appear to be significantly influenced by BMI in terms of surgical outcomes, laparotomy conversion rate, intraoperative and postoperative complications rate, and duration of hospital stay. The technical difficulties can be solved if skilled surgeons and anesthetists are available.

Predicting Pregnancy after Surgery for Pelvic Endometriosis: A Multivariate Analysis Based on Objective Clinical Data

Background Endometriosis is a common disorder in women of reproductive age and is a major cause of pelvic pain and infertility. Counseling women with endometriosis about their reproductive future remains a difficult task. Because many women are diagnosed with endometriosis before any attempt to conceive, they still are not considered infertile and therefore a thorough investigation of fertility parameters is not advisable at that time. The aim of the present study was to evaluate clinical factors that are promptly available upon diagnosis, to see which of them might predict a subsequent pregnancy in women with endometriosis. Methods Surgical and clinical data were obtained from 71 women who underwent laparoscopy for endometriosis in two tertiary medical centers and responded to a follow-up interview after an average of 18 months. Data were analyzed with multivariate logistic regression. Results The only independent predictors of becoming pregnant during the follow-up period were age (adjusted odds ratio for age &gt;30 y=0.063, 95% confidence interval [CI] 0.015–0.262, p Conclusions While women reporting acyclic pelvic pain are less likely to achieve pregnancy after endometriosis surgery, age remains the only independent, strong predictor of time to pregnancy and of becoming pregnant.

Predicting pregnancy after surgery for pelvic endometriosis: A multivariate analysis based on objective clinical data

BackgroundEndometriosis is a common disorder in women of reproductive age and is a major cause of pelvic pain and infertility. Counseling women with endometriosis about their reproductive future re...

Bilateral ureteric obstruction from pelvic endometriosis

Endometriosis is an uncommon cause of ureteric obstruction. When it occurs, unilateral involvement predominates. We report a case characterized by the unusual presentation of acute hypertensive retinopathy and renal failure. The patient was treated surgically by ureterolysis with omental wrapping, total hysterectomy and salpingo-oophorectomy. Nephrectomy was not performed on the non-functioning renal unit as the obstruction had been relieved. Patients who have previously been treated with conservative surgery for pelvic endometriosis are at risk of recurrent symptomatic disease, and require long-term follow-up with particular consideration being given to monitoring of the upper tracts by renal ultrasound.

Treatment of vaginal endometriosis with danazol.

Six infertile patients with vaginal endometriosis were treated with danazol at 600 mg daily for 6 months. Three patients had previously undergone surgery for pelvic endometriosis. After 4 months of danazol treatment there was a clear reduction in the size and number of the lesions in all the patients. At the end of the treatment 4 patients still had small lesions, which showed histological evidence of regressive changes. Four women became pregnant within 6 months of the termination of therapy.

SURGICAL TREATMENT OF ENDOMETRIOSIS WITH CONSERVATION OF REPRODUCTIVE POTENTIAL

Abstract 1. A follow-up and analysis of 60 cases of pelvic endometriosis, in which abdominal surgery was performed with conservation of the reproductive potential, are presented in this paper. 2. Among 38 patients with sterility averaging 5 years' duration, 24 (63 per cent) became pregnant within an average time of7 1/2 months following surgery. 3. A second pelvic operation in 13 cases (21 per cent) is indicative of the responsibility and risk that is involved when conservative surgery is elected for pelvic endometriosis. 4. The preservation of the reproductive potential in the young and in the infertile patient, when subjected to surgery for pelvic endometriosis, has given long-term results which justify this conservatism.