Surgery For Severe Endometriosis Research Articles

Surgery for Severe Endometriosis and ART Outcome and Effect of Time Interval Between Surgery and FET

Surgery for Severe Endometriosis and ART Outcome and Effect of Time Interval Between Surgery and FET

Impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK: a national database study.

The COVID-19 pandemic has had a significant effect on healthcare services, particularly affecting patients who suffer from chronic conditions. However, the pandemic's effect on endometriosis surgery is not yet known. To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level. The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space. Annual audits of this database were obtained from the BSGE. Publicly available data on COVID-19 cases and population were obtained from the UK Office for National Statistics. Numbers of annual BSGE-registered endometriosis operations. A total of 8204 operations were performed. The number of operations decreased by 49.4% between 2019 and 2020 and then increased in 2021, but remained 10.5% below average pre-pandemic levels, indicating at least 980 missed operations between 2019-2020. Median operations per centre decreased by 51.0% in 2020 (IQR 29.4% - 75.0%) and increased in 2021 but remained 33% below pre-pandemic levels. There was no change in the type of surgery performed. All 11 administrative regions of Great Britain had reduced numbers of operations in 2020 compared with the average for 2017-2019, with a median 44.2% decrease (range 13.3% - 67.5%). Regional reduction in operations was correlated with COVID-19 infection rates (r=0.54, 95% CI of r 0.022 - 1.00, p=0.043). The number of operations performed annually in the UK for severe endometriosis fell dramatically during the COVID-19 pandemic and is yet to normalise. This study shows the dramatic effect that the COVID-19 pandemic has had on UK services for endometriosis surgery, which may continue to affect patients and clinicians for a considerable time to come.

555 - The Endometriosis Fertility Index Accurately Predicts Fertility Outcomes in Women Having Surgery for Severe Endometriosis

Study Objective: To determine fertility outcomes and predictors of live births following resection of stage III-IV endometriosis.

The Role of Ovarian Suspension in Endometriosis Surgery: A Randomized Controlled Trial

Study ObjectiveA very high percentage of patients with severe pelvic endometriosis develop adhesions after laparoscopic surgery. The objective of this trial was to evaluate the role of ovarian suspension performed during surgery for severe endometriosis on ovarian adhesions and postoperative pelvic pain. DesignA randomized controlled trial (Canadian Task Force classification I). SettingThe tertiary care University Hospital of Bologna, Bologna, Italy. PatientsEighty patients with ovarian and posterior deep infiltrating endometriosis were included in the study. InterventionsPatients underwent laparoscopic surgery for endometriosis and were randomized sequentially into 2 groups: transient ovarian suspension was performed in the treatment group (n = 40), whereas in the control group (n = 40) ovaries were left free in the pelvis. Symptom intensity (dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, and dysuria) were ranked using a visual analog scale. Postsurgical ovarian adhesions were evaluated using transvaginal ultrasonographic scans performed by an ultrasound operator who was blinded to the details of the operative procedure and women's randomization allocation. Complications, lesion localization, endometrioma diameter, and surgery time were recorded. Measurements and Main ResultsAt follow-up, a significantly lower rate of ultrasound-detectable ovarian adhesions with the uterus and the bowel was observed in the treatment group, respectively (46.7% vs 77.3%, p = .003 and 26.7% vs 68.2%, p < .0005). Patients in the control group showed a higher percentage of fixed ovaries with moderate and severe adhesions than the treatment group, respectively (56.8% vs 28.9%, p = .003 and 20.5% vs 8.9%, p = .110). No differences between the 2 groups were found regarding complications and pelvic pain. ConclusionOvarian suspension seems to be an additional effective surgical procedure associated with an increased ovarian mobility in women treated for severe endometriosis. Moreover, it is feasible, safe, simple, and fast. Hence, it should be routinely used during laparoscopic surgery for endometriosis.

Health-related quality of life following surgical menopause and following gonadotrophin-releasing hormone analogue-induced pseudomenopause

Objective. To compare the health-related quality of life (HRQOL) following surgical menopause with that following gonadotrophin-releasing hormone analogue (GnRHa)-induced pseudomenopause.Materials and methods. Thirty-one women who received 3.75 mg of triptorelin injection subcutaneously every 4 weeks for 12 weeks after conservative surgery for severe endometriosis were reviewed (Group A). Thirty women who had surgical menopause for non-malignant conditions were reviewed after 12 weeks (Group B). Menopause-rating scale (MRS II) was used to assess the HRQOL.Result. Surgical menopause caused significant deterioration of HRQOL after 12 weeks, as compared to that caused by the pseudomenopause induced by the GnRHa injection (total MRS score: Group A, 16.60; Group B, 20.41; p = 0.04). Among the three subscales, there were no differences in the scores of somato-vegetative symptoms (Group A, 6.63; Group B, 6.90; p = 0.72) and urogenital symptoms (Group A, 3.50; Group B, 4.80; p = 0.06). Psychological symptoms showed significant difference (Group A, 6.46; Group B, 8.70; p = 0.01).Conclusion. Surgical menopause causes significant deterioration of HRQOL than that caused by the pseudomenopause state of GnRHa injection. Psychological symptoms are more pronounced in surgical menopause.

The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice

Objective With the increasing number of operative laparoscopies performed for the treatment of deep pelvic endometriosis, technical difficulties and risk of complications inevitably increase. We report our experience using JJ stents, in women treated for deep pelvic endometriosis, with regard to prevention and management of ureteral lesions. Design Descriptive retrospective analysis between March 2004 and March 2007. Setting Department of Obstetrics and Gynaecology, University Hospital, Strasbourg, France. Population and methods Cases of women who underwent laparoscopic surgery for severe endometriosis and who needed a JJ stent in their management were recorded. Laparoscopic surgery was performed at the Department of Obstetrics and Gynaecology at CMCO-SIHCUS and Hautepierre Hospitals, Strasbourg, which are referral centres in the treatment of deep endometriosis. Main outcome measures To evaluate the contribution of JJ stent in the prevention and management of ureteral lesions from endometriotic origin and/or iatrogenic origin in women treated for deep pelvic endometriosis. Results A total of 145 women had surgery for deep pelvic endometriosis. Seventeen (11.7%) women had a JJ ureteral stent inserted. In 82.4% of women, the stent was inserted pre- or peroperatively. We noted three ureteral complications, of which only one needed management by laparotomy. Conclusions Except in extreme cases, management of ureteral endometriosis should be performed laparoscopically. Ureteral lesions whether iatrogenic, or secondary to endometriotic disease, can be treated by cystoscopy, JJ stent and laparoscopy. The combination of these three elements is the optimal management and is unlikely to cause subsequent complications. Laparotomy and its associated morbidity should be avoided.