Treatment Of Abdominal Wall Endometriosis Research Articles

Clinical value of focused ultrasound ablation surgery in the treatment of abdominal wall endometriosis

Objective: To explore the effectiveness and safety of focused ultrasound ablation surgery (FUAS) for abdominal wall endometriosis. Methods: From November 2019 to October 2022, a total of 34 patients with abdominal wall endometriosis who underwent FUAS were collected, and their clinical features, imaging features, intraoperative treatment and side effects after treatment were analyzed retrospectively, and the improvement of symptoms and re-intervention were followed up. Results: (1) Characteristics of clinical data: the average age of 34 patients with abdominal wall endometriosis was (32.8±3.8) years old. The largest diameter of the lesion was 48 mm, and the median lesion diameter was 24 mm. Thirty cases (88%, 30/34) had moderate to severe periodic pain in abdominal incision before FUAS. All patients were diagnosed by preoperative magnetic resonance imaging, including 19 cases (56%, 19/34) of superficial type, 8 cases (24%, 8/34) of intermediate type and 7 cases (21%, 7/34) of deep type. (2) FUAS treatment parameters: ablation was completed with average operation time of (64±18) minutes, average sonication time was (385±108) s, (103±11) W of average power, (38 819±16 309) J of average total energy, the average treatment area volume of (3.11±1.42) cm3, and (377.79±106.34) s/h of average treatment intensity. (3) Efficiency: the pain of patients after FUAS was significantly relieved, and the pain scores of patients after 1 month, 3 months, 6 months and 1 year after FUAS were significantly decreased (Z=-4.66, -5.13, -5.11 and -4.91, all P<0.01). One year after FUAS, the near relief and effective pain relief rate was 74% (25/34), and the clinical effective rate was 85% (29/34). Five patients recurred after one year, including 3 patients who underwent abdominal wall endometriosis lesion resection and 2 patients who received drug treatment. One month after FUAS, the size of the lesion did not change significantly compared with that before FUAS (P>0.05), and the size of the lesion decreased significantly after FUAS at 3 months, 6 months and 1 year (Z=-2.15, -2.67 and -3.41, all P<0.05). It has no difference in pain relief among different types (P>0.05), but has significant difference in focus reduction among three types (P<0.01). (4) Safety: there were 34 cases (100%, 34/34) of skin burning sensation, 19 cases (56%, 19/34) of pain in the treatment area and 2 cases (6%, 2/34) of hematuria. All patients got better after corresponding treatments. Conclusion: FUAS is safe and effective for the treatment of abdominal wall endometriosis, which has clinical application value.

Clinical analysis of 244 cases with abdominal wall endometriosis

Objective: To investigate the clinical characteristics, diagnosis, treatment, outcomes and prognostic factors of abdominal wall endometriosis (AWE). Methods: A total of 265 AWE patients who underwent surgical treatment in The First Affiliated Hospital of Anhui Medical University from January 2010 to April 2023 were retrospectively selected, and 244 patients had complete follow-up data. According to different depth of lesions, the enrolled patients were divided into three types: type Ⅰ (subcutaneous fat layer, n=30), type Ⅱ (anterior sheath muscle layer, n=174) and type Ⅲ (peritoneum layer, n=40). The general clinical features, perioperative conditions, recurrent outcome and prognostic factors were analyzed in three types. Results: (1) Compared with type Ⅲ patients, the age of onset, parity and incidence of pelvic endometriosis were significantly decreased in type Ⅱ patients [(32.0±4.0) vs (30.0±4.6) years, 1.6±0.6 vs 1.4±0.5, 10.0% (4/40) vs 1.7% (3/174), respectively; all P<0.05], while the proportion of patients with transverse incision was significantly increased [37.5% (15/40) vs 67.3% (115/171); P<0.01]. The first symptoms of type Ⅰ and type Ⅱ were mainly palpable mass in the abdominal wall [73.3% (22/30), 63.2% (110/174), respectively], but the first symptom of type Ⅲ was pain in the abdominal wall [55.0% (22/40); all P<0.05]. (2) No matter the results of preoperative B-ultrasound or intraoperative exploration, the lesion diameters of type Ⅰ, type Ⅱ and type Ⅲ showed significant upward trends (all P<0.05). The proportions of lesion diameter≥3 cm in type Ⅱ and type Ⅲ [67.8% (118/174), 80.0% (32/40)] were significantly higher than that in type Ⅰ (all P<0.05). The median operation time and blood loss of type Ⅰ and Ⅱ were significantly lower than those of type Ⅲ (type Ⅰ vs type Ⅲ: 37.5 vs 50.0 minutes, 10 vs 20 ml, all P<0.05; type Ⅱ vs type Ⅲ: 35.0 vs 50.0 minutes, 10 vs 20 ml, all P<0.05). (3) The median follow-up time was 49 months, the overall symptom remission rate was 98.4% (240/244), and the recurrence rate was 7.0% (17/244). There were no significant differences in recurrence rate and recurrence free time among three types (all P>0.05). Multivariate regression analysis showed that the depth, number, diameter of lesions and postoperative adjuvant medication were not significant factors for postoperative recurrence (all P>0.05). Conclusions: The clinical manifestations of type Ⅲ are the most serious, including obvious abdominal pain symptoms, larger lesion diameter, prolonged operation time, increased intraoperative blood loss and increased incidence of pelvic endometriosis. Complete resection of lesions is an effective treatment for AWE, with high symptom remission rate and low recurrence rate. The depth, number, diameter of lesions and postoperative adjuvant medication are not risk factors for recurrence.

Safety and efficacy of microwave ablation for abdominal wall endometriosis: A retrospective study.

This retrospective study aimed to evaluate the safety and feasibility of ultrasound-guided microwave ablation in the treatment of abdominal wall endometriosis (AWE). AWE is a rare form of endometriosis that often results in cyclic abdominal pain. The current treatment algorithm for AWE is not well established. Microwave ablation technology is a promising new thermal ablation technique for treating AWE. This was a retrospective study of nine women with pathologically proven endometriosis of the abdominal wall. All patients were treated with ultrasound-guided microwave ablation. Grey-scale and color Doppler flow ultrasonography, contrast-enhanced ultrasonography, and MRI were used to observe the lesions before and after treatment. The complications, pain relief, AWE lesion volume, and volume reduction rate were recorded 12 months after treatment to evaluate the treatment efficacy. Complications were classified according to the Common Terminology Criteria for Adverse Events and the Society of Interventional Radiology classification system. Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with microwave ablation. The average initial nodule volume was 7.11 ± 5.75 cm3, which decreased significantly to 1.85 ± 1.02 cm3 at the 12-month follow-up with a mean volume reduction rate of 68.77 ± 12.50%. Periodic abdominal incision pain disappeared at 1 month after treatment in all nine patients. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A. Ultrasound-guided microwave ablation is a safe and effective technique for the treatment of AWE, and further study is warranted.

Treatment for Abdominal Wall Endometriosis: Ultrasound-guided Percutaneous Injection of Lauromacrogol Sclerotherapy

Abdominal wall endometriosis (AWE) is a rare form of endometriosis. Surgical excision is commonly used to treat AWE, but extensive surgical excision may result in other complications. Some scholars have also used high-intensity focused ultrasound, cryoablation, and thermal ablation to treat AWE1. Sclerotherapy is an effective alternative for pelvic endometriosis2. Bozkurt et al. treated AWE with sclerotherapy by alcohol injection3. Lauromacrogol is a new type of sclerosing agent that targets the endothelial cell and causes protein denaturation and cell death4.

8439 Differences in Outcomes between Percutaneous Image-Guided Cryoablation Versus Surgical Excision for Abdominal Wall Endometriosis

<h3>Study Objective</h3> To compare the outcomes of percutaneous image-guided cryoablation versus surgery for abdominal wall endometriosis (AWE) <h3>Design</h3> Retrospective cohort study of all patients treated for AWE from 01/2000 to 02/2022. <h3>Setting</h3> Academic tertiary health system. <h3>Patients or Participants</h3> Women who underwent cryoablation (n=25) or surgical excision (n=50) for treatment of AWE. <h3>Interventions</h3> Percutaneous image-guided cryoablation versus surgical excision. <h3>Measurements and Main Results</h3> There was no significant difference between patients undergoing cryoablation versus surgery in terms of age (37±4.6 vs 35.9±6.1, p=0.37), parity (2 [2,3] vs 2 [1,3], p=0.53), presence of pelvic endometriosis (68% vs 68%, p=0.99), number of prior surgeries (2 [2,4] vs 2 [2,3], p=0.79) and cesarean deliveries (2 [1,2] vs 1 [1,2], p=0.73). Mean BMI was significantly higher in the cryoablation group (34.6±8.6 vs 28.7±6.8, p=0.005). Most patients in both cryoablation and surgery groups had no prior intervention for AWE (60% vs 78%), however 36% of cryoablation and 22% of surgical patients underwent prior surgical excision of AWE. The most common location was prior CS scar (cryoablation 80% vs surgery 86%). Lesion number and size (cm) was similar for both cryoablation and surgical groups (1 [1,1] vs 1 [1,1], p=0.059, and 2.7 [1.8,4.0] vs 2.6 [1.7,5.0], p=0.97). Median length of hospital stay was similar between groups (cryoablation 1 [0,1] vs surgery 0 [0,2], p=0.42). Complications included wound infection (cryoablation 4%, surgery 6%), hematoma (cryoablation 8%, surgery 4%), edema (cryoablation 12%, surgery 0%). Recurrence after treatment was similar between cryoablation (24%) and surgery (18%) groups (p=0.76). There was significant decrease of pain in both groups, however this decrease was not significantly different between groups p-value 0.83. <h3>Conclusion</h3> Percutaneous image-guided cryoablation seems equivalent to surgical excision for the treatment of AWE in terms of pain reduction and recurrence risk with low risk of complications. It is a potential option to consider for women wanting to avoid surgery or who are not surgical candidates.

Ultrasound-guided microwave ablation for symptomatic abdominal wall endometriosis and treatment response evaluation with contrast-enhanced imaging: The first experience.

Abdominal wall endometriosis (AWE) is a relatively uncommon condition associated with diagnostic and therapeutic difficulties among all the extra pelvic endometriosis. The main therapies include surgery and oral contraceptive administration. Percutaneous cryoablation and high intensity focused ultrasound (HIFU) are also proven to be valid alternatives. Microwave ablation (MWA) as one of the thermal ablation methods has not been applied in the treatment of AWE yet. Herein the feasibility of ultrasound (US) -guided MWA for AWE was explored and treatment response evaluation was carried out using contrast-enhanced imaging. Three consecutive patients who underwent US-guided MWA for AWE with typical symptoms were included in this retrospective study. US, magnetic resonance imaging (MRI), laboratory tests, and US-guided core-needle biopsy were conducted for pre-treatment assessment and ruling out malignancy. The interventional procedure was carried out under local anesthesia with MWA and the output power was 60w. Post-treatment contrast-enhanced ultrasound (CEUS) was performed to evaluate the instant treatment response. The follow-up intervals were 1 month, 6 months, and 12 months after treatment. The clinical symptoms and condition of AWE lesions were recorded in each follow-up. The MWA procedure was completed in all the patients with no blood perfusion inside each lesion by instant CEUS after treatment. The mean ablation time was 687 seconds (s) for a single patient (ranged from 660s to 742s). Clinical symptoms were relieved evidently at the end of the follow-up. The pain according to the visual analogue scale (VAS) decreased from 4-6 before treatment to 0-2 after treatment. Mild to moderate complications included slightly abdominal pain and fat liquefaction occurred. In terms of technical outcomes, the volume of all six lesions reduced in different degrees at the end of follow-up (ranged: 16.6% to 100%). US-guided MWA may be a feasible and promising approach for symptomatic AWE.

Abdominal wall endometriosis misdiagnosed as a desmoid tumor: A case report.

IntroductionAbdominal wall masses have different aetiologies. Diagnosis includes desmoid tumors (DTs) and other benign and malignant lesions, among which abdominal wall endometriosis (AWE). Diagnosis is challenging if symptoms are aspecific, and the contribution of imaging may be weak. We present a case of AWE that according to clinical history and imaging was misdiagnosed as DT.Presentation of caseA healthy 35-year-old female presented, 4 years after a cesarean delivery, a rapidly growing painless subumbilical mass within the right rectus abdominis muscle. Ultrasound and magnetic resonance imaging suspected a DT. The patient underwent complete resection of the mass and pathological examination revealed foci of endometriosis in the muscle. Patient's post-operative course was uneventful and at 18-month follow-up, no recurrence has been detected.DiscussionThe current case highlights differences in clinical presentation and imaging in case of AWE and DTs, underlining possible pitfalls in diagnosis. In young women with previous gynaecological abdominal surgery, AWE is the most likely disease when a mass in the region of the scar appears. Differential diagnosis is complex and rare entities like DTs should nevertheless be taken into consideration. A complete surgical resection with negative margins is considered the primary treatment for AWE and for selected DTs. Final pathology of the tumor can state the precise diagnosis.ConclusionSince AWE and DTs share similar clinical signs and aspecific imaging exams, both diseases should be considered in case of abdominal wall mass in female patients of childbearing age and history of uterine-related surgery.

Exploring the Diagnostic Performance of Magnetic Resonance Imaging in Ultrasound-Guided High-Intensity Focused Ultrasound Ablation for Abdominal Wall Endometriosis.

ObjectiveThis study aimed to explore the clinical value of magnetic resonance imaging (MRI) combined with ultrasound-guided high-intensity focused ultrasound (USg-HIFU) for the diagnosis and treatment of abdominal wall endometriosis (AWE).MethodsMagnetic resonance imaging was performed before and after USg-HIFU. Information on clinical characteristics of patients, MRI characteristics of lesions, and treatment outcomes were collected. Thirty AWE lesions in 29 patients were examined before HIFU treatment, while 27 patients were examined after treatment. The results of MRI and color doppler ultrasound before surgery, as well as the volume and the apparent diffusion coefficient (ADC) values of the lesions before and after USg-HIFU treatment were compared. We also observed the clinical symptoms remission, recurrence, and ablation rates of the lesions in follow-up after HIFU treatment.ResultsThe locations of the 30 AWE lesions were identified by MRI before USg-HIFU treatment. Their sizes appeared larger on MRI than ultrasound (P < 0.05). A total of 27 lesions were evaluated by MRI after USg-HIFU treatment, of which 92.6% (25/27) lesions were of high or slightly high signal intensity on T1-weighted images, and 77.8% (21/27) lesions were of mixed signal intensity on T2-weighted images. The mean ADC values of AWE lesions were 1.47 (1.20–1.59) × 10–3mm2/s and 1.86 (1.61–2.12) × 10–3mm2/s for pre-and post-HIFU treatment (P < 0.05). Patients with higher ablation rates (>50%) had a higher complete/partial remission rate than those with lower ablation rates (<50%), and had a lower recurrence rate (P < 0.05).ConclusionMRI is a useful tool for identifying the location, size, and concurrent changes of AWE before and after USg-HIFU treatment, which is beneficial for follow-up monitoring and defining treatment efficacy.

Cumulative Recurrence Rate and Risk Factors for Recurrent Abdominal Wall Endometriosis after Surgical Treatment in a Single Institution.

PurposeThis study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment.Materials and MethodsA retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected.ResultsEighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6–106). The median age was 37 years (range, 22–48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment.ConclusionThe recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.

Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management.

Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE. Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive lesions. Laparotomy with wide local excision is considered standard treatment for AWE with great success. Novel techniques in minimally invasive surgery have been described as effective for the treatment of AWE. A multidisciplinary surgical approach is often warranted for successful excision and reapproximation of skin and/or fascial defects. Noninvasive therapies including ultrasonic ablation or cryotherapy are also emerging as promising treatment strategies in select patients. Recent studies provide further evidence to guide diagnosis through physical exam and imaging as well as pretreatment planning. Treatment options for AWE are rapidly expanding with novel approaches in minimally invasive and noninvasive therapies now available.

The safety of echo contrast-enhanced ultrasound in high-intensity focused ultrasound ablation for abdominal wall endometriosis: a retrospective study.

We aimed to investigate the efficacy and safety of echo contrast-enhanced ultrasound (CEUS) during high-intensity focused ultrasound (HIFU) ablation therapy for abdominal wall endometriosis (AWE). A total of 67 patients with AWE were treated with HIFU ablation, and their demographic characteristics were retrospectively analysed. Blood perfusion of the focal lesion was assessed before the operation, during ablation and after the operation with the use of an ultrasound contrast agent, and the effect of the ultrasound contrast agent on treatment was assessed over a 1-year follow-up period. The degree of symptom relief and adverse effects were evaluated after HIFU ablation. Eighty-two lesions were ablated in 67 patients. CEUS showed that all lesions were successfully ablated with HIFU. The shrinkage ratio of the lesions significantly increased over the follow-up period. Intermittent pain disappeared at 1 month after the operation, and the patients' pain scores significantly decreased at the 1-year follow-up. The mean [± standard deviation (SD)] lesion volume was 7.64±8.95 cm3 on B-mode ultrasound. The post-HIFU non-perfused volume was 18.34±24.08 cm3, and the rate of massive changes on greyscale imaging was 96.16%±5.44% at 12 months. During the procedure, the main complications were a prickling sensation and tenderness in the treatment area and/or a transient "hot" sensation on the skin. After the procedure, there was no obvious discomfort except for pain. Two patients developed an approximately 1-cm area of skin that exhibited a waxy appearance. Seven patients had haematuria. No severe complications were observed. Ultrasound contrast agents are effective and safe for evaluating the effect of HIFU ablation on AWE, and this approach provides significant guidance and evaluation benefits for the use of HIFU treatment for AWE without obvious side effects.

Analysis of Clinical Diagnostic Value of High Frequency Colour Doppler Ultrasound for Abdominal Wall Endometriosis

Abdominal wall endometriosis is a common endometriosis, which is located outside the endometrium, such as the myometrium or subcutaneous fat layer of the abdominal wall, forming a mass, active and infiltrating into the surrounding tissue, accompanied by menstrual pain, and seriously affecting the quality of life of patients. With the increasing operation of caesarean section and other traumatic operations, the incidence rate of abdominal wall endometriosis is increasing. Because of the variety of clinical manifestations of abdominal wall endometriosis, there are many kinds of diagnostic methods. Choosing the appropriate diagnostic methods to confirm abdominal wall endometriosis has become the primary work of diagnosis and treatment of abdominal wall endometriosis. This paper discusses the clinical value of high frequency colour doppler ultrasound in the diagnosis of abdominal wall endometriosis. Compared with the diagnosis of ordinary ultrasound and high frequency colour doppler ultrasound, the location, shape, size, boundary, internal echo, blood flow velocity, blood flow resistance and other parameters of the mass in the focus were observed. It is proved that the application of high-frequency colour doppler ultrasound can greatly improve the ultrasonic diagnosis rate of abdominal wall endometriosis, and it is non-invasive, radiation-free, low price, easy for patients to accept. It provides a high value clinical diagnosis basis for the early detection and treatment of abdominal wall endometriosis.

Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach.

Abdominal wall endometriosis (AWE) is a rare form of endometriosis that often results in substantial pain and debility. The current treatment algorithm for AWE is not well established. The purpose of this review is to describe the Mayo Clinic experience with thermal ablation of symptomatic AWE as well as to review current imaging and interventional literature regarding the diagnosis and treatment of AWE.

Endometrioza prednjeg trbušnog zida iz ugla opšteg hirurga

Objective. Endometriosis is benign disease which is characterized by the presence of the functional endometrial tissue out of the uterine cavity. Abdominal wall endometriosis (AWE) represents any presence of endometrium in the abdominal wall outside the peritoneal cavity. The aim of the work is to analyze the clinical characteristics and surgical treatment of this condition. Methods. We have analyzed 14 cases of AWE operated on in our department in period from 01.01.2011. to 12.31.2019. Data were obtained by retrospective analysis of medical histories of operated patients, and were analyzed by the method of descriptive statistic. Results. The average age of patients was 33 (26-41) years. In most patients there was data about previous operations on the lower abdomen (Caesarean section). In the clinical picture the dominant elements were pain and palpable lesion in all patients. The pain is more often of the non-cyclic type (62,4 %). All patients underwent an ultrasound examination. Radical resection (R0) was achieved in most patients, while in one patient R1 resection was involved (7,2%). Recurrence occurred in one patient. Conclusion. Even its relatively rare, AWE can be significant condition for two reasons. First are difficulties and complications it may create for the patient, and second is that it can be a serious differential diagnostic problem for physicians. In younger patients with palpable and painful lesions in the lower abdomen, and with a history of previous gynecological surgeries, it is necessary to think about AWE in differential diagnosis. Surgery with mandatory histopathological examination is the method of choice in the treatment of AWE. The results of surgical treatment are excellent if sufficient radically is achieved (R0 resection).

Abdominal Wall Endometriosis – Case Series

Endometriosis is primarily a disease of pelvis. Extra pelvic endometriosis is defined, when eutrophic endometrial tissue is detected in any site other than pelvic cavity with the specification that this invasion is benign (non-neoplastic) in nature. Endometriotic lesions are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but it can occur anywhere in the body. Extra pelvic endometriosis is a rare condition and it’s most common extra-pelvic location is the abdominal wall, occurring most frequently after cesarean delivery or any other abdominal surgery. Other sites are gastrointestinal tract, respiratory tract, pleura, pericardium, diaphragm and primary umbilical endometriosis. Patient’s usually present with painful mass in the abdominal wall during menstrual period, sometimes with a typical presentation, but recently incidences of scar endometriosis is increased. Two cases are presented here. To obtain a definitive diagnosis and optimal treatment for abdominal wall endometriosis, complete excision &amp; histopathological examination are necessary. Here we presents 3 cases with umbilical endometriosis who presented between 13 to 28 years of age. Our all cases presented with a cyclical painful, abdominal mass and sometimes bleeding from umbilical mass. Also we highlight the importance of early recognition and appropriate surgical intervention to minimize morbidity and mortality from endometriosis.&#x0D; Bangladesh J Obstet Gynaecol, 2019; Vol. 34(2): 134-140

High-Intensity Focused Ultrasound in the Treatment of Abdominal Wall Endometriosis

Study ObjectiveTo evaluate high-intensity focused ultrasound (HIFU) ablation therapy for abdominal wall endometriosis (AWE). DesignA retrospective study. SettingGynecologic department of a teaching hospital in China. PatientsThirty patients with AWE were treated from May 2013 to December 2015. InterventionsThirteen patients were treated with HIFU ablation and 17 patients with surgical resection. Measurements and Main ResultsColor Doppler ultrasonography and magnetic resonance imaging were used to observe the lesions before and after treatment. In addition, recovery time, complications, and adverse reactions of the 2 groups were compared. Menstrual pain was relieved after treatment in all 30 patients. After treatment, the lesions in patients who underwent HIFU ablation decreased gradually, and there was no recurrence. Symptoms recurred in 1 patient in the surgery group 12 months after surgery. The post-treatment hospital length of stay of the HIFU ablation group (1.00 ± 0 days) was significantly shorter than that of the surgical group (5.23 ± 1.24 days; p <.001). The incidence of fever (0% vs 11.8%; p = .049) and complications of the urinary system (7.7% vs 17.6%; p = .043) in the HIFU ablation group were significantly lower than that of the surgical group. ConclusionsHIFU ablation therapy is a promising treatment for AWE, and further study is warranted.

Clinical analysis of high-intensity focussed ultrasound ablation for abdominal wall endometriosis: a 4-year experience at a specialty gynecological institution

Objective: To evaluate the long-term clinical effect of high-intensity focussed ultrasound (HIFU) as a non-invasive modality for ablation of abdominal wall endometriosis (AWE) foci.Methods: All women who were diagnosed with cutaneous endometriosis and underwent HIFU ablation and 4-year follow-up were included. Patient symptoms, imaging performed, HIFU ablation, recurrence, lesion location, size and number were collected and analyzed.Results: A total of 51 women with 57 painful abdominal wall masses with a median volume of 4.00 cm3 and a mean age of 30.5±2.12 years were treated with HIFU. The main symptoms were a palpable painful abdominal mass (93%), protrusion of the skin (28.1%, 16) or lack of protrusion of the skin (71.9%, 41). Ultrasound was initially performed in 100% (51) of women, whereas 6% (3) required MRI examinations to distinguish the features and range of the masses. Ablation was performed with a median 300 s of sonication time, 40 min treatment time, 150 W of power and 41800 J of total energy to treat lesions that were a median volume of 3.83 cm3. No severe complications occurred, except in one patient with a first-degree skin burn, during the 48-month follow-up period. The pooled recurrence of cutaneous endometriosis occurred in 3.9% (2) of women.Conclusion: The diagnosis of AWE should be confirmed with imaging of the lesion number, location, size and features before HIFU ablation. HIFU should be the first choice for the treatment of AWE as it is a non-invasive method, with high efficiency and safety and rapid postoperative recovery.

Treatment of Abdominal Wall Endometriosis Using a Mini-Abdominoplasty Design

Treatment of Abdominal Wall Endometriosis Using a Mini-Abdominoplasty Design

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

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.

Cryoablation of Abdominal Wall Endometriosis: A Minimally Invasive Treatment.

The objective of this study is to present cryoablation as a minimally invasive definitive treatment for abdominal wall endometriosis. We describe our experience with the outpatient application of cryoablation to treat symptomatic abdominal wall endometriosis in three patients. This feasibility study shows that minimally invasive cryoablation treated abdominal wall endometriosis in three patients and provided a prompt clinical response.