Introduction There is increasing evidence that intermediate and long‐term bowel dysfunction may occur as a consequence of radical surgery for rectal deep endometriosis (DE). Typical symptoms include constipation, feeling of incomplete evacuation, clustering of stools, and urgency. This is described in the colorectal surgical literature as low anterior resection syndrome (LARS). Within this, several studies suggested that differences regarding functional outcomes could be favorable to more conservative surgical approaches, that is, excision of endometriotic tissue with preservation of the luminal structure of the rectal wall when compared with classical segmental resection techniques for DE, especially when performed for low DE. Material and methods A total of 211 patients undergoing rectal surgery for low DE (≤7 cm from the anal verge) in three different tertiary referral centers between October 2009 and December 2018 were retrospectively reviewed regarding major complications and LARS. From the 211 eligible patients, six women were excluded because of loss to follow‐up. Finally, a total number of 205 patients were enrolled for the statistical analysis; 139 with nerve‐ and vessel‐sparing segmental resection (NVSSR) and 66 operated for laparoscopic‐transanal disk excision (LTADE) were included. Gastrointestinal functional outcomes of the two procedures were compared using the validated LARS questionnaire. The median follow‐up time was 46 ± 11 months. As a secondary outcome, the surgical sequelae were examined. Results We found no statistically significant difference between the incidence of LARS (31.7% and 37.9%, respectively) among patients operated by LTADE when compared with NVSSR (P = .4). The occurrence of LARS was positively associated with the use of protective ileostomy or colostomy (P = .02). A higher rate of severe complications was observed in women undergoing LTADE (19.7%) when compared with patients with NVSSR (9.0%, P = .029). Conclusions LARS is not more frequent after NVSSR when compared with a more conservative approach such as LTADE in patients undergoing rectal surgery for low DE. To confirm our findings prospective studies are required.

Departmental sources Background:The role of gamma-synuclein (SNCG) has been widely examined in malignant conditions due to its possible role in disease progression, but very little information is available on its theoretical function on endometriosis formation. Material/Methods:Between January 2016 and December 2016, we collected peritoneal fluid and plasma samples from 45 consecutive female patients, of which 15 were without endometriosis, 15 had minimal to mild endometriosis, and 15 had moderate to severe endometriosis. The statistical power was 0.98. We evaluated SNCG levels in the peritoneal fluid and plasma of patients diagnosed with endometriosis, and we compared them with the levels obtained from disease-free control subjects by using enzyme-linked immunosorbent assay. Results:SNCG levels were statistically significantly (1.2-fold) higher in the peritoneal fluid of patients with endometriosis compared to controls (p=0.04). We did not find a significant difference between SNCG levels in the plasma of our endometriosis patients and the control group (p=0.086). However, despite previous data showing very limited expression of SNCG in healthy tissues, we found SNCG in the peritoneal fluid of all of the patients in our healthy control group. Conclusions:Levels of SNCG were statistically significantly higher in the peritoneal fluid of patients with endometriosis compared to disease-free controls, which may indicate its possible role the formation and progression of the disease. Moreover, its biological function should be further investigated due to the conflicting results concerning its expression in healthy tissues.

Objectives: To test the accuracy of TVS applying the IDEA approach for suspected rectosigmoid DE and to determine the frequency of other pelvic diseases mimicking DE in patients undergoing surgery. Materials und Methods: Prospective single center observational study including consecutive women undergoing TVS for clinically suspected rectosigmoid DE followed by conservative or surgical therapy. TVS findings were compared with those obtained by laparoscopy and confirmed histologically. Results: Of the 671 included patients, 128 women opted for medical therapy, and 6 patients decided for surgery but did not give consent to participate in the study. 537 women were enrolled in the final analysis. 279 (52%) exhibited surgically confirmed rectosigmoid DE. The sensitivity and specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio (LR+/-) and accuracy of TVS for diagnosing DE in the rectosigmoid were 93.5%, 94.6%, 94.9%, 93.1%, 17.24, 0.07, 94.04%. 12 women who were clinically suspected for DE and mimicked sonographic signs fulfilling the IDEA criteria did exhibit other pathologies. Diagnoses were as follows: vaginal Gartner duct cyst (3/291;1.0%), anorectal abscess (3/291;1.0%), rectal cancer (2/291;0.7%), hydrosalpinx (2/291;0.7%), metastatic endometrial cancer (1/291;0.35%) and Crohn’s disease (1/291;0.35%). Conclusion: TVS for diagnosing colorectal DE applying the IDEA criteria is highly accurate for presurgical diagnosis. However, additional pelvic pathologies are encountered in 4-5% of women attending for suspected rectosigmoid DE. These need to be taken into account when investigating patients for suspected DE. Ziel: Die Prüfung der diagnostischen Aussagekraft der TVS nach dem IDEA-Protokoll bei Verdacht auf rektosigmoidale TIE und Bestimmung der Häufigkeit möglicher anderwertiger pathologischer Veränderungen. Material und Methode: Prospektive TVS-basierte Beobachtungsstudie mit konsekutivem Einschluss von Patientinnen mit klinischem Verdacht auf rektosigmoidale TIE. Die Ergebnisse der TVS wurden mit den Ergebnissen der chirurgischen Therapie verglichen. Ergebnisse: Von den 671 Patientinnen, die sich einer TVS unterzogen, 128 Frauen entschieden sich für eine medikamentöse Therapie. 6 Patientinnen entschieden sich für einen chirurgischen Eingriff, gaben aber keine Zustimmung zur Teilnahme an der Studie. 537 Patientinnen wurden in die Studie aufgenommen. 279 (52%) Patientinnen wiesen histologisch verifizierte rektosigmoidale TIE auf. Die Sensitivität und Spezifität, der PPV der NPV, die LR+ und die LR- sowie die Genauigkeit der TVS zur Diagnose von rektosigmoidealen TIE lagen bei 93,5 %, 91,8 %, 94,9 % 89,7 %, 11,54, 0,07, 92,9 %. 12 Frauen, bei denen ein klinischer und sonografischer Verdacht auf rektosigmoidale TIE bestand wiesen andere Pathologien auf: Gartner-Gang Zyste der Vaginalwand (3/291;1,0 %), anorektaler Abszess (3/291;1,0 %), Rektumkarzinom (2/291;0,7 %), Hydrosalpinx (2/291;0,7 %), metastasierendes Endometriumkarzinom (1/291;0,35 %) und Morbus Crohn (1/291;0,35 %). Schlussfolgerungen: Die TVS zur prächirurgischen Diagnose der rektosigmoidalen TIE unter Anwendung des IDEA-Protokolls ist aussagekräftig. Bei etwa 4-5 % der Patientinnen mit sonografischen, IDEA-basierten Zeichen einer rektosigmoidalen TIE, müssen anderwertige Krankheiten in Betracht gezogen werden.

Bevezetés: Mélyen infiltráló endometriosis esetén a laesiók több mint 5 mm mélyen infiltrálják a peritonealis felszínt. Bélérintettség a páciensek 3–37%-ában fordul elő. Célkitűzés: A szerzők a bélendometriosis miatt végzett műtétek során szerzett tapasztalataikat mutatják be. Módszer: 2009 és 2020 között 675 páciens esett át bélreszekción belet érintő, mélyen infiltráló endometriosis miatt a Semmelweis Egyetem Szülészeti és Nőgyógyászati Klinikájának Baross utcai részlegén. Négy különböző műtéti technika került alkalmazásra: „shaving”, discoid, szegmentális és NOSE-reszekció (természetes testszájadékon keresztül végzett specimeneltávolítás). Eredmények: 182 esetben „shaving”-et, 93 esetben discoid reszekciót, 130 esetben NOSE-technikát, illetve 270 esetben hagyományos szegmentális bélreszekciót alkalmaztunk. 40 esetben ultramély anastomosist készítettünk. A műtéti idő medián értéke 85 perc volt, a legrövidebb beavatkozás 25 percig, a leghosszabb 585 percig tartott. Az első 10 bélműtét átlagos műtéti ideje 260 (± 161,3) perc, az utolsó 10 műtété 114 (± 47,0) perc volt. Az átlagos vérveszteség 10 (± 20,3) ml, az átlagos kórházi tartózkodás pedig 6 (± 2,3) nap volt. Súlyos sebészeti szövődmény (Clavien–Dindo III. vagy súlyosabb) 18 esetben alakult ki. Összesen 17 esetben alakítottunk ki sigmoideo-, illetve ileostomát. Laparotomiás konverzióra 6 esetben volt szükség. Megbeszélés: Intézményünkben ugyanaz a team végezte a beavatkozásokat, ami az egyes sebészek technikája helyett a műtéti technikák eredményességét mutathatja. A műtétek szövődményrátája tapasztalt sebészi team esetén nem nagy, a műtéti idő az elvégzett műtétek számával arányosan, szignifikánsan csökken. Következtetés: A belet érintő, mélyen infiltráló endometriosis biztonságosan és hatékonyan kezelhető mind a konzervatív megközelítésnek tekinthető „shaving” vagy discoid, mind a radikálisabb megközelítésként számontartott hagyományos szegmentális vagy NOSE-reszekcióval. Orv Hetil. 2023; 164(9): 348–354.

Background: Ultrasound elastography displays information on tissue stiffness. Deep endometriotic nodules are hard fibrotic tissues. Patients are recognized as having deep endometriosis only after several years from the onset of symptoms, therefore it is important to improve diagnostic capabilities. Cases: In this case series, our purpose was to present the applicability and feasibility of transvaginal strain elastography. Five patients with various complaints compatible with endometriosis underwent transvaginal ultrasound with strain elastography. Using the 'International Deep Endometriosis Analysis' group (IDEA) protocol along with transvaginal strain elastography, preoperative examination clearly demonstrated the size and extent of deep endometriosis. Conclusion: This ultrasonographic technique was effective regardless of whether the ligaments of the female reproductive tract, or the organs of the urinary and intestinal tract were infiltrated.