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

Abstract

Purpose of review 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 findings 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. Summary 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.

Laparoscopic treatment of abdominal wall endometriosis: A case series

“…This study indicates that laparoscopic surgery for AWE has the advantages of simultaneous diagnosis and treatment of other pelvic lesions. In our study, 87.5% (7/8) of patients with AWE were found to have concomitant pelvic endometriosis during surgery, which is consistent with previous studies [ 4 , 6 , 10 , 17 ]. In traditional laparotomy for AWE, it is not necessary to routinely open the abdominal cavity if the AWE lesion is located in the subcutaneous or muscular layer of the abdominal wall and is not involved with the peritoneum; therefore, concomitant pelvic endometriosis and other lesions within the abdominal cavity cannot be diagnosed or treated simultaneously.…”

“…The current study showed that laparoscopic surgery for AWE is safe, effective and feasible and could be considered a treatment option for AWE. Laparotomic resection of AWE lesions is the first-line treatment for AWE [ 3 , 10 ]. Previous studies have shown a success rate of >95% and a postoperative recurrence rate of 1.5–11.4% for laparotomic wide local resection of AWE lesions with at least 1 cm negative margins; however, wide local resection may lead to complications such as incision infection, delayed healing, and incisional hernia [ 3 , 10 ].…”

“…Laparotomic resection of AWE lesions is the first-line treatment for AWE [ 3 , 10 ]. Previous studies have shown a success rate of >95% and a postoperative recurrence rate of 1.5–11.4% for laparotomic wide local resection of AWE lesions with at least 1 cm negative margins; however, wide local resection may lead to complications such as incision infection, delayed healing, and incisional hernia [ 3 , 10 ]. HIFU ablation, a noninvasive thermal ablation technique, has been performed to treat AWE for many years, with efficacy rates of up to 92% and recurrence rates ranging from 0% to 8%.…”

“…HIFU ablation, a noninvasive thermal ablation technique, has been performed to treat AWE for many years, with efficacy rates of up to 92% and recurrence rates ranging from 0% to 8%. However, complications such as skin burns and injury to surrounding tissues and organs have been reported with HIFU ablation of AWE [ 7 , [10] , [11] , [12] , [13] ]. CT/MRI-guided cryoablation is another noninvasive surgical treatment for AWE and was first reported by Cornelis et al in 2014 [ 14 ].…”

“…Currently, the exact pathogenesis of AWE is poorly understood, and direct implantation of the endometrium into the abdominal wall at the site of incision for surgeries involving the uterus such as caesarean section and hysterectomy and surgery for endometriosis is widely considered the chief pathogenic mechanism of AWE [ [2] , [3] , [4] , 10 , [17] , [18] , [19] ]. Previous studies have suggested that 80.1% ∼ 99.6% of AWE patients have a history of surgery involving the uterus [ 2 , 3 , 10 , 17 ]. In this study, 87.5% (7/8) of the AWE patients had a history of caesarean section, which is consistent with previous research.…”