Associated ileocaecal location is a marker for greater severity of low rectal endometriosis

Abstract

Objective To determine whether ileocaecal endometriosis (ICE) is a marker for low rectal endometriosis (LRE) severity.Design Retrospective cohort study. Setting France.Population and sample Analysis of 375 colorectal resections performed in women undergoing complete surgery for LRE from January 1995 to December 2015 in a university centre for endometriosis.Methods Univariate and multivariate analysis of anatomical, postoperative clinical, and long-term outcomes according to presence of ICE.Main outcomes and measures Mean number and type of deep infiltrating endometriosis (DIE) lesions, the existence of an associated endometrioma, and mean total American Society for Reproductive Medicine (ASRM) score.Results The prevalence of ICE was 25.6%. Primary end-point data showed that women with ICE had a significantly higher adjusted number of DIE lesions (OR = 1.43, 95% CI 1.02-3.03; P = 0.048), higher prevalence of endometriomas (OR = 1.91, 95% CI 1.04-3.51; P = 0.044), more associated DIE sigmoid lesions (OR = 2.12, 95% CI 1.07-3.91; P = 0.025), and a higher mean total ASRM score (OR = 2.07, 95% CI 1.12-4.14; P = 0.025). Women with ICE resected during the surgical procedure for LRE did not have more adverse postoperative clinical outcomes than ICE-negative patients.Conclusion Ileocaecal endometriosis was significantly associated with greater LRE severity. In a complete surgical resection strategy, combining resection of ICE and LRE did not appear to increase postoperative rates of complications, morbidity or recurrence, nor did it seem to impair long-term clinical outcomes.Keywords Complete surgery, deep infiltrating endometriosis, disease severity, ileocaecal endometriosis, low rectal endometriosis.Tweetable abstract In women with low rectal endometriosis, 25% have an associated ileocaecal location that is a marker for severity.

Focal adenomyosis of the outer myometrium and deep infiltrating endometriosis severity

“…Imaging procedures are now a suitable way to diagnose both endometriosis and adenomyosis (17,54,55), and they allow exact mapping of the lesion without a need for laparoscopy (2). Surgery for severe DIE, with multiple DIE locations (bladder, digestive, and ureteral), could be difficult with incomplete procedures and entails a risk of severe complications (25,56). Furthermore, because endometriosis can recur after its surgical management (57), iterative procedures are more likely due to previous unfinished surgeries (37,56,58).…”

“…The surgery consisted of complete surgical excision of the endometriotic lesions. Perioperative care was assessed as previously described (25). All of the women underwent complete surgical excision of their endometriosis lesions during the study period at our institution.…”

Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates

“…This prospective cohort study consisted of a continuous series of 101 bowel endometriosis patients without a prior history of surgery for endometriosis who underwent in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) treatment at a university hospital between January 2016 and December 2018. The inclusion criteria for this study were the following: endometriosis-related infertility as the main indication for ART, where infertility was defined as at least 12 months of unprotected intercourse not resulting in pregnancy (37); bowel endometriosis involvement, defined as the involvement of at least the muscularis layer of the bowels on magnetic resonance imaging (MRI) (38); and age %43 years. The exclusion criteria were patients with a prior history of surgery for endometriosis; oocyte donation or vitrified oocyte procedures; and patients already included in another ART research protocol.…”