Colorectal Endometriosis: Ample data without definitive recommendations.

Abstract

The preoperative work-up and optimal surgical approach to colorectal endometriosis is a highly studied topic lacking definitive recommendations. Synthesis of the available data can be extremely challenging for surgeons due to the heterogeneity of existing comparisons, a variety of studied surgical outcomes, and a predominant focus on operative complications. While these considerations are extremely important for surgeons performing such complex gynecologic surgery there is still much to be desired with regards to evidence based guidelines for the preoperative assessment and surgical technique for colorectal endometriosis. Having an established guideline stating in which clinical situations endometriosis surgeons should performing rectovaginal shaving, versus discoid excision, versus segmental resection would be extremely important for all pelvic surgeons, even those operating in high-volume centers dedicated to the surgical management of complex endometriosis. This perspective highlights the shortcomings of the available data and attempts to create an algorithm surgeons can follow when performing surgery for colorectal endometriosis. This algorithm is based on our expert opinion after synthesising available data.

A systematic literature review on the utilization of extended operating room hours to reduce surgical backlogs

“…One of the proposals they discussed is the possibility of considering routine cataract integrated practice units with high volume weekend/evening following independent patient lists. Moawad et al ( 23 ) presented a perspective paper proposing to extend surgical hours on weekdays to increase OR access to resume elective surgical activity after the COVID-19 suspensions. In a letter to the editor, Samson ( 24 ) quantified the amount of additional OR hours, or the required extra shifts to be added to daily schedules, to compensate for the cancellation of cases due to the COVID-19 pandemic.…”

Diagnosis of Bowel Endometriosis Using Endoscopic Ultrasound-guided Fine Needle Aspiration

“…Involving a multidisciplinary team is crucial for determining the best therapeutic options to address clinical and surgical factors, patient preferences, and impact on the quality of life. 5,20 The main objectives of therapy are a symptomatic improvement, debulking disease load, and suppression and delay of its recurrence and progression. 1 This can be tackled through medical management (hormonal suppression, NSAIDs, danazol, or aromatase inhibitors) or surgery depending on clinical severity and complications, such as bowel obstruction or perforation.…”

Subtypes of Deep Endometriosis According to Laparoscopic Revision

“…Найбільш часто глибокий ендометріоз комбінувався із перитонеальним ендометріозом, дещо рідше із ураженням яєчників. Серед уражень порожнистих органів ендометріозом частіше зустрічався ендометріоз кишківника, більшість випадків припадають на пряму кишку, рідше уражається сигмоподібна та апендикс [20], потім ендометріоз сечовивідних шляхів, перш за все це ураження сечового міхура, рідше сечоводів [21].…”