Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

Abstract

Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.

An exposure to endocrine active persistent pollutants and endometriosis — a review of current epidemiological studies

“…Endometriosis is more common in Caucasians than African Americans and Asians, in taller women with lower BMI and genetic factors increase its risk by 50% (Chatman 1976 ). It is the most common cause of deep dyspareunia, pelvic pain, and reduced fertility (Ota et al 2018 ). Numerous articles indicate association with exposure to persistent EDCs and development of endometriosis.…”

Are double-J stents in surgery for deep infiltrating endometriosis always necessary? A retrospective analysis.

“…The return of symptoms can be expected if the hormonal therapy is interrupted. Moreover, sometimes progression of DIE can be observed even under hormonal therapy [11]. For these reasons and/or in the presence of organ obstruction, surgical therapy should be considered [11].…”

“…Moreover, sometimes progression of DIE can be observed even under hormonal therapy [11]. For these reasons and/or in the presence of organ obstruction, surgical therapy should be considered [11]. The therapy of deep infiltrating endometriosis places the highest demands on interdisciplinary cooperation, as surgical involvement of the gastrointestinal tract and/or the urogenital tract can lead to radical surgical operations [12].…”

Effect of nodule size on symptoms and the choice of surgical technique in patients with bladder endometriosis

“…12 In such cases, surgeons should resect the affected tissue and restore the patient’s urinary function. 2,13,14 This study aimed to evaluate the relationship between bladder EDT, the lesion size, and the subsequent surgical technique used to excise the lesion. 15…”