Laparoscopic treatment of bowel endometriosis in infertile women

Stepniewska, Anna; Pomini, Paola; Bruni, Francesco; Mereu, Liliana; Ruffo, Giacomo; Ceccaroni, Marcello; Scioscia, Marco; Guerriero, Massimo; Minelli, Luca

doi:10.1093/humrep/dep083

Cited by 130 publications

(114 citation statements)

References 34 publications

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“…Particularly, in more aggressive, infiltrating forms of the disease, there appears to be a predominant action of cell immunity, with cells, enzymes and cytokines provoking adhesion, infiltration and maintenance of the foci of ectopic endometrial tissue. Deeply infiltrating endometriosis is a major issue in several studies related to this disease, including etiopathogenesis, clinical data, imaging methods and an intense clinical and surgical treatment debate 16,17,18,19,20,21 . There are still some topics that have no consensus, such as the best imaging method for diagnosis of deep lesions (mainly bowel endometriosis) 18,19 and the best option for treatment of these lesions, due to the complication risk related to the more advanced surgical procedures 20,21 .…”

Section: Discussionmentioning

confidence: 99%

Th1 and Th2 immune responses related to pelvic endometriosis

Podgaec¹,

Dias²,

Chapron³

et al. 2010

Rev. Assoc. Med. Bras.

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Section: Discussionmentioning

confidence: 99%

Th1 and Th2 immune responses related to pelvic endometriosis

Podgaec¹,

Dias²,

Chapron³

et al. 2010

Rev. Assoc. Med. Bras.

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“…Two studies have evaluated the spontaneous PR in women undergoing resection of DIE but leaving in situ colorectal endometriosis [32,33] (Table 1). The spontaneous PR was 26.5% (95% CI = 14-39) (Figure 2).…”

Section: Spontaneous Fertility In Women With In Situ Colorectal Endommentioning

confidence: 99%

“…Three studies reported the PR after MAR including the two previously mentioned series with resection of DIE and leaving in situ colorectal endometriosis [32,33] and one including patients with no surgery [37] …”

Section: Fertility After Mar In Women With In Situ Colorectal Endometmentioning

confidence: 99%

Colorectal endometriosis and fertility

Daraı̈

Cohen

Ballester

2017

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: The goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes.Study design: MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: "deep endometriosis", "deep infiltrating endometriosis", "bowel endometriosis", "colorectal endometriosis", "fertility", "infertility", "IVF-ICSI", "Assisted Reproductive Techniques (ART)", and "MAR".Results: Spontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI = 14-39). PR after MAR was 27.4% (95% CI = 19-35) and the overall PR was 37.9% (95% CI = 29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI = 28-34) without difference between the groups. PR after MAR was 19.8% (95% CI = 17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI = 18-25) and 15.5% (95% CI = 11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI = 48-54). Conclusion:Our review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.

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Section: Endometriosis and Role Of Laparoscopy In Management Of Infermentioning

confidence: 99%

“…Stepniewska et al [106] in one of the largest series retrospectively looked at the effect of laparoscopic surgery for endometriosis with colorectal segmental resection on subsequent fecundity rate. They concluded that complete removal of endometriosis with bowel segmental resection had better post-operative fertility than removal of endometriosis without bowel resection [106]. Ferrero et al in their study suggested that although spontaneous pregnancy may occur after bowel resection, these patients may require infertility treatment, especially women ≥35 years [107].…”

Section: Endometriosis and Role Of Laparoscopy In Management Of Infermentioning

confidence: 99%

Laparoscopic surgery for endometriosis-associated infertility: a pathophysiologic approach

Pahlajani

Falcone

2010

Gynecol Surg

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Endometriosis has been one of the most confusing gynecological diseases since it was first described. Whereas there is a reasonable body of evidence in literature to demonstrate an association between endometriosis and infertility, a definite cause and effect relationship has not been established. The mechanism by which endometriosis causes infertility remains an enigma. Virtually every aspect of reproduction in women with endometriosis has been investigated and purported to be impaired. Impairment of implantation and pregnancy rates seems to affect women with endometriosis. Whether this is due to poor quality embryos derived from impaired oocytes or endometrial defects or both has been argued. Structural abnormalities of the uterine wall and tube in women with endometriosis have also been described by other researchers. Adding more confusion to this topic is the altered immune function and the peritoneal environment and their detrimental effects on the sperm motility and morphology. This uncertain pathophysiology has resulted in the lack of consensus on the treatment of endometriosis-associated infertility. The aim of this review is to describe the current pathophysiology of endometriosis-related infertility, how laparoscopic surgery may influence fertility rates.

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Laparoscopic treatment of bowel endometriosis in infertile women

Cited by 130 publications

References 34 publications

Th1 and Th2 immune responses related to pelvic endometriosis

Th1 and Th2 immune responses related to pelvic endometriosis

Colorectal endometriosis and fertility

Laparoscopic surgery for endometriosis-associated infertility: a pathophysiologic approach

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