Management of deep endometriosis

Abstract

Deep endometriosis is still a challenging disease in terms of diagnosis and treatment. About 10-12% of women of reproductive age will have a form of endometriosis. This can affect pelvic as well as extra pelvic locations. Risk of malignant transformation has been studied over a long period of time. Medical and surgical treatments can be proposed to patients for endometriosis-associated pain depending on the severity of symptoms and location of the disease. Results and outcomes are different according to different publications. Understanding of the benefit of surgical treatment on fertility is increasing. The place of medical and surgical treatment in recurrent symptoms or disease is also of interest. Presented here is a review on the management of endometriosis in the light of recent data. Further investigations in many fields of endometriosis are still required.

Feasibility Profile of Endometrial Nodule Resection in the Uterosacral and Rectovaginal Ligament

“…In this study, all surgeons did the procedure through same technique described by Wattiez. 6 The technique consisted of general and specific strategy. First step in general strategy was to hold adhesiolysis so that it would describe better exposure to the pelvic anatomy, followed by ureter identification and pararectal space dissection.…”

“…4,5 The nodules of DIE were commonly found at uterosacral ligament (USL) compared with rectovaginal location, followed by bowel and urological involvement. 6 If the nodules are located on uterosacral or rectovaginal ligament, nodules resection procedure can be performed more safely than other location of nodules. Meanwhile, if the nodules have bowel or urological involvement, endometriotic nodules resection requires more advanced technique with higher risk of organ injury.…”

¿Por qué la endometriosis infiltrativa profunda debe ser considerada una entidad diferente a la endometriosis peritoneal?

“…Diferentes tipos de resecciones intestinales, anastomosis o resecciones ureterales con posterior reimplante, ureterolisis extensas, resecciones o colgajos vesicales, disecciones profundas en las paredes pélvicas en busca de compromiso nervioso por la enfermedad, hacen parte de la gran cantidad de procedimientos potenciales que pueden llegar a requerirse en una paciente con endometriosis infiltrativa profunda y, por tanto, no son susceptibles de ser catalogados bajo un mismo código procedimental (89)(90)(91)(92)(93)(94)(95).…”

<p>Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment</p>

“…Disease involving the bowel can be associated with severe pain. [5][6][7] DE can be found at multiple locations within the pelvis, but more frequently remain localized to the posterior compartment where it can involve the ureters, the torus uterinum, the uterosacral ligaments, the bowel, and the vaginal wall.…”