Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up

Abesadze, Elene; Sehouli, Jalid; Mechsner, Sylvia; Chiàntera, Vito

doi:10.1016/j.jmig.2019.08.019

Cited by 16 publications

(8 citation statements)

References 45 publications

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“…Barra et al excluded patients with a history of surgery for endometriosis, whereas the other three studies included patients who had previously undergone surgery for endometriosis, but the specific surgical methods were not described. Results of several other studies indicated that advanced and appropriate surgical approaches are essential and efficient for endometriosis, especially deep infiltrating endometriosis, with regard to fertility rate, recurrence rate, and symptom improvement [31,32]. Overall, the quality of the studies included in our meta-analysis was moderate.…”

Section: Color Version Available Onlinementioning

confidence: 90%

Pretreatment of Dienogest for Women with Endometriosis in in vitro Fertilization: A Systematic Review and Meta-Analysis

Lin

Zhang

et al. 2023

Gynecol Obstet Invest

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Introduction Dienogest (DNG) was demonstrated to be comparable to gonadotropin-releasing hormone agonist (GnRH-a) in controlling symptoms of endometriosis. GnRH-a is used before in vitro fertilization (IVF) in women with endometriosis to improve pregnancy outcomes. We aimed to determine the effect of DNG pretreatment on IVF outcomes, including number of mature oocytes, rate of clinical pregnancies, and rate of live births in women with endometriosis. Methods All studies involving DNG, IVF and endometriosis were searched from the PubMed, Ovid/MEDLINE, Wanfang, CQVIP, China National Knowledge Infrastructure databases and ClinicalTrials.gov. The study population was women with endometriosis in IVF. Randomized controlled trials and cohort studies were included. All included studies comprised a DNG group and a control group. The outcomes were number of mature oocytes, rate of clinical pregnancies and rate of live births. We calculated the odds ratio or mean difference, and 95% confidence interval for each study, and used a random-effects model to estimate the results. Results Five articles were screened by the search strategy. One article without a control group was excluded. Finally, four articles with 422 patients were included. No significant differences in number of mature oocytes (MD=-1.27, 95% CI=-3.63-1.09, I²=91%), the rate of clinical pregnancies (odds ratio = 1.07, 95% CI = 0.33–3.47, I² = 84%) or the rate of live births (odds ratio =1.13, 95% CI=0.37‐3.45, I²=83%) were found between the DNG group and the control group. Conclusion Pretreatment with DNG for women with endometriosis who underwent IVF could not improve the number of mature oocytes, the rate of clinical pregnancies or the rate of live births.

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Section: Color Version Available Onlinementioning

confidence: 90%

Pretreatment of Dienogest for Women with Endometriosis in in vitro Fertilization: A Systematic Review and Meta-Analysis

Lin

Zhang

et al. 2023

Gynecol Obstet Invest

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“…All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery for endometriosis. A suspended hormonal pretreatment for 2 months followed the surgery [ 48 ]. In all cases, a careful evaluation of the whole abdominal cavity was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Excision was carried out by grasping the peritoneum with the endometriotic lesion, thus distancing it from the underlying tissue. Using laparoscopic scissors, the lesion along with a border of normal peritoneum was extracted [ 48 ]. We did not use barrier methods to prevent adhesions.…”

Section: Methodsmentioning

confidence: 99%

When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases

Dückelmann

Taube

Abesadze

et al. 2021

Arch Gynecol Obstet

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Purpose To analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility. Methods Using our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed. Results Laparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed. Conclusion According to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.

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“…Postoperative fertility rates of 54% up to 62% have been demonstrated. More than half of these pregnancies had been conceived spontaneously without ART [84,85]. The chances of conceiving naturally are especially high in the first 12-18 months after the operation [86].…”

Section: Surgical Treatment and Assisted Reproductive Technology (Art)mentioning

confidence: 99%

Pathogenesis of Endometriosis: The Origin of Pain and Subfertility

Gruber

Mechsner

2021

Cells

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112

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Endometriosis (EM) and adenomyosis (AM) are common conditions with pain and infertility as the principal symptoms. The pathophysiology of pain in EM and AM comprises sensory and somatoform pain mechanisms. Over time, these may aggravate and lead to individual complex disease patterns if not diagnosed and treated. Despite the known facts, several years often pass between the onset of symptoms and diagnosis. Chronic pain disorders with changes on a neuronal level frequently arise and are linked to depressive disorders, with the process becoming a vicious cycle. Additionally, women with EM and AM suffer from sub- and infertility. Low fecundity rates are caused by anatomical changes in combination with behavioral changes in the sexual activity of women with chronic pain as well as local proinflammatory factors that not only decrease implantation rates but also promote early abortions.

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Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up

Cited by 16 publications

References 45 publications

Pretreatment of Dienogest for Women with Endometriosis in in vitro Fertilization: A Systematic Review and Meta-Analysis

Pretreatment of Dienogest for Women with Endometriosis in in vitro Fertilization: A Systematic Review and Meta-Analysis

When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases

Pathogenesis of Endometriosis: The Origin of Pain and Subfertility

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