Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis

Abstract

Introduction Deep infiltrating endometriosis (DIE) affects between 3.8% and 37% of all endometriosis patients, mostly affecting rectovaginal septum or retrocervical space and characterized by the severe endometriosis-related complaints. Nowadays, generally managed with surgery. However, this is associated with a risk of postoperative complications. To better evaluate intra-and postoperative complications and outcomes for rectovaginal (RVE) and retrocervical endometriosis (RCE), the preoperative management should be accurately described and compared. Methodology This is a cohort retrospective study performed at the Endometriosis Centre of Charité-University Clinic, Berlin. 34 patients were investigated in their reproductive age, n = 19 with RVE and n = 15 RCE, operated between 2011 and 2015. The surgical approach was divergent in both groups. Single laparoscopy was performed in RCE patients (RCEP) and vaginal assisted laparoscopy in RVE patients (RVEP). Long-term postoperative outcome included complications, fertility rate and recurrence rate. Results The median follow-up time was three years (y). Symptom-free status was revealed in n = 12 RVEP and n = 9 RCEP. Postoperatively, endometriosis-related complaints were presented in n = 7 RVEP and n = 6 RCEP, but with significant pain relief. From n = 8 RVE patients seeking fertility, pregnancy occurred in n = 7 and from n = 9 RCEP pregnancy appeared in n = 5 patients in the meantime of 6 months. Postoperative complications were reported in n = 1 RVEP with early postoperative bleeding, after ureter leakage and n = 1 RCEP with postoperative anastomotic insufficiency. The postoperative recurrence rate was equivalent to zero. Conclusion The appropriate surgical approach for each group, preserving anatomy and functionality of the organs, seems to be very essential and efficient.

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

“…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.…”

Does Robot Assisted Laparoscopy (RAL) Have an Advantage in Preservation of Ovarian Reserve in Endometriosis Surgery? Comparison of Single-Port Access (SPA) RAL and SPA Laparoscopy

“…Complete resection of all visible lesions and restoration of the distorted pelvic anatomy are the treatment goals of endometriosis surgery to prevent recurrence and reduce pain [24]. Abesadze et al have reported that successful removal of DIE in the posterior compartment of the deep pelvis reduces pain and recurrence and increases fertility rate [25,26]. In order to achieve this aim, endometriosis surgery can vary according to the severity of the disease from simple cystectomy of endometrioma to urinary tract and bowel surgery requiring advanced techniques.…”

Endometriosis, an Ongoing Pain—Step-by-Step Treatment

“…Especially during initial diagnosis, persisting pain under adequate therapy is an important indication for surgery. In this case, surgery often proves to be very effective in reducing pain as well as central sensitization [19,20]. In case of a recurrence, however, the situation is different and the indication for repeated surgery should be carefully examined.…”