Surgical treatment of deep endometriosis and risk of recurrence

Vignali, M; Bertulessi, C; Masini, A; Filardo, P; Spadaccini, G; Oggioni, Giulia; Busacca, Mauro

doi:10.1016/s1074-3804(04)80368-2

Cited by 123 publications

(69 citation statements)

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“…In cases of DIE, the success of surgery correlated with the radicality of the surgical exeresis (Garry, 1997;Chopin et al, 2005;Vignali et al, 2005). Generally, DIE is presented as a pathology with a high risk of recurrence, estimated at 30% (Redwine and Wright, 2001;Fedele et al, 2004a, b).…”

Section: Discussionmentioning

confidence: 99%

“…During the follow-up visits, we evaluated the persistence/intensity of pre-operative painful symptoms and bladder DIE recurrence. Bladder DIE recurrence was defined as a clinical reappearance of the disease (Vignali et al, 2005) or radiological evidence that mandated a new operation (Fedele et al, 2004a, b). Follow-up visits took place 8 days post-operatively (to remove the Foley catheter), 6 weeks after surgery and then every 6 month for the first year and yearly thereafter.…”

Section: Methodsmentioning

confidence: 99%

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Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

et al. 2010

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background: Deep infiltrating endometriosis (DIE) is presented as a disease with high recurrence risk. Bladder DIE is the most frequent location in cases of urinary endometriosis. Surgical removal has been recommended for bladder DIE but long-term outcomes remains unevaluated. The objectives of this study are to evaluate the rate of recurrence after partial cystectomy for patients presenting with bladder DIE and to outline the surgical modalities for handling associated posterior DIE nodules.methods: Seventy-five consecutive patients with histologically proved bladder DIE were enrolled at a single tertiary academic center between June 1992 and December 2007. A partial cystectomy was performed for each patient. Complete surgical exeresis of all associated symptomatic DIE lesions was carried out during the same surgical procedure. Bladder DIE patients were classified into three groups: patients with isolated bladder DIE (Group A); patients with associated symptomatic posterior DIE (Group B); patients with associated asymptomatic posterior DIE (Group C). Bladder DIE recurrence was defined as a clinical reappearance of the disease or radiological evidence that mandated a new surgical procedure. We assessed pelvic pain symptoms pre-and post-operatively using a 10-cm visual analogue scale.results: In a series of 627 patients with DIE, we observed 75 patients (12%) with bladder DIE. With a 50.9 + 44.6 months mean followup after partial cystectomy no patient presented evidence of bladder DIE recurrence. Post-operatively, we observed a significant improvement with respect to pain symptoms, with only two patients (2.7%) developing major complications during follow-up. Among patients with non-operated associated asymptomatic posterior DIE lesions (n ¼ 15), a second surgical procedure indicated for pain symptoms was necessary in only one patient (6.7%).conclusions: For patients presenting with bladder DIE, no patients required further surgery for bladder recurrence after radical surgery consisting in partial cystectomy. Exeresis of associated posterior DIE nodules is indicated only when they are symptomatic.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

et al. 2010

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“…When deep endometriosis affecting the rectosigmoid is clinically suspected, whether or not in association with lesions in other areas of the pelvis, it is fundamental to perform an adequate imaging exam capable of indicating whether one or more lesions are present, the size and depth of the lesion(s) and the distance between the lowest lesion and the anal verge (Chapron et al, 2004;Goncalves et al, 2009). With this information, it is then possible to define the treatment option to be implemented, bearing in mind that, when medical therapy fails in relieving painful symptoms, the most comprehensive surgical procedure is an adequate form of pelvic pain management, improving patient's quality of life and reducing recurrence rates of the disease, a situation generally confused with the persistence of lesions following incomplete surgical procedures (Kavallaris et al, 2003;Garry et al, 2000;Remorgida et al, 2005;Vignali et al, 2005;Dubernard et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy

et al. 2009

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background: Successful surgical treatment of deep bowel endometriosis depends on obtaining detailed information about the lesions, prior to the procedure. The objective of this study was to determine the capability of transvaginal ultrasonography with bowel preparation (TVUS-BP) to predict the presence of one or more rectosigmoid nodules and the deepest bowel layer affected by the disease. results: With respect to bowel nodule detection and presence of at least two rectosigmoid lesions, TVUS-BP had a sensitivity of 97 and 81%, specificity 100 and 99%, positive predictive value (PPV) 100 and 93% and negative predictive value (NPV) 98 and 96%, respectively. Regarding diagnosis of infiltration of the submucosal/mucosal layer, TVUS-BP had a sensitivity of 83%, specificity 94%, PPV 77%, NPV 96%.conclusions: These findings show that TVUS-BP is an adequate exam for evaluating the presence of one or more rectosigmoid nodules and the deepest layer affected in deep infiltrating bowel endometriosis, confirming the importance of this technique for defining the most appropriate surgical strategy to be implemented.

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“…Extensive coagulation causing termal amage to the rectal and/ or ureteral wall results with subsequent necrosis and perforation or fistula formation. Incomplete excision of endometriosis is the major cause recurrence following surgery [19]. In one study, recurrence rate of deep endometriosis with excision of the nodule and resection of the posterior vaginal fornix, without resection of the vaginal fornix and bowel resection without resection of the vaginal fornix was 3.7%, 16% and 20% respectively [20].…”

Section: Complications and Recurrence Of Bowel Endometriosismentioning

confidence: 99%

Laparoscopic management of the advanced and rectovaginal endometriosis with gastrointestinal involvement: A review of the current literature

Kahyaoğlu¹

2014

CMJ

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Endometriosis is the presence of endometrial gland and stromal tissue outside the uterus with a potentially invasive nature despite being a benign disease process. The exact prevalence of the disease is not known but 10-15% of reproductive age women are affected. The peritoneal and rectovaginal endometriosis are two distinct entities of the disease with different symptoms and treatment strategies. Dyschezia and deep dyspareunia with nodularity on sacrouterine ligaments during rectovaginal examination are specific symptoms of deeply infiltrating endometriosis (DIE). Rectovaginal or bowel involvement is estimated to be present in 5 to 12 percent of women with endometriosis and the most common site is the rectosigmoid colon. Medical treatment of DIE with colorectal involvement results with symptomatic relief without any curative effect on endometriotic foci. Colorectal endometriosis treatment is a major challenge for the clinicians when incidentally encountered during a diagnostic laparoscopy. As randomised controlled studies comparing medical with surgical treatment for rectovaginal or bowel endometriosis are lacking; the impact of the surgical treatment modalities on clinical improvement of the symptoms, complications, recurrence and pregnancy rates is not known. Current literature indicates that, patients without bowel occlusion and/ or rectal bleeding with mucosal involvement caused by DIE should be treated with conservative technique specifically described as "shaving" method that have lower complication and recurrence rates than the invasive technique including bowel resection and anastomosis.Keywords: Laparoscopy, gastrointestinal, rectovaginal, bowel endometriosis, surgical treatment ÖzetEndometriozis iyi huylu bir hastalık prosesi olmasına rağmen endometrial gland ve stromanın uterus dışında potansiyel olarak invazif bir davranışla bulunmasıdır. Hastalığın kesin prevelansı bilinmemektedir fakat üreme çaındaki kadınların yaklaşık %10-15'i etkilenmiştir. Peritoneal ve rektovajinal endometriozis hastalığın farklı semptom ve tedavi stratejileri olan iki ayrı antitesidir. Rektovajinal muayene sırasında sakrouterin ligamentlerde nodülarite ile beraber diskezi ve derin disparanü derin infiltratif endometriozisin (DİE) spesifik semptomlarıdır. Endometriozisli hastaların yaklaşık %5-12'sinde rektovajinal veya barsak tutulumu mevcut olduğu tahmin edilmektedir ve en sık tutulan bölge rektosigmoid kolondur. Kolorektal tutumlu DİE'nin tıbbi tedavisi endometriotik odaklar üzerinde herhangi bir küratif etki etmeden semptomatik rahatlama sağlar. Tanısal bir laparoskopi sırasında tesadüfen saptandığında kolorektal endometriozis tedavisi klinisyenler için major bir sorundur. Rektovajinal veya barsak endometriozisinin medikal ve cerrahi tedavisini birbiri ile karşılaştıran randomize kontrollü çalışmalar olmadığı için cerrahi tedavi modalitelerinin semptomlarda klinik düzelme, komplikasyonlar, rekürrens ve gebelik oranları üzerine etkisi bilinememektedir. Güncel literatüre göre, barsak oklüzyonu ve/ veya rektal kanama...

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Surgical treatment of deep endometriosis and risk of recurrence

Cited by 123 publications

References 0 publications

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy

Laparoscopic management of the advanced and rectovaginal endometriosis with gastrointestinal involvement: A review of the current literature

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