The feasibility of laparoscopic bowel resection performed by a gynaecologist to treat endometriosis

Pereira, Ricardo; Zanatta, Alberto; Serafini, P.; Redwine, David B.

doi:10.1097/gco.0b013e32833beae0

Cited by 18 publications

(11 citation statements)

References 39 publications

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“…The operative field in deep infiltrating endometriosis with bowel involvement is very different from that of rectal cancer surgery. In agreement with other major centers [38,39], we recommend surgery for bowel endometriosis to be centralized to tertiary referral units. In our experience, a center with 2-3 gynecologists and 2 general surgeons performing at least 40 procedures per year comprises a robust setup for acquiring and upholding experience with this highly complex procedure.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Riiskjær¹,

Forman²,

Kesmodel

et al. 2016

Gynecol Obstet Invest

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Aims: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis. Methods: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. Results: The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases. Conclusion: A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Riiskjær¹,

Forman²,

Kesmodel

et al. 2016

Gynecol Obstet Invest

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“…Among the bowel segments the rectosigmoid is the most commonly involved by endometriosis (65.7%) [ 17 ], followed by vermiform appendix, terminal ileum, cecum and descending colon, in order of frequency [ 51 ]. Rectosigmoid endometriosis is often associated with other pelvic locations and with a second intestinal lesion in 55% of cases [ 3 ].…”

Section: Mr Imaging Findingsmentioning

confidence: 99%

Endometriosis: clinical features, MR imaging findings and pathologic correlation

et al. 2018

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ObjectiveWe illustrate the magnetic resonance imaging (MRI) features of endometriosis.BackgroundEndometriosis is a chronic gynaecological condition affecting women of reproductive age and may cause pelvic pain and infertility. It is characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus and includes three different manifestations: ovarian endometriomas, peritoneal implants, deep pelvic endometriosis. The primary locations are in the pelvis; extrapelvic endometriosis may rarely occur. Diagnosis requires a combination of clinical history, invasive and non-invasive techniques. The definitive diagnosis is based on laparoscopy with histological confirmation. Diagnostic imaging is necessary for treatment planning. MRI is as a second-line technique after ultrasound. The MRI appearance of endometriotic lesions is variable and depends on the quantity and age of haemorrhage, the amount of endometrial cells, stroma, smooth muscle proliferation and fibrosis. The purpose of surgery is to achieve complete resection of all endometriotic lesions in the same operation.ConclusionOwing to the possibility to perform a complete assessment of all pelvic compartments at one time, MRI represents the best imaging technique for preoperative staging of endometriosis, in order to choose the more appropriate surgical approach and to plan a multidisciplinary team work.Teaching Points • Endometriosis includes ovarian endometriomas, peritoneal implants and deep pelvic endometriosis. • MRI is a second-line imaging technique after US. • Deep pelvic endometriosis is associated with chronic pelvic pain and infertility. • Endometriosis is characterized by considerable diagnostic delay. • MRI is the best imaging technique for preoperative staging of endometriosis.

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“…Since relatively common gynecological pathologies, such as deep infiltrating endometriosis (DIE) and advanced ovarian cancer (aOC), also affect other pelvic organs, intestinal surgery is frequently required for their management . The full extent of the disease, including bowel involvement, may not be apparent preoperatively and represents an incidental finding during the surgical procedure . In the case of aOC (International Federation of Obstetrics and Gynecology stage III or more) complete cytoreduction is essential for achieving complete remission and prolonging disease‐free survival .…”

Section: Introductionmentioning

confidence: 99%

“…In both instances the ability to perform complete resection surgery may have a significant influence on the risk of disease recurrence . It has been proposed that, as in gynecological cancer, the surgical treatment of severe DIE would be best done by a pelvic surgeon with advanced skills and hence centralized to referral centers, but that this type of surgery should not be carried out by any gynecologist.…”

Section: Introductionmentioning

confidence: 99%

Intestinal surgery performed by gynecologists

Martínez-Serrano

Martínez‐Román

Pahisa

et al. 2015

Acta Obstet Gynecol Scand

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The feasibility of laparoscopic bowel resection performed by a gynaecologist to treat endometriosis

Abstract: The single-surgeon model approach in laparoscopic excision of endometriosis that includes bowel resection may provide advantages for both the patients and healthcare system. The best model should be decided on the maximum benefit of the patient.

Cited by 18 publications

References 39 publications

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Endometriosis: clinical features, MR imaging findings and pathologic correlation

Intestinal surgery performed by gynecologists

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