Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients

Abstract Background Endometriosis is a challenging gynecological condition that has a profound influence on the quality of life of affected women. Transvaginal ultrasound is considered the first-line imaging method in preoperative assessment of the extent and severity of endometriosis. Accurate preoperative mapping can aid the surgeon in patient counselling, selection of the most appropriate surgical method that minimizes the operative and post-operative complications. The aim of our study is to evaluate the accuracy of transvaginal sonography (TVS) in precisely assessing the size, location and extent of deep infiltrating endometriosis (DIE) using a new modified endometriosis mapping proforma with histopathological confirmation. Our prospective observational study included 101 women with clinically suspected DIE who underwent TVS followed by laparoscopy from October 2018 to December 2020 with a maximum of 4 weeks interval. Precise mapping of DIE was done during TVS and laparoscopy. Results were correlated with histopathology findings. Results DIE was confirmed by histopathology in 88 patients. Sensitivity and specificity for individual DIE locations were rectovaginal septum 67.9% and 98.6%; vagina 52.2% and 98.7%; uterosacral ligaments 82.5% and 96.2%; torus 96.4% and 97.3%; parametrium 68.8% and 96.9%; rectum 100% and 98.8%; bladder 100% and 100%, ureters 63.4% and 99.0%; scar endometriosis 100% and 100%; pouch of Douglas obliteration 97.7% and 100%. No statistically significant difference was detected between ultrasound and histopathology size. Ultrasound tended to underestimate the lesion size; the underestimation was more pronounced for lesions > 3 cm. “Butterfly” and “tram-track” signs are two new sonographic signs related to posterior compartment DIE. No post-operative complications were recorded. There were no cases of DIE recurrence. Eleven out of 22 cases of infertility achieved pregnancy during 18 months follow-up. Conclusion TVS provides a thorough and accurate evaluation of the extent of endometriosis. An experienced radiologist can use E-PEP to provide an accurate demonstration of the location and extent of DIE which helps the surgeon select the most appropriate surgical approach ensuring radical treatment of the disease and minimizing short- and long-term complications.

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Perioperative complications and mortality in elderly patients following surgery for femoral fracture: prospective observational study

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2019.10.008 ◽

2019 ◽

Vol 69 (6) ◽

pp. 569-579

Author(s):

Talita de Almeida Barbosa ◽

André Moreira Fogaça de Souza ◽

Fábio Caetano Oliveira Leme ◽

Letícia Dalla Vecchia Grassi ◽

Fabio Bussolan Cintra ◽

...

Keyword(s):

Observational Study ◽

Elderly Patients ◽

Femoral Fracture ◽

Prospective Observational Study ◽

Perioperative Complications ◽

Complications And Mortality

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Re: Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. S. Reid, C. Lu, N. Hardy, I. Casikar, G. Reid, G. Cario, D. Chou, D. Almashat and G. Condous. Ultrasound Obstet

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.14704 ◽

2014 ◽

Vol 44 (6) ◽

pp. 632-632

Author(s):

J. L. Alcazar

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Deep Infiltrating Endometriosis ◽

Multicenter Prospective Observational Study ◽

Infiltrating Endometriosis

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Transvaginal specimen extraction after laparoscopic bowel resection in deeply infiltrating endometriosis

Orvosi Hetilap ◽

10.1556/oh.2014.29841 ◽

2014 ◽

Vol 155 (11) ◽

pp. 420-423 ◽

Cited By ~ 1

Author(s):

Attila Bokor ◽

Ákos Pohl ◽

Péter Lukovich ◽

János Rigó Jr.

Keyword(s):

Laparoscopic Surgery ◽

Perioperative Complications ◽

Postoperative Bleeding ◽

Extraction Procedure ◽

Vaginal Wall ◽

Rectovaginal Septum ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Deeply Infiltrating Endometriosis ◽

Infiltrating Endometriosis

The authors report a case of a 27-year-old patient who had deeply infiltrating endometriosis involving the rectum, sigmoid colon and the rectovaginal septum, which was removed by laparoscopic surgery. During surgery the affected bowel segment, the deeply infiltrating nodule of the rectovaginal septum and the posterior vaginal wall were resected and the 12 cm long specimen was removed transvaginally. Postoperative bleeding was noted in the first postoperative day, which was treated laparoscopically, aswell. This case history confirms data from the literature showing that the natural orifice specimen extraction procedure can widely be applied during operations for deeply infiltrating endometriosis and that laparoscopic anterior resection is a safe and feasible method for the treatment of colorectal deeply infiltratnig endometriosis. Moreover, perioperative complications can be treated by means of laparoscopic surgery. Orv. Hetil., 2014, 155(11), 420–423.

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