Surgical treatment of endometriosis: location and patterns of disease at reoperation
|
|
- Chastity Neal
- 5 years ago
- Views:
Transcription
1 Surgical treatment of endometriosis: location and patterns of disease at reoperation Elizabeth Taylor, M.D., and Christina Williams, M.D. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, British Columbia Women s Hospital and Health Care Centre, Vancouver, British Columbia, Canada Objective: To assess the behavior of revised American Fertility Society stages I and II endometriosis after surgical treatment, by observation of location of pelvic involvement at reoperation. Design: Prospective study. Setting: Tertiary referral center at a university-based hospital. Patient(s): Thirty-nine women with persistent or recurrent chronic pelvic pain after laparoscopic excision or ablation of histologically confirmed endometriosis who underwent a second laparoscopy. Intervention(s): Laparoscopic pelvic mapping and surgical treatment of endometriosis, followed by repeat laparoscopic pelvic mapping of endometriosis at a second laparoscopy. Result(s): Superficial peritoneal endometriosis (revised American Fertility Society stage I II) endometriosis recurred in 37% of pelvic regions after surgical treatment. Endometriosis was more likely to recur in a treated pelvic region than an adjacent or distant pelvic region (relative risk 2.54; 95% confidence interval ). A region adjacent to a previously affected pelvic region that was unaffected by endometriosis at the initial laparoscopy was more likely to have endometriosis at the second laparoscopy than a pelvic region distant from the treated pelvic region (relative risk 1.29; 95% confidence interval ). Unaffected regions at initial laparoscopy had a low probability of having new endometriosis (11%) in the second laparoscopy. Conclusion(s): Recurrence of histologically proven endometriosis after surgical excision is more likely to cluster close to the original area of involvement, reflecting either incomplete excision at the initial surgery or a nonrandom favored implantation of new endometrial implants in adjacent peritoneum. Further studies are needed to elucidate the pathophysiology and mechanisms of recurrence of endometriosis. (Fertil Steril Ò 2010;93: Ó2010 by American Society for Reproductive Medicine.) Key Words: Endometriosis, laparoscopy, recurrent Endometriosis is an intriguing disease in which tissue resembling endometrium is found outside the uterine cavity. Endometriosis is associated with subfertility, dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Chronic pelvic pain affects 14.7% of women of reproductive age (1) and is attributable to endometriosis in more than one third of cases (2). The pain associated with endometriosis may be treated surgically, medically, or both. Failure to provide adequate longterm pain relief and adverse effects of currently available medical therapies are an indication for surgical treatment of endometriosis. Endometriosis can be ablated, excised, or both. Laparoscopic excision of endometriosis results in improved pain relief and improved quality of life after 6 months compared with diagnostic laparoscopy alone (3), but endometriosis can recur. Six months after laparoscopic excision of endometriosis, endometriosis was present at laparoscopy in 44% of Received April 18, 2008; revised September 3, 2008; accepted September 29, 2008; published online November 11, E.T. has nothing to disclose. C.W. has nothing to disclose. Reprint requests: Christina Williams, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, British Columbia Women s Hospital and Health Care Centre, D600, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada (FAX: ; cwilliams3@cw.bc.ca). women (3). Two other studies have demonstrated similar recurrence rates. In the first, Redwine (4) reported a series of 359 women with laparoscopic excision of endometriosis. Forty-three percent of women (35 of 81) who required reoperation for pelvic pain had recurrent or persistent endometriosis (4). In the second study, Wheeler and Malinak (5) reported a series of 423 women with endometriosis treated through a laparotomy incision and observed a 33% rate of recurrent endometriosis in the 62 women who required reoperation. These studies included patients at all revised American Fertility Society (rafs) stages, and the findings suggest that endometriosis recurs in 33% 44% of women after surgical treatment. This is surprising, given that endometriosis is considered incurable. Furthermore, Redwine (3) found that in reoperated women with endometriosis, there were fewer pelvic areas of involvement than at initial excisional surgery. In the subset of women who have persistent CPP after laparoscopic laser ablation of endometriosis, 29% have progressive disease, 29% have disease regression, and 42% have static disease 1 year after laparoscopic ablation of endometriosis (6). The reason for the frequent recurrence of endometriosis is postulated to be the continuous implantation of uterine endometrial fragments deposited by retrograde menstruation in pelvic peritoneum (7). As such, endometriosis is often /10/$36.00 Fertility and Sterility â Vol. 93, No. 1, January doi: /j.fertnstert Copyright ª2010 American Society for Reproductive Medicine, Published by Elsevier Inc.
2 considered to be a surgically incurable disease, and hormonal induction of amenorrhea or hysterectomy and bilateral salpingo-oophorectomy is performed on women with CPP and endometriosis. Knowledge of the location and pattern of recurrent endometriosis may clarify whether such disease represents incomplete treatment or de novo disease. We sought to assess the location of recurrent endometriosis in women with CPP and to examine whether the pelvic region of recurrent endometriosis is related to the region of previously treated disease and whether recurrence is more likely in a particular pelvic region. MATERIALS AND METHODS We reviewed the medical records of 600 women who underwent laparoscopy performed by a single surgeon (C.W.) between January 1999 and December All of these women had CPP and localized tenderness on pelvic pain mapping suggestive of endometriosis. Of the women, 61 (10%) had persistent or recurrent pelvic pain and localized tenderness after the initial laparoscopy, necessitating a second laparoscopy. We included women who had two laparoscopies at our center (by C.W.) with visual and histologic evidence of endometriosis at the initial laparoscopy and who had persistent CPP or dyspareunia and localized tenderness on pelvic examination resistant to medical therapy. Repeat laparoscopy was not performed for dysmenorrhea alone without lateral pain or localized tenderness on pelvic examination. Endometriosis was diagnosed at the second laparoscopy if proven by histologic evidence in the excised tissue. Women were excluded from the study if they had previously undergone hysterectomy, bilateral salpingo-oophorectomy, or if the pelvis could not be visualized at both laparoscopies. Thirty-nine women were included in this study. The initial surgery was performed in a standardized fashion under general anesthesia. All procedures included inspection of pelvic and peritoneal organs, and sharp adhesiolysis. All visible endometriosis was ablated or excised. Excision was used exclusively during the second procedure. Ablation was performed using monopolar diathermy at a coagulation current of 40 W using a needle-tip instrument. Only superficial lesions less than 2 to 3 mm in diameter and 1 to 2 mm in depth were ablated. Complete whitening and desiccation of the lesion, leaving normal surrounding peritoneum, was achieved. Excision was carried out using a needle-tip instrument with a blend of 50 W cutting and 40 W coagulation. Excision was performed by grasping the peritoneum harboring the endometriosis and excising the normal peritoneum around the implants with a monopolar needle-tip instrument until the base and surrounding areas were free of visible endometriosis. The stage of disease, as defined by the rafs classification system, was recorded (8). The pelvis was visually divided FIGURE 1 Map of pelvis. The presence or absence of endometriosis was recorded for each pelvic region at the initial and second laparoscopy. L ¼ left; R ¼ right; CDS ¼ cul-de-sac. into 12 regions (Fig. 1). The presence of disease, treatment administered (ablation or excision), and histology were documented for each region. An adjacent pelvic region was defined as a pelvic region immediately medial or lateral to the region of interest. The ovarian regions did not have laterally adjacent regions. A distant pelvic region was defined as a pelvic region not adjacent to the pelvic region of interest. Statistical Analysis At each of the 12 pelvic regions the change from the initial laparoscopy to the second regarding presence (1) or absence (0) of endometriosis was recorded as 1 (from 1 to 0), 0 (from 0 to 0), 1 (from 0 to 1), or 9 (from 1 to 1). These transitions were tested against the treatment given (0, no treatment; 1, cautery; 2, excision) by means of contingency table c 2 tests, and significant results were localized by means of adjusted standardized deviations. Similar analyses were performed by totaling across all regions, including as well as excluding the bladder. Kappa coefficients of agreement were also derived for each case. The probability of a new diagnosis of endometriosis at the second laparoscopy was derived in each region that was immediately adjacent to an index region at the initial laparoscopy. The corresponding standard errors of the estimated probabilities were also calculated, allowing for comparisons under different treatments. RESULTS Thirty-nine women with an average age of 30 years (range, years) were included. Before referral to our center, 58 Taylor and Williams Location of recurrent endometriosis Vol. 93, No. 1, January 2010
3 44% of women (17 of 39) had undergone one previous laparoscopy, 20% (8 of 39) had two previous laparoscopies, and 10% (4 of 39) had three previous laparoscopies. Fifty-three percent of women who had undergone one previous laparoscopy had ablation of endometriosis performed, whereas in the remaining 47% the endometriosis was not treated. Women undergoing two or more procedures had ablation of endometriosis on at least one occasion. No patient had undergone previous excision of endometriosis. The average time between the initial and second laparoscopy included in this study was 18.4 months (range, 2 52 months; SD 13.0). Hormonal treatment was used between the two study laparoscopies in 16 of 39 women (5 received an estrogen progestogen combination, 7 received progestogen only, 3 received GnRH agonists, and 1 received danazol). Hormonal treatment was discontinued in all women at least 2 months before the second laparoscopy. All women had rafs stage I or II endometriosis at the initial laparoscopy. Of the 468 regions in 39 women, 108 regions (23%) had endometriosis present at the initial laparoscopy (median 2.5 regions per woman) and 76 regions (16%) at the second laparoscopy (median 1.0 regions per woman). Sixty-one percent of women (24 of 39) had less disease at the second laparoscopy than at the initial laparoscopy, and 33% (13 of 39) had no endometriosis at the second laparoscopy. The frequency of endometriosis by pelvic region was similar (P>.05) at both laparoscopies (Fig. 2). Endometriosis was excised from 85% of regions and ablated in 15% of regions with endometriosis at the initial laparoscopy. New Endometriosis: Disease Found in a Previously Disease-Free Pelvic Area Thirty-eight percent of women (15 of 39) had new endometriosis at the second laparoscopy. In those 360 regions (77%) with no endometriosis at the initial laparoscopy, endometriosis was present in 41 (11%) at the second laparoscopy. Recurrent Endometriosis: Disease Found Again in a Treated Pelvic Region The probability of recurrent endometriosis was 37%. There was no recurrent endometriosis in any anterior peritoneal region. The probability of recurrent endometriosis by pelvic region (excluding anterior peritoneal regions) is shown in Figure 3. There was no difference in the rate of recurrent endometriosis between areas that were excised or ablated. Endometriosis was more likely to recur in the treated pelvic region than in an adjacent or distant pelvic region (relative risk 2.54; 95% confidence interval ). If a pelvic region adjacent to a region with endometriosis was free of endometriosis at the initial laparoscopy the probability that endometriosis was present in that region at the second laparoscopy was 20%, compared with 16% for a nonadjacent pelvic regions (relative risk 1.29; 95% confidence interval ). The intersurgery interval when endometriosis was present in the same region at both laparoscopies was shorter (mean, 10 months) than if endometriosis was present only at the initial laparoscopy, treated with excision or ablation, and had no endometriosis at the second laparoscopy (mean, 15 months) (P¼.001). DISCUSSION In this study we observed that the distribution of endometriosis in women with recurrent or persistent pain after laparoscopic ablation or excision of endometriosis is similar to that observed at the initial laparoscopy. We also confirmed that not all persistent or recurrent pelvic pain is due to endometriosis in women who have undergone surgical treatment, because not all reoperated patients had endometriosis. This FIGURE 2 Distribution of endometriosis by pelvic region at the initial and second laparoscopy. R ¼ right; L ¼ left. Fertility and Sterility â 59
4 FIGURE 3 Probability of recurrent endometriosis by pelvic region. R ¼ right; L ¼ left. is consistent with previously published work that examined the relationship between the location of endometriosis at reoperation and the location of the primary lesion. Two previous studies have demonstrated that endometriosis is more often localized on the left hemipelvis, and recurrent disease after surgical treatment is more likely to occur on the left hemipelvis, suggesting a similar distribution of endometriosis before and after surgical treatment (9, 10). Our observation that endometriosis is most likely to recur in the treated region may reflect incomplete excision or ablation of endometriosis. Endometriosis is known to extend beyond the margins visible under white light at laparoscopy (11). Such occult disease might explain recurrent disease being more often located at the site of original, albeit treated, disease and the finding that previously unaffected adjacent pelvic regions are more likely to have endometriosis than distant pelvic regions. Another explanation is that endometriosis has a propensity to occur and recur in a specific pelvic region if embryologic tracts of retroperitoneal susceptible substrate tissue are incompletely treated and subsequently undergo metaplasia, perhaps aided by the tissue growth factors associated with wound healing (12). Such tracts need not have an identical ability to develop endometriosis at the same time in the future or disease of the same virulence. Several works have shown that endometriosis is most often located in the posterior compartment of the pelvis (13 15) and on the left side (16, 17). Furthermore, ovarian endometriomas are located significantly more frequently on the left ovary than on the right (9, 10, 16). We observed that 94% of women with persistent or recurrent CPP after laparoscopic excision or ablation of endometriosis had less or no endometriosis at the second laparoscopy. Indeed, 33% of women in our study were cured of endometriosis after surgical treatment. This rate is less than the cure rate of 56% 66% reported previously. This difference may be attributed to patient selection. Women were selected for reoperation if they had failed medical treatment and had lateral pelvic pain and localized pelvic tenderness. This might explain our low reoperation rate (61 of 600). Interestingly, despite use of these strict criteria for reoperation, 33% of the women had no histologic endometriosis identified. It is possible that CPP after surgical treatment of endometriosis may be a consequence of up-regulation of pain signals and not recurrent disease. Our low reoperation rate may also be attributed to the nutrition advice, pain management, counseling, and education provided at our center. This study provides insight into the natural history of surgically treated endometriosis in CPP patients. After surgical treatment of rafs stage I and II endometriosis, recurrent disease occurs most frequently at the site of treated disease. Moreover, regions that are adjacent and nonadjacent have a similar risk of developing endometriosis by the time of second laparoscopy. The probability that a previously uninvolved region develops disease is low (11%). This knowledge enhances our understanding of the pathogenesis of endometriosis and improves our ability to counsel patients undergoing surgical treatment of endometriosis. REFERENCES 1. Mathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol 1996;87: Guo SW, Wang Y. The prevalence of endometriosis in women with chronic pelvic pain. Gynecol Obstet Invest 2006;62: Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril 2004;82: Redwine DB. Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease. Fertil Steril 1991;56: Wheeler JM, Malinak LR. Recurrent endometriosis: incidence, management, and prognosis. Am J Obstet Gynecol 1983;146: Sutton CJG, Pooley AS, Ewen SP, Haines P. Follow-up report on a randomized controlled trial of laser laparoscopy in the treatment of pelvic 60 Taylor and Williams Location of recurrent endometriosis Vol. 93, No. 1, January 2010
5 pain associated with minimal to moderate endometriosis. Fertil Steril 1997;68: Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 1927;14: American Fertility Society. The American Fertility Society classification of endometriosis. Fertil Steril 1997;67: Vercellini P, Aimi G, de Giorgi O, Maddalena S, Carinelli S, Crosignani PG. Is cystic ovarian endometriosis an asymmetric disease? Br J Obstet Gynaecol 1998;105: Ghezzi F, Beretta P, Franchi M, Parissis M, Bolis P. Recurrence of ovarian endometriosis and anatomical location of the primary lesion. Fertil Steril 2001;75: Buchweitz O, Staebler A, Tio J, Kiesel L. Detection of peritoneal endometriotic lesions by autofluorescence laparoscopy. Am J Obstet Gynecol 2006;195: Gaetje R, Holtrich U, Engels K, Kissler S, Rody A, Karn T, et al. Endometriosis may be generated by mimicking the ontogenetic development of the female genital tract. Fertil Steril 2007;87: Ishimaru T, Masuzaki H. Peritoneal endometriosis: endometrial tissue implantation as its primary etiologic mechanism. Am J Obstet Gynecol 1991;165: Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher- Lavenu MC, et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod 2006;21: Redwine DB. Ovarian endometriosis: a marker for more severe pelvic and intestinal disease. Fertil Steril 1999;73: Al-Fozan H, Tulandi T. Left lateral predisposition of endometriosis and endometrioma. Obstet Gynecol 2003;20: Parazzini F. Left:right side ratio of endometriotic implants in the pelvis. Eur J Obstet Gynecol Reprod Biol 2003;111:65 7. Fertility and Sterility â 61
Surgical management of peritoneal endometriosis. GKS koulutuspäivät Jaana Fraser PKSSK
Surgical management of peritoneal endometriosis GKS koulutuspäivät 24.9.2009 Jaana Fraser PKSSK Peritoneal endometriosis Tumor-like small lesions, located on the surface of peritoneum Diameter some millimeters
More informationClinical Case Reports: Open Access
Clinical Case Reports: Open Access Mini Review Vol 1 Iss 2 Surgical Management of Endometriosis- A Mini Review Kanika Chopra *, Debasis Dutta and Kanika Jain Department of Minimally Invasive Gynaecology,
More informationDefinition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the uterus.
Dept. of Obstetrics t and Gynecology Faculty of Medicine University of Sumatera Utara Endometriosis Definition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the
More informationMANAGEMENT OF REFRACTORY ENDOMETRIOSIS
(339) MANAGEMENT OF REFRACTORY ENDOMETRIOSIS Serdar Bulun, MD JJ Sciarra Professor and Chair Department of Ob/Gyn Northwestern University ENDOMETRIOSIS OCs Teenager: severe dysmenorrhea often starting
More informationLaparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery
Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery Luigi Fedele, M.D., a Stefano Bianchi, M.D., a Giovanni Zanconato, M.D., c Nicola Berlanda, M.D.,
More informationA prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas
FERTILITY AND STERILITY VOL. 82, NO. 6, DECEMBER 2004 Copyright 2004 American Society for Reproductive Medicine ublished by Elsevier Inc. rinted on acid-free paper in U.S.A. A prospective, randomized study
More informationFDG-PET value in deep endometriosis
Gynecol Surg (2011) 8:305 309 DOI 10.1007/s10397-010-0652-6 ORIGINAL ARTICLE FDG-PET value in deep endometriosis A. Setubal & S. Maia & C. Lowenthal & Z. Sidiropoulou Received: 3 December 2010 / Accepted:
More informationCNGOF Guidelines for the Management of Endometriosis
CNGOF Guidelines for the Management of Endometriosis Anatomoclinical forms of endometriosis Definitions Endometriosis is defined as the presence of endometrial tissue containing both glands and stroma
More informationCritical Appraisal of Endometriosis Management for Pain and Subfertility
Critical Appraisal of Endometriosis Management for Pain and Subfertility N. F. Zuberi,J. H. Rizvi ( Department of Obstetrics and Gynaecology, The Aga Khan University, Karachi. ) Introduction Endometriosis
More informationEndometriosis. What you need to know. 139 Dumaresq Street Campbelltown Phone Fax
Endometriosis What you need to know 139 Dumaresq Street Campbelltown Phone 4628 5292 Fax 4628 0349 www.nureva.com.au September 2015 What is Endometriosis? Endometriosis is a condition whereby the lining
More informationEndometriosis. Assoc.Prof.Pawin Puapornpong, Faculty of Medicine, Srinakharinwirot University.
Endometriosis Assoc.Prof.Pawin Puapornpong, Faculty of Medicine, Srinakharinwirot University. Endometriosis Definition: Ectopic Endometrial Tissue True Incidence Unknown:? 1-5% Does NOT Discriminate by
More informationMoneli Golara Consultant Obstetrician and Gynaecologist Barnet Hospital Royal Free NHS Trust
Moneli Golara Consultant Obstetrician and Gynaecologist Barnet Hospital Royal Free NHS Trust Endometriosis one of the most common conditions requiring treatment Growth of endometrial like tissue outside
More informationLaparoscopy and Endometriosis: Preventing Complications and Improving Outcomes. Luis C. Paez M.D.
Laparoscopy and Endometriosis: Preventing Complications and Improving Outcomes Luis C. Paez M.D. Assumptions Pelvic pain Not desiring immediate fertility H & P suggest endometriosis OC/NSAID failures Endo
More informationDeep and superficial endometriotic disease: the response to radical laparoscopic excision in the treatment of chronic pelvic pain
Gynecol Surg () 3: 99 DOI./s39--- ORIGINAL ARTICLE S. Banerjee. K. D. Ballard. D. P. Lovell. J. Wright Deep and superficial endometriotic disease: the response to radical laparoscopic excision in the treatment
More informationEndometriosis of the ureter and bladder are not associated diseases
ENDOMETRIOSIS Endometriosis of the ureter and bladder are not associated diseases Mauricio Simoes Abrao, M.D., Ph.D., a,b Joao Antonio Dias, Jr, M.D., a,b Patrick Bellelis, M.D., a Sergio Podgaec, M.D.,
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationDepartment of Obstetrics and Gynaecology, Royal Surrey County Hospital, Guildford, United Kingdom
FERTILITY AND STERILITY Vol. 62, No.4, October 1994 Copyright c 1994 The American Fertility Society Printed on acid-free paper in U. S. A. Prospective, randomized, double-blind, controlled trial of laser
More informationThe Use of GnRH Agonists in the Treatment of Endometriomas With or Without Drainage
The Use of GnRH Agonists in the Treatment of Endometriomas With or Without Drainage Pages with reference to book, From 30 To 32 Sertac Batioglu, Havva Celikkanat, Mustafa Ugur, Leyla Mollamahmutoglu, Huseyin
More informationEndometriosis. *Chocolate cyst in the ovary
Endometriosis What is endometriosis? Endometriosis is a common condition in young women. It's chronic, painful, and it often progressively gets worse over the time. *Chocolate cyst in the ovary Normally,
More informationRenato Seracchioli, M.D., Mohamed Mabrouk, M.D., Clarissa Frasca, M.D., Linda Manuzzi, M.D., Luca Savelli, M.D., and Stefano Venturoli, M.D.
Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial Renato Seracchioli, M.D., Mohamed Mabrouk, M.D.,
More informationunderstanding endometriosis Authored by Dr KT Subrayen Sponsored by
understanding endometriosis Authored by Dr KT Subrayen Sponsored by in this booklet What is Endometriosis? 1 What causes Endometriosis? 3 What does Endometriosis look like? 4 Common symptoms of Endometriosis
More informationSurgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation
Surgical treatment of endometriosis: a prospective randomized double-blinded trial comparing excision and ablation Martin Healey, M.D., W. Catarina Ang, M.B., B.S., and Claudia Cheng, M.B., B.S. Royal
More informationDoes Helica treatment of early endometriosis confer short- and long-term benefits in terms of pain relief and sub-fertility?
Gynecol Surg (2013) 10:213 217 DOI 10.1007/s10397-013-0803-7 ORIGINAL ARTICLE Does Helica treatment of early endometriosis confer short- and long-term benefits in terms of pain relief and sub-fertility?
More informationDifference Between PCOS and Endometriosis
Difference Between PCOS and Endometriosis www.differencebetween.com Key Difference PCOS vs Endometriosis Ovaries play an important role in the reproduction and the maintenance of the female body. They
More informationSurgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
Page: 1 of 7 Last Review Status/Date: June 2015 for Primary and Secondary Dysmenorrhea Description Two laparoscopic surgical approaches are proposed as adjuncts to conservative surgical therapy for the
More informationPosterior Deep Endometriosis. What is the best approach? Posterior Deep Endometriosis. Should we perform a routine excision of the vagina??
Posterior Deep Endometriosis What is the best approach? Dept Gyn Obst Polyclinique Hotel Dieu CHU Clermont Ferrand France Posterior Deep Endometriosis Organs involved - Peritoneum - Uterine cervix -Rectum
More informationSurgical treatment of deep endometriosis and risk of recurrence
Journal of Minimally Invasive Gynecology (2005) 12, 508-513 Surgical treatment of deep endometriosis and risk of recurrence Michele Vignali, MD, Stefano Bianchi, MD, Massimo Candiani, MD, Giovanna Spadaccini,
More informationPre and post surgical medical therapy. Mauro Busacca M.D. Dept of Obstetrics and Gynecology University of Milan- Italy
Pre and post surgical medical therapy Mauro Busacca M.D. Dept of Obstetrics and Gynecology University of Milan- Italy introduction A disease is an open problem when two conditions are nor satisfied: The
More informationKissing ovaries : a sonographic sign of moderate to severe endometriosis
Kissing ovaries : a sonographic sign of moderate to severe endometriosis Fabio Ghezzi, M.D., a Luigi Raio, M.D., b Antonella Cromi, M.D., a Daniela Günter Duwe, M.D., b Paolo Beretta, M.D., a Marco Buttarelli,
More informationIs the endometriosis recurrence rate increased after ovarian hyperstimulation?
Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Thomas M. D Hooghe, M.D., Ph.D., Bénédicte Denys, M.D., Carl Spiessens, Ph.D., Christel Meuleman, M.D., and Sophie Debrock,
More information1 2 Infertile women are seven to ten times more likely to have endometriosis than their fertile 3 The mechanism by which endometriosis develops is unknown Theories for the histogenesis of endometriosis
More informationBy Surgery traditionally has been a mainstay
Endometriosis: does surgery make a difference? There appears to be value in treating pain and infertility, yet it may be far less than anticipated. Here, the author reviews various techniques. By Surgery
More informationSurgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea Policy Number: 4.01.17 Last Review: 11/2013 Origination: 11/2007 Next Review: 11/2014 Policy Blue Cross and Blue Shield
More informationPalm Beach Obstetrics & Gynecology, PA
Palm Beach Obstetrics & Gynecology, PA 4671 S. Congress Avenue, Lake Worth, FL 33461 561.434.0111 4631 N. Congress Avenue, Suite 102, West Palm Beach, FL 33407 Endometriosis The lining of the uterus is
More informationSurgical Management of Endometriosis associated Infertility
Surgical Management of Endometriosis associated Infertility Dr. Ingrid Lok Specialist in Obstetrics and Gynaecology (Honorary Clinical Associate Professor, CUHK) HA commission training 24.2.2014 Endometriosis
More informationA multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of
A multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of Endometrioma and deep infiltrating endometriosis Professor C. Chapron and the Group
More informationInvestigations and management of severe endometriosis
Investigations and management of severe endometriosis Dr Jim Tsaltas Head of Gynaecological Endoscopy and Endometriosis Surgery Monash Health Monash University Dept of O&G Melbourne IVF Freemasons Hospital
More informationSurgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea. Original Policy Date
MP 4.01.10 Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea Medical Policy Section OB/Gyn/Reproduction Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date
More informationPELVIC PERITONEAL DEFECTS AND ENDOMETRIOSIS: ALLEN-MASTERS SYNDROME REVISITED
FERTU.ITY AND STERILITY Copyright " 1981 The American Fertility Society Vol. 36, No. 6, December 1981 Printed in U.S A. PELVIC PERITONEAL DEFECTS AND ENDOMETRIOSIS: ALLEN-MASTERS SYNDROME REVISITED DONALD
More informationResults of implication of aromatase inhibitors in therapy of genital endometriosis Yarmolinskaya M. (Speaker), Bezhenar V., Molotkov A.
Results of implication of aromatase inhibitors in therapy of genital endometriosis Yarmolinskaya M. (Speaker), Bezhenar V., Molotkov A. Ott's Research Institute of Obstetrics, Gynecology and Reproductology,
More informationBy: Dr. Safoura Rouholamin
By: Dr. Safoura Rouholamin Introduction Endometriosis as an enigmatic disease is most commonly found on the ovaries and presents with pelvic pain and infertility. laparoscopic stripping has been introduced
More informationChapter 3. Renato Seracchioli Mohamed Mabrouk Clarissa Frascà Linda Manuzzi Luca Savelli Stefano Venturoli Fertil Steril Jul; 94(2):
Chapter 3 Long-term oral contraceptive pills and postoperative pain management after laparoscopic excision of ovarian endometrioma: a randomized controlled trial Renato Seracchioli Mohamed Mabrouk Clarissa
More informationEndometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد
Endometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد Objectives:- To know what is endometriosis The sites where it occur To explain its itiology & pathogenesis To know the clinical features
More informationLong-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial
Long-term cyclic and continuous oral contraceptive therapy and endometrioma recurrence: a randomized controlled trial Renato Seracchioli, M.D., Mohamed Mabrouk, M.D., Clarissa Frasca, M.D., Linda Manuzzi,
More informationEndometriosis an Enigma- Review Article
Volume 2 Issue 1 2018 Page 212 to 217 Editorial Gynaecology and Perinatology ISSN: 2576-8301 Endometriosis an Enigma- Review Article Dr. Sreelatha S 1 *, Dr. Shruthi A 2, Dr. Vandana Ambastha 2, Dr. Asha
More informationEndometriosis A new look at an old disease
Endometriosis A new look at an old disease Cindy M Mosbrucker MD Franciscan Womens Health, Urogynecology and Pelvic Surgery Gig Harbor, WA 1 My Background Northwestern University Med School 1990 Residency
More informationTheFormationofaScoringSystemtoDiagnoseEndometriosis. The Formation of a Scoring System to Diagnose Endometriosis
Global Journal of Medical Research: E Gynecology and Obstetrics Volume 18 Issue 1 Version 1.0 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Online ISSN: 49-4618
More informationSOUTH AFRICAN GUIDELINE FOR TREATMENT OF ENDOMETRIOSIS
SOUTH AFRICAN GUIDELINE FOR TREATMENT OF ENDOMETRIOSIS SASREG PUBLICATION Recommended treatment protocols for the South African patient population based on the European Society of Human Reproduction and
More informationEndometriosis - MRI findings with anatomic-pathologic correlation
Endometriosis - MRI findings with anatomic-pathologic correlation Poster No.: C-2551 Congress: ECR 2015 Type: Educational Exhibit Authors: E. Matos, A. T. Almeida, A. Sanches; Vila Nova de Gaia/PT Keywords:
More informationADENOMYOSIS CHRONIC PELVIC PAIN IN WOMEN IMAGING CHRONIC PELVIC PAIN IN WOMEN CHRONIC PELVIC PAIN IN WOMEN ADENOMYOSIS: PATHOLOGY ADENOMYOSIS
CHRONIC PELVIC PAIN IN WOMEN IMAGING CHRONIC PELVIC PAIN IN WOMEN MOSTAFA ATRI, MD Dipl. Epid. UNIVERSITY OF TORONTO Non-menstrual pain of 6 months Prevalence 15%: 18-50 years of age 10-40% of gynecology
More informationCONSERVATIVE TREATMENT OF ENDOMETRIOSIS: THE EFFECTS OF LIMITED SURGERY AND HORMONAL PSEUDOPREGNANCY*t
SCIENTIFIC ARTICLES FERTILITY AND STERILITY Copyright c 1976 The American Fertility Society Vol. 27, No.7, July 1976 Printed in U.S.A. CONSERVATIVE TREATMENT OF ENDOMETRIOSIS: THE EFFECTS OF LIMITED SURGERY
More informationPublic Statement: Medical Policy Statement: Background:
ARBenefits Approval: 10/12/2011 Effective Date: 01/01/2012 Revision Date: Code(s): 58578, unlisted laparoscopy procedure, uterus Medical Policy Title: Surgical Interruption of Pelvic Nerve Pathways for
More informationClinica Ostetrica e Ginecologica I, Istituto Luigi Mangiagalli, University of Milano, Milan, Italy
FERTILITY AND STERILITY VOL. 80, NO. 2, AUGUST 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Comparison of a levonorgestrel-releasing
More informationCoexistence of Endometriosis and Uterine Dysfunction in Infertile Women
Coexistence of Endometriosis and Uterine Dysfunction in Infertile Women Ludwig Kiesel University of Münster Department of Gynecology and Obstetrics Münster, Germany Symptoms: Risk of Endometriosis Compared
More informationEndometriosis: Endometriosis. Overview 2/24/19. Systematic approach to scanning for deep infiltrating endometriosis
Endometriosis Endometriosis: Superficial endometriosis Ovarian endometrioma Deep infiltrating endometriosis (DIE) TVS is an accurate and reliable diagnostic tool for diagnosing DIE Diagnostic performance
More informationENDOMETRIOSIS When and how to implement treatment
ENDOMETRIOSIS When and how to implement treatment Francisco Carmona Hospital Clínic ENDOMETRIOSIS TREATMENT It depends on the severity of symptoms the patient's desire for pregnancy the extent of disease
More informationEndometriosis Information Leaflet
Endometriosis Information Leaflet What is Endometriosis? Endometriosis is a condition where tissue similar to the lining of the womb (endometrium) is found outside the womb. About 1 out of 10 women of
More informationLaparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection
FERTILITY AND STERILITY VOL. 76, NO. 2, AUGUST 2001 Copyright 2001 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Laparoscopic treatment
More informationSmita Jain, M.B., M.S.* and Maureen E. Dalton, F.R.C.O.G. Sunderland Royal Hospital, Sunderland, Tyne and Wear, United Kingdom
ENDOMETRIOSIS FERTILITY AND STERILITY VOL. 72, NO. 5, NOVEMBER 1999 Copyright 1999 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. Chocolate
More informationA Rare Presentation of Endometriosis with Recurrent Massive Hemorrhagic Ascites which Can Mislead
Case Report INTERNATIONAL JOURNAL OF WOMEN'S HEALTH AND REPRODUCTION SCIENCES http://www.ijwhr.net A Rare Presentation of Endometriosis with Recurrent Massive Hemorrhagic Ascites which Can Mislead Article
More informationChronic Pelvic Pain. Bridget Kamen, MD Obstetrics and Gynecology, Confluence Health. I have no disclosures
Chronic Pelvic Pain Bridget Kamen, MD Obstetrics and Gynecology, Confluence Health I have no disclosures Objectives A little epidemiology Understand there are both gynecologic and non-gynecologic causes
More informationENDOSCOPIC MANAGEMENT OF A URETERAL OBSTRUCTION CAUSED BY ENDOMETRIOSIS: A CASE REPORT
ENDOSCOPIC MANAGEMENT OF A URETERAL OBSTRUCTION CAUSED BY ENDOMETRIOSIS: A CASE REPORT Hsu-Cheng Juan, 1 Hsin-Chih Yeh, 1 Hsi-Lin Hsiao, 1 Shean-Fang Yang, 2 and Wen-Jeng Wu 1,3 Departments of 1 Urology
More informationSurgery of symptomatic DIE is required
Laparoscopic treatment of deeply infiltrating endometriosis i ESRHE 27/11/2009 Leuven M Nisolle, J Dequesne, C Innocenti, JM Foidart University of Liège,Belgium Deep infiltrating endometriosis Rectovaginal
More informationManaging infertility when adenomyosis and endometriosis co-exist
Managing infertility when adenomyosis and endometriosis co-exist Jinhua Leng Beijing,China Endometriosis Endometriosis (EM) is a common, benign, ovary hormone-dependent gynecologic disorder which affects
More informationCase 9539 Endometriosis in the canal of Nuck
Case 9539 Endometriosis in the canal of Nuck Monteiro V, Cunha TM Section: Genital (Female) Imaging Published: 2011, Sep. 27 Patient: 26 year(s), female Authors' Institution V Monteiro 1 TM Cunha 2 1 Unidade
More informationPost-operative use of oral contraceptive pills for prevention of anatomical relapse or symptomrecurrence after conservative surgery for endometriosis
Human Reproduction, Vol.24, No.11 pp. 2729 2735, 2009 Advanced Access publication on July 22, 2009 doi:10.1093/humrep/dep259 ORIGINAL ARTICLE Gynaecology Post-operative use of oral contraceptive pills
More informationMinimal Access Surgery in Gynaecology
Gynaecology & Fertility Information for GPs August 2014 Minimal Access Surgery in Gynaecology Today, laparoscopy is an alternative technique for carrying out many operations that have traditionally required
More informationThe many faces of Endometriosis
The many faces of Endometriosis Beryl Benacerraf M.D Harvard Medical School What is Endometriosis? Endometriosis is defined as the presence of normal endometrial tissue occurring outside of the endometrial
More informationImpact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles
1 st SEUD Meeting, 9 May 2015, Paris, France Impact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles ENDOMETRIOSIS ovarian endometrioma
More informationEthicon Women s Health & Urology eclinical Compendium Article Summary
Ethicon Women s Health & Urology eclinical Compendium Article Summary Title Postoperative Adhesion Prevention With an Oxidized Regenerated Cellulose Adhesion Barrier in Infertile Women Author(s) Sawada
More informationFERTILITY SPARING IN ENDOMETRIAL CANCER
FERTILITY SPARING IN ENDOMETRIAL CANCER Prof. Dr. Bülent Özçelik Erciyes University Medical Faculty Department of Obstetrics and Gynecology Gynecologic Oncology Unit Endometrial Cancer Most frequent gynecologic
More informationMalignant Transformation from Endometriosis to Atypical Endometriosis and Finally to Endometrioid Adenocarcinoma within 10 Years
Published online: September 21, 2013 1662 6575/13/0063 0480$38.00/0 This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC)
More informationReview Surgical management of endometriosis
The Obstetrician & Gynaecologist 10.1576/toag.9.3.147.27333 www.rcog.org.uk/togonline 2007;9:147 152 Review Review Surgical management of endometriosis Authors Nicholas Kenney / James English Key content:
More informationPelvic Pain: Overlooked
EDUCATION EXHIBIT 3 Pelvic Pain: Overlooked and Underdiagnosed Gynecologic Conditions 1 CME FEATURE See accompanying test at http:// www.rsna.org /education /rg_cme.html LEARNING OBJECTIVES FOR TEST 1
More informationClear cell carcinoma arising from abdominal wall endometriosis: a unique case with bladder and lymph node metastasis
Liu et al. World Journal of Surgical Oncology 2014, 12:51 WORLD JOURNAL OF SURGICAL ONCOLOGY CASE REPORT Open Access Clear cell carcinoma arising from abdominal wall endometriosis: a unique case with bladder
More information2 Philomeen Weijenborg, Moniek ter Kuile and Frank Willem Jansen.
Adapted from Fertil Steril 2007;87:373-80 Intraobserver and interobserver reliability of videotaped laparoscopy evaluations for endometriosis and adhesions 2 Philomeen Weijenborg, Moniek ter Kuile and
More informationEndometriosis and Infertility - FAQs
Published on: 8 Apr 2013 Endometriosis and Infertility - FAQs Introduction The inner lining of the uterus is called the endometrium and it responds to changes that take place during a woman's monthly menstrual
More informationPREGNANCY AND RECURRENCE RATES IN INFERTILE PATIENTS OPERATED FOR OVARIAN ENDOMETRIOSIS
Rev. Med. Chir. Soc. Med. Nat., Iaşi 2015 vol. 119, no. 1 SURGERY ORIGINAL PAPERS PREGNANCY AND RECURRENCE RATES IN INFERTILE PATIENTS OPERATED FOR OVARIAN ENDOMETRIOSIS Monica Holicov Luţuc 1, D. Nemescu
More informationEndometriosis: Correlation of Severity of Pain with Stages of Disease
Journal of Bangladesh College of Physicians and Surgeons Vol. 34, No. 3, July 2016 Endometriosis: Correlation of Severity of Pain with Stages of Disease TS CHOWDHURY a, N MAHMUD b, TA CHOWDHURY c Summary:
More informationVaginal parturition decreases recurrence of endometriosis
Vaginal parturition decreases recurrence of endometriosis Carlo Bulletti, M.D., a Anna Montini, Ph.D., b Paolo Levi Setti, M.D., c Antonio Palagiano, M.D., d Filippo Ubaldi, M.D., e and Andrea Borini,
More informationEffect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain
Original Article Effect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain Murat Api, M.D., Ph.D., Aysen Telce Boza, M.D.*, Semra Kayatas, M.D., Mustafa Eroglu, M.D. Zeynep Kamil
More informationThe AAGL Classification System for Laparoscopic Hysterectomy
February 2000, Vol. 7, No. 1 The Journal of the American Association of Gynecologic Laparoscopists The AAGL Classification System for Laparoscopic Hysterectomy All portions in quotation marks are taken
More informationEndometriosis-associated pelvic pain: evidence for an association between the stage of disease and a history of chronic pelvic pain*
F ERTILITY AND STERILITY Copyright " 1997 American Society for Reproductive Medicine Published by Elsevier Science Inc. Vo!. 68, No. 1, J uly 1997 Printed on acid -free paper in U. S. A. Endometriosis-associated
More informationInitial evaluation of the use of the potassium-titanyl-phosphate (KTP/532)* laser in gynecologic laparoscopy
-- FERTU.JTY AND STERILITY Copyright c 1986 The American Fertility Society Printed in U.SA. Initial evaluation of the use of the potassium-titanyl-phosphate (KTP/532)* laser in gynecologic laparoscopy
More informationRisk of appendiceal endometriosis among women with deep-infiltrating. Gynecology, University of North Carolina, Chapel Hill, NC, USA
Article Type: Clinical Article Subheading: Gynecology Risk of appendiceal endometriosis among women with deep-infiltrating endometriosis Janelle K. Moulder 1, *,, Matthew T. Siedhoff 2, Kathryn L. Melvin
More informationWhat is Endometriosis?
What is Endometriosis? Obstetrics & Gynaecology Women & Children s Services This leaflet has been designed to give you important information about your condition / procedure, and to answer some common
More informationMYOMA of UTERUS. By Zhengyu Li M.D. GYN/OB Department West China Second Univ. Hospital, S.U.
MYOMA of UTERUS By Zhengyu Li M.D GYN/OB Department West China Second Univ. Hospital, S.U. zhengyuli@scu.edu.cn General Consideration Benign neoplasms composed primarily of smooth muscle. Most common solid
More informationAnalysis of risk factors for the removal of normal ovarian tissue during laparoscopic cystectomy for ovarian endometriosis
Human Reproduction, Vol.24, No.6 pp. 1402 1406, 2009 Advanced Access publication on February 26, 2009 doi:10.1093/humrep/dep043 ORIGINAL ARTICLE Gynaecology Analysis of risk factors for the removal of
More informationMenstrual characteristics in Korean women with endometriosis: a pilot study
Original Article Obstet Gynecol Sci 2018;61(1):142-146 https://doi.org/10.5468/ogs.2018.61.1.142 pissn 2287-8572 eissn 2287-8580 Menstrual characteristics in Korean women with endometriosis: a pilot study
More informationLong-term follow-up of patients surgically treated for ruptured ovarian endometriotic cysts
Available online at www.sciencedirect.com Taiwanese Journal of Obstetrics & Gynecology 50 (2011) 306e311 Original Article Long-term follow-up of patients surgically treated for ruptured ovarian endometriotic
More informationEndometriosis: An Overview
Endometriosis: An Overview www.bcwomens.ca Welcome to the BC Women s Centre for Pelvic Pain and Endometriosis. This handout will give you some basic information about endometriosis. It will also explain
More informationEndoscopic versus laparotomy management of endometriomas*
FERTILITY AND STERILITY Copyright e 1994 The American Fertility Society Printed on acid-free paper in U. S. A. Endoscopic versus laparotomy management of endometriomas* Bruce G. Bateman, M.D.t:j: Lisa
More informationThe accomplished gynecologic surgeon
For mass reproduction, content licensing and permissions contact Dowden Health Media. SURGICAL TECHNIQUES THE RETROPERITONEAL SPACE Keeping vital structures out of harm s way Knowledge of the retroperitoneal
More informationEndometriosis of the Appendix Resulting in Perforated Appendicitis
27 Endometriosis of the Appendix Resulting in Perforated Appendicitis Toru Hasegawa a Koichi Yoshida b Kazuhiro Matsui c a Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama,
More information(BMI)=18.0~24.9 kg/m 2 ;
33 10 Vol.33 No.10 2013 10 Oct. 2013 Reproduction & Contraception doi: 10.7669/j.issn.0253-357X.2013.10.0672 E-mail: randc_journal@163.com - ( 400013) : () GnRH-a - () : IVF- ET 233 A (I~II 102 ) B (III~IV
More informationEndometriosis: Unveiling the contemporary issues in diagnosis and treatment
Annals of Health Research Volume 4, Issue No 1: 1-6 January-June 2018 DOI: 10.30442/ahr.0401-1-01 ORIGINAL RESEARCH Endometriosis: Unveiling the contemporary issues in diagnosis and treatment Fabamwo AO*,
More informationOriginal Article. Abstract
Original Article Frequency of endometriosis among infertile women and association of clinical signs and symptoms with the Laparoscopic staging of Endometriosis Urooj Bakht Khawaja, 1 Ameer Ali Khawaja,
More informationLaparoscopic Morcellation of Didelphic Uterus With Cervical and Renal Aplasia
CASE REPORT Laparoscopic Morcellation of Didelphic Uterus With Cervical and Renal Aplasia Albert Altchek, MD, Michael Brodman, MD, Peter Schlosshauer, MD, Liane Deligdisch, MD ABSTRACT This is a case report
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablation in uterine leiomyoma management, 719 723 Adnexal masses diagnosis of, 664 667 imaging in, 664 665 laboratory studies in, 665
More informationDiagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis
Ultrasound Obstet Gynecol 2009; 34: 595 600 Published online 14 October 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.7356 Diagnostic accuracy and potential limitations of transvaginal
More information