Objective The aim of the present study was to compare post-operative complications and recurrence of three surgical techniques: segmental resection, discoid excision and nodule shaving. Study design From January 2014 to December 2017, 143 patients who underwent segmental bowel resections for endometriosis at “La Paz” University Hospital, were enrolled and grouped by different techniques. We compared post-operative complications and recurrence rate in three groups: 76 (53%) patients underwent segmental resection (group I), 20 (14%) patients underwent discoid resection (group II) and 47 (33%) patients underwent rectal shaving (group III). Qualitative data was defined by absolute values and percentages, and quantitative data by mean and standard deviation. Qualitative variables between groups were compared using Chi- squared test. While quantitative data between groups was performed by means of t -test and ANOVA test. For all statistical tests a value of p < 0.05 will be considered statistically significant. Result Segmental resection was associated with higher rate of severe post-operative complications in comparison with discoid resection or shaving technique (23.5% versus 5% versus 0% respectively) (p = 0.005). We showed statistical differences among the three study groups for nodule size (p < 0.001) and localization (p = 0.02). Our analysis showed statistical differences among the three groups in term of additional procedures performed at the same time of bowel surgery, in particular in case of endometriosis of the ureter (p = 0.001) and the parametrium (p = 0.04). After a long follow-up (46.4 ± 0.5 months for the group I, 42.2 ± 1.6 months for the group II, 39.7 ± 1.8 months for the group III), the shaving group was associated to higher recurrence rate (12.7%) in comparison with the discoid group (5%) and the segmental resection group (1.3%) (p = 0.01). Conclusion We showed that segmental resection is associated with high rate of postoperative complications. Conversely, this strategy should avoid the need of further interventions in young patients. Conservative surgery, such as discoid resection and shaving, revealed a higher recurrence rate and could be more appropriate in women approximating menopause because of the lower possibility of recurrence.

It has been suggested that in doubtful cases of coeliac disease, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte count increases the likelihood of coeliac disease. Aim: To evaluate the diagnostic accuracy of both an isolated increase of TCRγδ + cells and a coeliac lymphogram (increase of TCRγδ + plus decrease of CD3 − intraepithelial lymphocytes) evaluated by flow cytometry in the diagnosis of coeliac disease. Methods: The literature search was conducted in MEDLINE and EMBASE. The inclusion criteria were: an article that allows for the construction of a 2 × 2 table of true and false positive and true and false negative values. A diagnostic accuracy test meta-analysis was performed. Results: The search provided 49 relevant citations, of which 6 were selected for the analysis, which represented 519 patients and 440 controls. Coeliac lymphogram: The pooled S and Sp were 93% and 98%, without heterogeneity. The area under the SROC curve (AUC) was 0.98 (95% CI, 0.97-0.99). TCRγδ + : Pooled S and Sp were both 95%, with significant heterogeneity. The AUC was 0.97 (95% CI, 0.95-0.98). Conclusions: Both TCRγδ + count and coeliac lymphogram assessed by flow cytometry in duodenal mucosal samples are associated with a high level of diagnostic accuracy for and against coeliac disease.In addition, the overlap between patients with non-coeliac gluten sensitivity and CD patients with a Marsh type I lesion becomes evident and makes differential diagnosis quite difficult [9,10]. Increasingly, clinicians face the challenge of making a diagnosis of patients who choose to live without gluten, without a previous diagnosis of CD. This is challenging, since both the serology and histology of the small intestine are normalized in patients with CD on a gluten-free diet (GFD). In these circumstances, HLA genotyping is of value, since CD is extremely improbable in patients who are HLA-DQ2/8 negative, though it is insufficient in HLA-DQ2/8 positive patients, since 30-40% of the healthy population are also positive.Other diagnostic approaches beyond conventional histology and serology have been introduced for the diagnosis of CD [11]. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for the Study of Coeliac Disease (ESsCD) guidelines suggest that in doubtful cases, a high CD3 + T-cell receptor gamma delta + (TCRγδ + ) intraepithelial lymphocyte (IEL) count increases the likelihood of CD diagnosis [4,5]. IELs are increased in the mucosa of untreated coeliac patients. In general, these IELs are CD3 + αβ + T-cell-receptor-bearing cells. However, 20-30% of CD3 + IELS are γδ + T-cell-receptor-bearing cells in CD, which comprise fewer than 10% of the IELs in non-coeliac subjects [12]. TCRγδ + IELs are considered to be highly sensitive and specific for CD, and, furthermore, remain elevated despite a GFD [13][14][15]. Non-T-cell CD3 − IELs are the second most abundant IEL subset in healthy mucosa. CD3 − IELs comprise heterogeneous phenotypes, of which the...

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Variability in symptoms hinders diagnosis. The gold standard for diagnosis is MRI, but clinical suspicion optimizes imaging test diagnosis. Segmental resection should be indicated in the majority of the cases.

Our aim was to study the advantages, complications and obstetrical outcomes of laparoscopic myomectomy (LM) compared with abdominal myomectomy (AM). We conducted a retrospective cohort study at La Paz University Hospital that included LMs and AMs performed between 2012 and 2018, analyzing 254 myomectomies (142 AMs [55.7%] and 112 LMs [43.9%]). The mean number of fibroids was 1.8 ± 1.5 and 3 ± 2.9 for the LM and AM groups, respectively (p &lt; 0.006). The mean size of the largest myoma was 7.6 cm ± 2.7 cm and 10.2 cm ± 5.4 cm for the LM and AM groups, respectively (p &lt; 0.001). LMs were associated with longer surgical times (p &lt; 0.001) and shorter hospitalizations (p = 0.001). There were no significant differences in the intraoperative and postoperative complication rates (p = 0.075 and p = 0.285 for LM and AM, respectively). The subsequent pregnancy rate was higher for the LM group (30.8% vs. 16.8%, p = 0.009), with a vaginal delivery rate of 69% and no cases of uterine rupture.

ORIGINAL RESEARCH ARTICLE to 40% (5). Thus, sciatica and endometriosis are frequent pathologies and it is not uncommon for them to occur simultaneously. Endometriosis as the cause of sciatica by direct involvement of the sciatic nerve is extremely rare. This condition was first described by Denton and Sherrill (6). In relation to this issue, the most important thing is that neuropathy can occur over time, and because diagnosis is usually delayed for years, serious and often irreversible consequences that affect the quality of life of patients happen. We report our experience in the diagnosis, management and treatment of two cases of endometriosis with histologic confirmation affecting the sciatic nerve. Methods After patients' specific consent, we retrospectively reviewed the medical charts of all sciatic nerve endometriosis cases followed up at the Endometriosis Unit of La Paz University Hospital since 2006 to the present. We searched in our Unit of Endometriosis database and the inclusion criteria were: recurrent catamenial sciatica, in the absence of spinal pathology, MRI pointing to endometriosis as the cause of symptoms and

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ObjectiveAssess the surgeons' workload during deep endometriosis surgery after ureteral ICGDesignProspective, consecutive, comparative, single-center studyPopulation41 patients enrolled to deep endometriosis surgery with ureteral ICG from January 2019 to July 2021 at La Paz University HospitalMethodsPatients were divided into 2 groups: patients operated during the learning curve of ureteral ICG instillation and patients operated after the technique was implemented and routinely performed. After surgery, the SURG-TLX form was completed by the surgeons. We evaluated whether a workload reduction occurred.Main outcomes measuresSurgeon's workload was measured using the SURG-TLX form, obtaining the total workload and 6 different dimensions (distractions, temporal demands, task complexity, mental demands, situational stress and physical demands)ResultsA significant positive correlation was found between surgical complexity and situational stress (p = 0.04). Mental demands (p = 0.021), physical demands (p = 0.03), and total workload (p = 0.025) were significantly lower when the technique was routinely performed. The mental demand, physical demands, and total workload perceived by the surgeons at the beginning of the implementation was higher (68 [39–72], 27 [11–46.5], 229 [163–240], respectively) than in the latter ones (40 [9–63], 11.5 [0–32.8], 152 [133.3–213.8], respectively). Distractions appeared to be higher in the latter surgeries (8.5 [0–27.8]) than in the first surgeries (0 [0–7]; p = 0.057).ConclusionsUreter ICG instillation prior to DE surgery significantly reduces the mental and physical demands and total workload of the surgeons in DE surgeries after overcoming the learning curve. Distractions appear to increase as surgical stress decreases.