Objective: This article offers insight into an academic institute's approach to the rare phenomenon of abdominalwall endometriosis (AWE). The article also provides data on concurrent pelvic endometriosis, which has not often been assessed in previous studies. The aim here is to describe the characteristics and management of AWE at an academic institute. Materials and Methods: A retrospective chart review was conducted on 28 patients with pathologically confirmed AWE at an academic institute. Results: The most commonly reported symptoms were constant pain (19/28; 67.9%), cyclic pain (16/28; 57.1%), and palpable mass (16/28; 57.1%). All patients reported having had prior abdominal surgery. Preoperative imaging included 14 magnetic resonance imaging scans, 11 computed tomography scans, and 8 ultrasounds. Nine general surgery and 19 anesthesiology preoperative consultations occurred. AWE was found within 5 cm of a previous incision in 24 of 28 patients; these were 20 cesarean-section and 4 laparoscopic incisions. The average size of the lesions was 3.8 cm. Four patients required mesh and 26 patients underwent concurrent laparoscopy at the time of excision. Endometriosis and/or adenomyosis was noted in 25 patients (96.2%). Fifteen patients underwent regional anesthetic blocking. The average length of stay for these patients was 1158.3 versus 1705.7 minutes for those who did not. Conclusions: Pain and a mass at a previous surgical site warrants a workup for AWE. If AWE is suspected, one should consider laparoscopy for any patient with symptoms suggestive of pelvic endometriosis. Perioperative, regional anesthetic blocks should be also considered.
INTRODUCTION: Endometriosis affects up to 10% of reproductive-age women and is highly co-morbid with other chronic pain conditions. Clinical suspicion is high that narcotics may be used as a mainstay of treatment for many women with endometriosis or chronic pelvic pain. Very few data are available regarding rates of narcotic use in this population. METHODS: Data were obtained from a commercial insurance claims database from employee-sponsored health plans. 706,863 patients with endometriosis/chronic pelvic pain were identified as cases. 706,863 patients without endometriosis/CPP were identified as age- and state-matched controls. Rates of narcotic use were compared in the year prior to diagnosis and the two years subsequent to diagnosis. Use subsequent to diagnosis was further analyzed by stratification by use prior to diagnosis. RESULTS: Narcotic use was higher prior to diagnosis (31.3 vs 21.3%), subsequent to diagnosis (56.3 vs 34.5%), and at higher morphine-equivalent dosages in cases vs. controls. Patient with narcotic use prior to diagnosis were more prone to use after diagnosis (74.2 vs 57.1%). All p-values <0.001. CONCLUSION: In patients with endometriosis or chronic pelvic pain, the rates of narcotic use are high both before and after diagnosis. Rates increase substantially following diagnosis. Narcotics are associated with decreased functional status and quality of life. Alternative therapies should be exhausted prior to use of narcotics as a primary mode of analgesia in these patients.
INTRODUCTION: The Essure is most commonly removed by bilateral salpingectomy with cornual resection (BS-CR) or total laparoscopic hysterectomy with bilateral salpingectomy (TLH-BS); however, limited data exists on Essure removal. The purpose of this study is to evaluate the safety and efficacy of Essure removal via BS-CR and TLH-BS. METHODS: A retrospective chart review and follow-up patient survey were conducted at an academic institute of patients undergoing surgical removal of the Essure device via BS-CR or TLH-BS between 2014 and 2017. RESULTS: 58 patients underwent Essure removal-33 via BS-CR and 25 via TLH-BS. The mean operative time for BS-CR was 61 minutes vs. 70.5 minutes for TLH-BS. All procedures had an estimated blood loss of less than 50mL. There were no intraoperative complications. Mean length of stay for BS-CR was 572.6 minutes vs. 772.4 minutes for TLH-BS. Postoperatively, 1 patient who underwent BS-CR presented to the emergency room (ER) due to subjective fevers; no pathology was identified. One TLH-BS patient was admitted with vaginal cuff cellulitis, and one presented to the ER for vaginal bleeding without cuff separation/dehiscence. Satisfaction was noted in 30/32 (93.8%) patients who underwent BS-CR vs. 20/20 (100%) who underwent TLH-BS. Improved quality of life was reported in 29/32 (90.6%) of patients who underwent BS-CR vs. 19/20 (95.0%) who underwent TLH-BS. 31/32 (96.9%) patients who underwent BS-CR reported they would undergo removal again vs. 19/20 (95.0%) who underwent TLH-BS. CONCLUSION: Bilateral salpingectomy with cornual resection and TLH-BS are likely comparable methods for Essure removal, with overall high satisfaction.
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