Diaphragmatic Endometriosis—A Single-Center Retrospective Analysis of the Patients’ Demographics, Symptomatology, and Long-Term Treatment Outcomes

Abstract

Diaphragmatic endometriosis is rare and forms 0.67–4.7% of all endometriosis cases. Evidence regarding its optimal management is lacking. In this study, we retrospectively analyzed the patient characteristics and long-term treatment outcomes of diaphragmatic endometriosis patients. Over a 4-year period, 23 patients were diagnosed with diaphragmatic endometriosis. The majority of patients had coexisting deep pelvic endometriosis. Cyclic upper abdominal pain was reported by 60.9% of patients, while cyclic chest and shoulder pain were reported by 43.5% and 34.8% of patients, respectively. Most patients were treated with laparoscopic lesion ablation, while 21.1% were treated with minimally invasive excision. The mean follow-up time was 23.7 months. Long-lasting resolution of the chest, abdominal, and shoulder pain occurred in 50%, 35.7%, and 25% of patients, respectively. Nonetheless, 78.9% of patients reported major improvement in their symptoms postoperatively. Significantly higher rates of postoperative shoulder, abdominal, and chest pain were observed in patients who received postoperative hormonal therapy compared with those who did not. All patients treated expectantly remained stable. Therefore, we recommend treating diaphragmatic endometriosis only in symptomatic patients. The risk of incomplete surgery should be minimized by a multidisciplinary diagnostic and therapeutic approach with a careful assessment of the diaphragm and the thoracic cavity.

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“…The exact incidence and prevalence of diaphragmatic endometriosis are unknown precisely yet. However, the prevalence of diaphragmatic endometriosis was reported to be 1.86–4.7% ( 55 ). The preoperative diagnosis is difficult and the management remains controversial ( 45 , 46 , 55 , 56 ).…”

“…However, the prevalence of diaphragmatic endometriosis was reported to be 1.86–4.7% ( 55 ). The preoperative diagnosis is difficult and the management remains controversial ( 45 , 46 , 55 , 56 ). It may cause catamenial symptoms or chronic pain.…”

“…However, it should be noted that in a recent study of Naem et al ( 55 ) patients with diaphragmatic endometriosis were followed up for a mean duration of 23 months. Although 78.9% of patients reported major postoperative improvement, the postoperative recurrence rates of diaphragmatic endometriosis-related symptoms were higher than expected, with complete pain relief being reported in 25–50% of patients.…”

“…Although 78.9% of patients reported major postoperative improvement, the postoperative recurrence rates of diaphragmatic endometriosis-related symptoms were higher than expected, with complete pain relief being reported in 25–50% of patients. On the other hand, asymptomatic lesions that were left in situ remained asymptomatic after a follow up period of 6–14 months ( 55 ). Therefore, caution should be made before operating diaphragmatic endometriosis, especially in the asymptomatic cases, where treatment seems to be unnecessary, and appropriate patient counseling about what to exactly expect postoperatively should be carried out ( 55 , 64 ).…”

“…On the other hand, asymptomatic lesions that were left in situ remained asymptomatic after a follow up period of 6–14 months ( 55 ). Therefore, caution should be made before operating diaphragmatic endometriosis, especially in the asymptomatic cases, where treatment seems to be unnecessary, and appropriate patient counseling about what to exactly expect postoperatively should be carried out ( 55 , 64 ).…”