Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options

Abstract

Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.

Anxiety and depression in patients with endometriosis: impact and management challenges

“…The diagnosis of endometriosis is traditionally based on laparoscopic inspection of the pelvis and should ideally be confirmed by histological examination of the excised lesions 7,16. The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), dysmenorrhea, dyspareunia and infertility 4. A significant proportion of women with endometriosis are asymptomatic, and the disease is often diagnosed during laparoscopic investigation due to other pelvic conditions 17,18.…”

“…A significant proportion of women with endometriosis are asymptomatic, and the disease is often diagnosed during laparoscopic investigation due to other pelvic conditions 17,18. Three different clinical presentations of endometriosis have been described, peritoneal endometriosis, endometriotic ovarian cysts and deeply infiltrating endometriosis (DIE) 4. DIE is the most aggressive presentation of endometriosis; it is characterized by an infiltration of >5 mm of endometrial tissue into the retroperitoneal space and accounts for ~20% of the cases 4,19,20.…”

Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

“…This is performed via laparoscopy, employing a mesenteric nerve-sparring and vascular sparring approach in order to preserve mesentery arteries, and surrounding autonomic nerve fibers that reduces bowel denervation 28 . Surgical treatment of DIE, especially employing full excision of endometriotic lesions, may enable the restoration of normal pelvic anatomy and its function 31 . It should be mentioned that even following laparoscopic excision of endometriotic lesions, women with previous DIE, may present with significantly higher pregnancy complications, for example hypertensive disorders, placenta previa and lower gestational weight 32 .…”

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

“…The presence of pathologies, especially in patients with a history of previous surgery, extended adhesions or deep infiltrating endometriosis may impair the clarity of the operation site [17]. The surgeon must be able to concentrate fully on the surgical procedure.…”