Review on endometriosis surgery

Koninckx, Philippe; Ussia, Anastasia; Keckstein, J; Malzoni, Mario; Adamyan, L.V.; Wattiez, Arnaud

doi:10.21037/gpm-21-17

Cited by 4 publications

(5 citation statements)

References 83 publications

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“…Dyspareunia represents 1/6th of FSFI; impaired functioning because of pain is 1/3rd of EHP-30; clinical gynaecological pain consists of severity, radiation, centralization, and cross-over of dysmenorrhoea, CPP, dyspareunia, dyschezia, and dysuria. Considering the many and partially overlapping variables, it cannot be excluded that a very large trial considering all parameters, including the severity of the nodule [ 81 ], might find a specific effect of bowel resections. However, eventual specific effects of bowel resection on sexuality are not expected to be clinically important.…”

Section: Discussionmentioning

confidence: 99%

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

Asencio,

Fins,

Mitie

et al. 2023

Clinics and Practice

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Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.

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Section: Discussionmentioning

confidence: 99%

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

Asencio,

Fins,

Mitie

et al. 2023

Clinics and Practice

Self Cite

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“…Judgment of surgery remains difficult. Quality is poorly defined, the severity of endometriosis is variable, and cystic and deep endometriosis is technically difficult and complication-prone surgery with oocyte damage, sexual problems and bladder, ureteral and bowel complications ( Koninckx et al, 2021b ). Randomisation is unrealistic and often unethical when surgeons are not equally trained in the techniques to be compared.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is limited to those undergoing laparoscopy and this decision is based on a variable mixture of clinical exams and symptoms and imaging. The accuracies of imaging such as ultrasound or MRI are well described ( Guerriero et al, 2021a ; Guerriero et al, 2021b ), but the predictive values vary with the prevalence, and their importance in clinical decision-making varies from little ( Koninckx et al, 2021b ; Koninckx et al, 2021c ) to very much ( Malzoni et al, 2020 ). We need to incorporate that the recognition of subtle and deep endometriosis ( Taylor et al, 2018 ) is variable.…”

Section: Discussionmentioning

confidence: 99%

Reconsidering evidence-based management of endometriosis

Koninckx¹,

Ussia²,

Al-Suwaidi³

et al. 2022

Facts Views Vis ObGyn

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Background: Without an adequate animal model permitting experiments the pathophysiology of endometriosis remains unclear and without a non-invasive diagnosis, information is limited to symptomatic women. Lesions are macroscopically and biochemically variable. Hormonal medical therapy cannot be blinded since recognised by the patient and the evidence of extensive surgery is limited because of the combination of low numbers of interventions of variable difficulty with variable surgical skills. Experience is spread among specialists in imaging, medical therapy, infertility, pain and surgery. In addition, the limitations of traditional statistics and p-values to interpret results and the complementarity of Bayesian inference should be realised. Objectives: To review and discuss evidence in endometriosis management Materials and Methods: A PubMed search for blinded randomised controlled trials in endometriosis. Results: Good-quality evidence is limited in endometriosis. Conclusions: Clinical experience remains undervalued especially for surgery. What is new? Evidence-based medicine should integrate traditional statistical analysis and the limitations of P-values, with the complementary Bayesian inference which is predictive and sequential and more like clinical medicine. Since clinical experience is important for grading evidence, specific experience in the different disciplines of endometriosis should be used to judge trial designs and results. Finally, clinical medicine can be considered as a series of experiments controlled by the outcome. Therefore, the clinical opinion of many has more value than an opinion.

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“…The quality and completeness of surgery for endometriosis are poorly defined. The severity of the disease and the surgery are variable, with cystic and deep endometriosis being technically difficult and complication prone causing oocyte damage, sexual problems and bladder, ureteral and bowel complications (76). Randomisation is irrealistic and can be unethical when surgeons are not equally trained in the techniques to be compared.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis is limited to those undergoing laparoscopy and this clinical decision is based on a variable mixture of clinical exams and symptoms and imaging. The accuracies of imaging as ultrasound or MRI are well described (78,79), but the predictive values vary with the locally variable prevalences, and their importance in clinical decision making varies from little (58,76) to very much (80). Not only the indication for laparoscopy is variable also the recognition of endometriosis (81) as demonstrated for subtle lesions and observed for deep and appendiceal endometriosis.…”

Section: Discussionmentioning

confidence: 99%

Hierarchy of evidence for endometriosis diagnosis and surgery.

Koninckx

Ussia

Keckstein

et al. 2022

Preprint

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Without an animal model and a non-invasive diagnosis, the pathophysiology of endometriosis is unclear and information is limited to symptomatic women. Lesions are biochemically variable. Medical therapy cannot be blinded and extensive surgery combines low numbers with variable difficulty and surgical skills. Experience is spread among specialists in imaging, medical therapy, infertility, pain and surgery. Besides the recent changes in interpreting statistical analyses, the limited good-quality evidence increases the importance of clinical experience. Therefore trial design, analysis and judgment of results should be done by experts in the different disciplines of endometriosis, before being translated into guidelines.

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Review on endometriosis surgery

Cited by 4 publications

References 83 publications

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

Reconsidering evidence-based management of endometriosis

Hierarchy of evidence for endometriosis diagnosis and surgery.

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