Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach

Roman, Horace; Vassilieff, Maud; Gourcerol, Guillaume; Savoye, Guillaume; Leroi, Anne Marie; Marpeau, L.; Michot, F; Tuech, Jean‐Jacques

doi:10.1093/humrep/deq332

Cited by 143 publications

(114 citation statements)

References 32 publications

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“…When colorectal resection is performed, post-operative complications include a higher rate of functional digestive and urinary outcomes [8]. In one series, major complications requiring further surgery occurred in 10.4% of patients and included: anastomotic leakage (4.7%), rectovaginal fistula (2.7%), anastomotic fistula (2%), perforation (0.5%), bowel obstruction (0.5%), uroperitoneum (1.5%), ureteral fistula (1%), bladder fistula (0.5%), pelvic abscess (0.5%), sepsis (0.5%), hemoperitoneum (2%), heterologous blood transfusion (6%), and, after 30 days, urinary retention (4.7%), constipation (2.6%) and peripheral sensory disturbance (1.5%) [9].…”

Section: Commentmentioning

confidence: 99%

“…Therefore a major conservative approach, centred on the patient's symptoms and needs has been advocated for endometriosis in general, and for deep endometriosis in particular [8,10]. The concept expressed by Aboulghar about surgical treatment of ovarian endometrioma might be extended to DIE [11].…”

Section: Commentmentioning

confidence: 99%

“…As size changes occurred in different ways in the patients, the beneficial effect of pregnancy on painful symptoms, such as deep dyspareunia and rectal tenesmus, may be due not only to a reduction in the size of DIE plaques and nodules but also most probably to a decrease in the intra-and peri-lesional inflammatory condition and to reduced production of prostaglandins and cytokines [8]. Amenorrhoea and the consequent reduction in cyclic bleeding at ectopic endometrial sites could also induce a regression of activity of the endometriotic implants.…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions

Coccia

Rizzello

Palagiano

et al. 2012

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions

Coccia

Rizzello

Palagiano

et al. 2012

European Journal of Obstetrics & Gynecology and Reproductiv

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“…Številni avtorji poročajo, da so bolj konzervativni posegi, kot sta postrganje (shaving) in izrezanje nodusa ali diskoidna resekcija, enako učin-koviti, z manj resnimi zapleti ter krajšim časom operiranja (17,23,24).…”

Section: Razpravljanjeunclassified

Kakovost življenja pred in po laparoskopski resekciji črevesa zaradi globoke infiltrativne endometrioze

2017

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Background: Te purpose of the study was to determine the quality of life in patients with bowel endometriosis before and afer laparoscopic bowel resection.Material and methods: In the retrospective study we included 91 patients who underwent laparoscopic resection of the bowel aﬀected by endometriosis at the Unit for Reproduction and the Unit for Gynecology, Department of Obstetrics and Gynecology Ljubljana, in the period from 2002 to 2011. Te study was retrospective. Te patients were sent a questionnaire regarding the symptoms before surgery and the eﬀect of surgery on bowel symptoms, painful menstruation, painful sexual intercourse, chronic pelvic pain and quality of life before and afer surgery; 76 (83.5 %) patients replied to the questionnaire.Results: Before surgery, 72 (94.7 %) patients reported painful menstruation. Improvement or complete relief afer surgery was registered in 57 (79.1 %). Out of 60 (78.9 %) patients who had painful sexual intercourse before surgery, 49 (81.7 %) reported improvement or complete relief afer surgery. Bowel symptoms, present in 52 (68.4 %) patients before surgery, improved or completely disappeared in 48 (92.4 %) afer surgery. Chronic pelvic pain, present in 53 (69.7 %) before surgery, decreased or did not exist any more in 45 patients (86.5 %). Te quality of life before surgery was very poor in 32 patients (42.1 %), and poor in 21 patients (27.8 %). Afer the operation, the quality of life was reported as improved in 22 (28.9 %) and signifcantly improved in 42 (55.3 %).Conclusions: Laparoscopic bowel resection, indicated in extensive symptomatic endometriosis, signifcantly improves the patients’ quality of life.

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“…Indeed management of pelvic deep infiltrating endometriosis relies on medical therapies or surgical interventions, and as far as recto-sigmoid locations are concerned, surgical laparoscopy is the reference technique for resection [6,7] . The recent trend is to prefer nodule excision, when feasible, than radical digestive resection [8,9] , therefore it is of utmost importance to appreciate endometriotic rectal and sigmoid infiltration, in the pre-operative staging. Diagnosis of recto-sigmoid endometriosis definitely relies on imaging as clinical examination is not sufficient for the diagnosis of location of deeply infiltrating endometriosis [10] .…”

Section: Introductionmentioning

confidence: 99%

Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis

Roseau¹

2014

WJGE

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Recto-sigmoid endoscopic ultrasonography (RS-EUS) has first been used in the staging of pelvic deep infiltrating endometriosis in the early 1990's. Since then, although publications have been sparse, RS-EUS is routinely used for this indication in few centers. In this paper, we focus on technical aspects and operating method of rectal and sigmoid endo-sonography, and describe the most characteristic echographic presentations of endometriosis of the lower digestive tract. Through a literature review, results obtained with different types of endo-rectal probes, either flexible endoscopic, or blind rigid, are presented and compared with those of other close imaging techniques: magnetic resonance imaging and the more recent trans-vaginal sonography. As well as these two latter techniques, RS-EUS appears as an interesting method in the staging of pelvic deep infiltrating endometriosis particularly to evaluate rectal and sigmoid infiltrations. However, more prospective studies are required, to correctly define respective indications for each exam, in the light of recent advancements in treating this frequent disease. Key words: Endometriosis; Rectum and sigmoid; Ultrasound; Endoscopic-ultrasonography; Surgical treatment; Magnetic resonance imaging Core tip: Pelvic deep infiltrating endometriosis is a disabling disease of increasing rate. Today new medical and surgical therapies are proposed in the management of pain and infertility, and the choice of an optimal treatment strategy requires a precise anatomic evaluation. Several imaging techniques are available, either additive or competitive, in this staging. Rectosigmoid endoscopic-ultrasonography (RS-EUS), is routinely used in the field of gastroenterology, mostly for staging of rectal cancer. Few studies have demonstrated it could also be of interest to image endometriotic rectosigmoid infiltrations. In this review, we tried to assess indications and results of RS-EUS, compared to those of magnetic resonance imaging and transvaginal sonography.Roseau G. Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis. World J Gastrointest

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Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach

Cited by 143 publications

References 32 publications

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions

The effect of the hormonal milieu of pregnancy on deep infiltrating endometriosis: serial ultrasound assessment of changes in size and pattern of deep endometriotic lesions

Kakovost življenja pred in po laparoskopski resekciji črevesa zaradi globoke infiltrativne endometrioze

Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis

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