Deep infiltrating endometriosis of the rectovaginal septum – an interdisciplinary problem

Nowa Medycyna ◽  
2019 ◽  
Vol 26 (3) ◽  
Author(s):  
Tomasz Songin
Keyword(s):  
Hormone Treatment ◽  
Deep Infiltrating Endometriosis ◽  
Rectovaginal Septum ◽  
Anal Sphincters ◽  
Surgical Methods ◽  
Diagnostic Modalities ◽  
Diagnostic Work ◽  
Pain Symptoms ◽  
Infiltrating Endometriosis

Endometriosis refers to the ectopic localization of the uterine glandular epithelium, which can infiltrate all peritoneal cavity organs as well as, though less commonly, distant locations. One of its most severe forms is deep infiltrating endometriosis (DIE) of the rectovaginal septum. In cases of DIE, the infiltration may involve the vagina, uterus, rectum, and the area of anal sphincters and pelvic floor muscles. The condition causes a variety of pain symptoms, including dyspareunia and dyschezia, and other intestinal complaints, significantly impairing the quality of a woman’s life. Important elements of the diagnostic work-up include obtaining the patient’s detailed history followed by transvaginal and transrectal examinations. Additional examinations recommended in patient assessment are transvaginal and transrectal ultrasonography, and MRI. The sensitivity and specificity of the methods may reach 91 and 98%, respectively. The combination of these diagnostic modalities significantly increases the rate of diagnosis, reducing the time to the start of treatment which, at present, is on average 7 years. The main management methods for DIE include pharmacotherapy and surgical treatment complemented by an appropriate diet, physiotherapy and psychotherapy. Hormone treatment markedly reduces pain, contributing to an improvement in the quality of life, and causes slight changes in the size of endometriotic lesions, which is associated with the relapse of symptoms after the discontinuation of medication. Surgical methods allow radical removal of lesions, but may cause significant complications, adversely affecting the function of the intestine, bladder, anal sphincters, and other body organs. In each case, the choice of optimum treatment should be adjusted individually to the patient based on the experience of the multidisciplinary team.

Surgical treatment of patients with deep infiltrating endometriosis of the rectovaginal septum

2021 ◽  
Vol 20 (4) ◽  
pp. 5-11
Author(s):  
E.A. Galliamov ◽  
◽  
L.N. Aminova ◽  
V.A. Alimov ◽  
A.G. Kozub ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Comparison Group ◽  
Chronic Pelvic Pain Syndrome ◽  
Main Group ◽  
Pelvic Pain Syndrome ◽  
Deep Infiltrating Endometriosis ◽  
Rectovaginal Septum ◽  
Infiltrating Endometriosis

Objective. To optimize the tactics of surgical treatment of deep infiltrating endometriosis of the rectovaginal septum, including with bowel involvement. Patients and methods. The study included 122 patients diagnosed with deep infiltrating endometriosis of the rectovaginal septum, who underwent surgical interventions of different volumes using laparoscopy. The patients were divided into a main group and a comparison group. The main group consisted of 92 patients with deep infiltrating endometriosis of the rectovaginal septum who underwent surgical treatment using the original technique of systematic approach; the comparison group consisted of 30 patients who were operated using the generally accepted technique. Results. There was a statistically significant decrease in the operation duration, intraoperative blood loss, as well as more effective relief of dysmenorrhea and chronic pelvic pain syndrome, less complications and relapses in the main group compared to the comparison group. In addition, it was found that the combination of three symptoms such as dysmenorrhea, dyspareunia and chronic pelvic pain increase the likelihood of deep infiltrating endometriosis up to 93%. Conclusion. Based on the results obtained, the proposed method of surgical treatment of deep infiltrating endometriosis is more efficient and safer in comparison with the generally accepted technique, which can be considered as a valid reason for its wide introduction into clinical practice. Key words: deep infiltrating endometriosis, bowel endometriosis, surgical treatment of endometriosis, treatment algorithm

scholarly journals Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 529 ◽  
Author(s):  
Edgardo Rolla
Keyword(s):  
Special Reference ◽  
Alternative Therapies ◽  
Diagnosis And Treatment ◽  
Deep Infiltrating Endometriosis ◽  
Peritoneal Disease ◽  
Quality Of Surgery ◽  
Diagnosis And Classification ◽  
Ovarian Endometriomas ◽  
Infiltrating Endometriosis

Endometriosis is an enigmatic disease that could start at birth. Its pathogenesis is supported by different theories. Accumulating facts relate it to a multigenic disorder. In this review of recent publications, the principal symptoms of the disease, pain and infertility, as well as its pathogenesis, diagnosis, and classification will be addressed. Endometriosis presents three main variants: superficial peritoneal disease, deep infiltrating endometriosis, and ovarian endometriomas. The management of the disease, surgery, and medical and alternative therapies will be discussed. Special reference will be made to the quality of surgery and how to understand patients with endometriosis and endometriosis.

scholarly journals The Association between Endometriosis Appearance during Laparoscopic Surgery and Pain Characteristic in Pelvic Endometriosis

2019 ◽  
pp. 116-121
Author(s):  
Herbert Situmorang ◽  
Renny Lestari ◽  
Eka R Gunardi
Keyword(s):  
Pelvic Pain ◽  
Reproductive Medicine ◽  
Disease Stage ◽  
Deep Infiltrating Endometriosis ◽  
Ovarian Endometriosis ◽  
Macroscopic Appearance ◽  
Keywords Endometriosis ◽  
American Society ◽  
Pain Symptoms ◽  
Infiltrating Endometriosis

Abstract Objective: To evaluate the correlation between the Altman Self-Rating Mania Scale (ASRM) score in endometriosis and severity pelvic pain in a group of women with endometriosis. Method: A total of 131 patients with pelvic pain who: conduct laparoscopy for diagnosis and therapy of endometriosis, have pain symptoms>3 months, and absence of pelvic anomalies. Dysmenorrhea, deep dyspareunia, dyschezia, dysuria, and chronic pelvic pain were evaluated using a 10-point visual analogue scale. The data was collected by assessing the medical record, and retrospective analysis was performed. Disease stage according to the American Society of Reproductive Medicine, the presence of adhesion, lesion type (Deep Infiltrating Endometriosis (DIE) or without DIE), and severity of pain symptoms were analysed by Spearman analysis. Different VAS between DIE vs non DIE group was analysed by Mann-Whitney analysis. Result: Stage IV endometriosis accounts for 79.4%. Based on the macroscopic appearance, ovarian endometriosis accounts for 92.4%, peritoneal endometriosis 82.4%, DIE was 40.5%, and adenomyosis was 19.1%. There was significant correlation between total ASRM, ovarian endometriosis, peritoneal lesion, Douglas pouch obliteration, adnexal adhesion score and VAS dysmenorrhea (r=0.303; 0,187; 0,203; 0,278; 0,266, p<0.05). There was significant VAS difference of DIE vs non DIE group; the difference was on dyspareunia (5.18±2.4 and 4.58±1.0, p<0.001] and dyschezia [5.28±2.2 and 4.86±0.7,p<0.001] Conclusion: There was a positive correlation between ovarian endometriosis score and severity of dysmenorrhea. There was also a difference in the degree of endometriosis-associated pain between DIE and non DIE group. Keywords: endometriosis, deep infiltrating endometriosis, dysmenorrhea, dyspareunia, dyschezia   Abstrak Tujuan: untuk mencari hubungan antara skor endometriosis ASRM dan karakteristik nyeri pelvik pada pasien endometriosis Metode: Sebanyak 131 pasien dengan nyeri pelvik yang menjalani laparoskopi untuk diagnosis dan terapi endometriosis, memiliki nyeri > 3 bulan, dan tidak mengalami kelainan organ pelvis. Dilakukan evaluasi terhadap dismenorea, dyspareunia dalam, diskezia, dysuria, dan nyeri pelvic kronik dengan menggunakan nilai 1-10 dari skala analog visual. Penelitian ini dilakukan di Rumah Sakit Umum Pusat Rujukan Nasional Dr. Cipto Mangunkusumo, Jakarta. Stadium endometriosis berdasarkan American Society of Reproductive Medicine, kejadian adhesi, jenis lesi (ada Endometriosis Susukan Dalam/ESD atau tanpa ESD), dan derajat keparahan nyeri dianalisis dengan analisis Spearman. Perbedaan skala nyeri antara ESD dan non ESD dianalisis dengan metode Mann-Whitney. Hasil: Sebanyak 79,4% pasien tergolong ke dalam endometriosis stadium IV. Berdasarkan tampilan makroskopik, endometriosis ovarium terdapat pada 92,4%, endometriosis peritoneal 82,4%, ESD 40,5%, dan adenomiosis pada 19,1%. Terdapat korelasi positif bermakna antara skor ASRM total, sub-skorkista endometriosis, endometriosis superfisial, obliterasi kavum douglas, dan adhesia dneksa dengan VAS dismenorea  (r=0,303; 0,187; 0,203; 0,278; 0,266, p<0,05). Pada kelompok ESD dan tanpa ESD, didapatkan perbedaan VAS dismenorea, dispareunia dalam, diskezia, dan nyeri pelvic kronik yang bermakna (6,13±1.7 dan 5,95±1,7, p = 0,560 ; 5,18±2.4 dan 4,58±1,0, p < 0,001; 5,28±2,2 dan 4,86±0,7 , p < 0,001; 2,20±2,8 dan 0,60±1,8, p <0,001) Kesimpulan:Terdapat korelasi positif bermakna antara skor ASRM dengan VAS dismenorea. Terdapat perbedaan VAS dismenorea, dyspareunia dalam, diskezia, dan nyeri pelvic kronik pada kelompok ESD dan tanpa ESD Kata kunci: endometriosis, endometriosis susukan dalam, dismenorea, dispareunia dalam, diskezia  

scholarly journals Impact on Quality of Life of Laparoscopic Nerve-sparing Radical Treatment of Parametrial Deep Infiltrating Endometriosis (Postoperative Pain Assessment and Functional Outcomes)

2022 ◽  
Author(s):  
Carlo Alboni ◽  
Veronica Sampogna ◽  
Mirvana Airoud ◽  
Stefania Malmusi ◽  
Antonino Farulla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcomes ◽  
Nerve Sparing ◽  
Deep Infiltrating Endometriosis ◽  
Urinary Function ◽  
Voiding Function ◽  
Validated Questionnaires ◽  
Laparoscopic Excision ◽  
Pain Symptoms

Abstract Objective: Complete eradication of parametrial nodules of Deep Infiltrating Endometriosis (DIE) is associated with a high risk of iatrogenic nerves damage and pelvic organs dysfunction. The aim of this study is to evaluate via validated questionnaires the effect of laparoscopic excision of parametrial DIE on quality of life as first outcome and on pain symptoms and post- operative voiding function (bladder and rectal) as secondary outcome.Study design: All patients undergoing laparoscopic excision of posterior or lateral parametrial DIE by a single expert surgeon between January 2013 and March 2017 were included in the study. A nerve-sparing approach was adopted in all patients. Quality of life (QoL) and Functional outcomes were evaluated using validated questionnaires (EHP-30 for the health profile, NBD score for intestinal function, ICIQ-FLUTS for urinary function), administered preoperatively and after surgery. Pain scores were collected before and after surgery using Visual Analogue Scale (VAS).Results: During the study period a total of fifty-nine patients met the inclusion criteria. Fifty-one patients agreed to fill out questionnaires for post-operative outcomes. EHP-30 scores had a significant improvement in all the domains analyzed even in the relationship with children and fertility module despite to the small number of patients answering those questions. No differences were found in terms of urinary function between pre and post-operative questionnaires (ICIQ-FLUTS). Bowel function improved in patients’ subjective perception. The NBD score showed that intestinal dysfunction related only to constipation and was reported as very minor by 76.4% of patients, minor by 11.8%, moderate by 5.9% by and severe by 5.95% of patients. Pain symptoms (VAS score) decreased significantly after surgery with the exception of chronic pelvic pain. (p value < 0,05). Conclusions: Laparoscopic nerve-sparing radical excision of parametrial DIE is safe and effective when performed by an expert surgical equipe. This approach can favorably impact on patients QoL. Moreover, it has proved to result in pain score and voiding function improvements.

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