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2991 Planned Multidisciplinary Surgical Approach to Deep Infiltrating Endometriosis
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231
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from gynecological pain to abdominal and musculoskeletal pain. Current best practices leaves women with the disease few options beyond surgery, especially for those suffering with central sensitization and nerve up-regulation due to the long term adaptations of the disease. Pelvic Physical Therapy can be a critical component to mobilize the body post operatively. An exercise prescription designed by a physical therapist may help integrate and quiet long standing nerve patterns thereby returning the woman with endometriosis back to her best possible quality of life. Design: 35 women with endometriosis following excision of endometriosis were given a specific exercise program to help with nerve and pain not reduced by surgery alone. The CHPPS questionnaire was administered at onset of physical therapy and then at the 3 and 9 month mark. Setting: Outpatient Private Physical Therapy Practice. Patients or Participants: People with Endometriosis, post excision of the disease by a specialist. Interventions: Specific Exercise prescription was given to 35 patients with endometriosis. Measurements and Main Results: Of the 35 women, 24 reported increases in quality of life, 6 reported changes in pain but no increase in quality of life and 5 did not complete the study either due to compliance. Conclusion: Women with endometriosis experience on average an 8 year diagnostic delay from onset of symptoms to treatment. This delay may increase issues within the central nervous system, additionally the overwhelming pain may cause a patient to become deconditioned. Even after the disease is removed, pain may remain. An exercise prescription by a pelvic physical therapist may help increase quality of life.
suggestive of bowel disease were strongly correlated (80%), therefore all patients underwent a preoperative colorectal consult. Combined hysterectomy and bowel resection were performed in 18 cases (54.5%), excision of endometriosis and bowel resection for DIE in six cases (18.1%). Six excision of DIE cases required bowel adhesiolysis alone (18.1%) and one case needed no colorectal intervention (3%). One case required conversion to laparotomy (3%). Conclusion: A planned multidisciplinary gynecological−colorectal approach for the management of DIE can be performed in a minimally invasive manner in patients with suspected colorectal disease. We recommend a stepwise approach of preoperative imaging and a colorectal consult to coordinate two surgical teams.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION G 2991 Planned Multidisciplinary Surgical Approach to Deep Infiltrating Endometriosis Cui J,1,* Moore KJ,2 Sadiq T,3 Schiff LD,4 Louie M,4 Carey ET4. 1School of Medicine, University of North Carolina, Chapel Hill, NC; 2Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC; 3 Department of Surgery, University of North Carolina, Chapel Hill, NC; 4 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Study Objective: To describe a multidisciplinary minimally invasive approach to deep infiltrating endometriosis (DIE) with colorectal and gynecologic surgeons. Design: A retrospective cohort study. Setting: Between 2014-2018, all patients with suspected DIE and intestinal involvement were assessed by a team of minimally invasive gynecologic surgeons (MIGS) and colorectal surgeons at the University of North Carolina Hospitals. Perioperative data were abstracted from medical records and analyzed. Patients or Participants: Women ≥18 years of age with suspected DIE. Interventions: MIGS and colorectal surgical teams planned combined cases in patients with clinical suspicion, prior diagnosis or radiographical evidence of DIE. Preoperative work-up included imaging, predominately lower endoanal ultrasound or pelvic MRI. Interventions indicated by patient’s goals and disease burden included variable combinations of gynecologic and colorectal procedures. Measurements and Main Results: Thirty-three patients were included, with a mean age of 37 years and average BMI of 30.5. Most were African American (48.5%) or Caucasian (33.3%) and had a prior laparotomic (56.7%) or laparoscopic (90.9%) surgery. At the initial gynecologic consult, patients reported hematochezia (21.2%), constipation (45.5%), dyschezia (66.7%), and straining during bowel movement (21.2%). An endoanal ultrasound (54.6%) and/or pelvic MRI (39.4%) were obtained based on symptoms and exam for suspected DIE. Imaging findings
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION H 2908 Ultrasound Findings in Patients Referred to an Endometriosis Unit in a Tertiary Centre: Does Previous Surgery Matter? Rius M,* Ros C, Escura S, deGuirior C, Gracia M, Martınez-Zamora MA, Carmona F. Hospital Clinic, Barcelona, Spain *Corresponding author. Study Objective: The objective of this study is to analyze the ultrasound findings in patients referred to an endometriosis unit with and without previous endometriosis surgeries over one-year period. Design: Retrospective study including 430 patients who had a first visit and an ultrasound scan at an endometriosis referral unit from January to December 2018. Information about surgical history and ultrasound findings was collected. Setting: Endometriosis referral unit in a tertiary hospital in Barcelona, Spain. Patients or Participants: 430 patients referred to the endometriosis unit were included. Interventions: Ultrasound scan was performed according to the protocol stablished in this unit. Measurements and Main Results: 177 patients (41.2%) had a previous history of endometriosis surgery. 72.9% of them had one previous surgery and 14.7% had two whereas 12.4% had three or more. Laparoscopy was the main route, which was used in 74.6% of them. The main procedures were endometrioma decapsulation (45.6%) followed by adnexal surgery (19.8%) and deep infiltrating endometriosis nodule excision (16%). Only 2.7% of patients had a previous bowel resection. When comparing the ultrasound findings between patients who have a previous endometriosis surgery with those without, statistically significant differences were found in the presence of ovarian adhesions, ovarian endometriomas, presence of intestinal endometriotic nodules and Douglas-blockage. Conclusion: More than 40% of patients referred to the endometriosis unit had had a previous surgery. They had a higher rate of presence of intestinal endometriotic nodules among other ultrasound findings. Thus, it reinforces the need of referral units in order to establish a precise treatment either medical or surgical with high-skilled surgeons. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION I 2043 Where do Women Draw the Line? Choosing Surgery for Endometriosis After Hormonal Medication Use Islam MR,1,* Wasson MN,1 Behbehani S,2 Yi J3. 1Mayo Clinic Arizona, Phoenix, AZ; 2Gynecology, Mayo Clinic, Phoenix, AZ; 3Mayo Clinic, Phoenix *Corresponding author.
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from gynecological pain to abdominal and musculoskeletal pain. Current best practices leaves women with the disease few options beyond surgery, especially for those suffering with central sensitization and nerve up-regulation due to the long term adaptations of the disease. Pelvic Physical Therapy can be a critical component to mobilize the body post operatively. An exercise prescription designed by a physical therapist may help integrate and quiet long standing nerve patterns thereby returning the woman with endometriosis back to her best possible quality of life. Design: 35 women with endometriosis following excision of endometriosis were given a specific exercise program to help with nerve and pain not reduced by surgery alone. The CHPPS questionnaire was administered at onset of physical therapy and then at the 3 and 9 month mark. Setting: Outpatient Private Physical Therapy Practice. Patients or Participants: People with Endometriosis, post excision of the disease by a specialist. Interventions: Specific Exercise prescription was given to 35 patients with endometriosis. Measurements and Main Results: Of the 35 women, 24 reported increases in quality of life, 6 reported changes in pain but no increase in quality of life and 5 did not complete the study either due to compliance. Conclusion: Women with endometriosis experience on average an 8 year diagnostic delay from onset of symptoms to treatment. This delay may increase issues within the central nervous system, additionally the overwhelming pain may cause a patient to become deconditioned. Even after the disease is removed, pain may remain. An exercise prescription by a pelvic physical therapist may help increase quality of life.
suggestive of bowel disease were strongly correlated (80%), therefore all patients underwent a preoperative colorectal consult. Combined hysterectomy and bowel resection were performed in 18 cases (54.5%), excision of endometriosis and bowel resection for DIE in six cases (18.1%). Six excision of DIE cases required bowel adhesiolysis alone (18.1%) and one case needed no colorectal intervention (3%). One case required conversion to laparotomy (3%). Conclusion: A planned multidisciplinary gynecological−colorectal approach for the management of DIE can be performed in a minimally invasive manner in patients with suspected colorectal disease. We recommend a stepwise approach of preoperative imaging and a colorectal consult to coordinate two surgical teams.
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION G 2991 Planned Multidisciplinary Surgical Approach to Deep Infiltrating Endometriosis Cui J,1,* Moore KJ,2 Sadiq T,3 Schiff LD,4 Louie M,4 Carey ET4. 1School of Medicine, University of North Carolina, Chapel Hill, NC; 2Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina Chapel Hill, Chapel Hill, NC; 3 Department of Surgery, University of North Carolina, Chapel Hill, NC; 4 Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC *Corresponding author. Study Objective: To describe a multidisciplinary minimally invasive approach to deep infiltrating endometriosis (DIE) with colorectal and gynecologic surgeons. Design: A retrospective cohort study. Setting: Between 2014-2018, all patients with suspected DIE and intestinal involvement were assessed by a team of minimally invasive gynecologic surgeons (MIGS) and colorectal surgeons at the University of North Carolina Hospitals. Perioperative data were abstracted from medical records and analyzed. Patients or Participants: Women ≥18 years of age with suspected DIE. Interventions: MIGS and colorectal surgical teams planned combined cases in patients with clinical suspicion, prior diagnosis or radiographical evidence of DIE. Preoperative work-up included imaging, predominately lower endoanal ultrasound or pelvic MRI. Interventions indicated by patient’s goals and disease burden included variable combinations of gynecologic and colorectal procedures. Measurements and Main Results: Thirty-three patients were included, with a mean age of 37 years and average BMI of 30.5. Most were African American (48.5%) or Caucasian (33.3%) and had a prior laparotomic (56.7%) or laparoscopic (90.9%) surgery. At the initial gynecologic consult, patients reported hematochezia (21.2%), constipation (45.5%), dyschezia (66.7%), and straining during bowel movement (21.2%). An endoanal ultrasound (54.6%) and/or pelvic MRI (39.4%) were obtained based on symptoms and exam for suspected DIE. Imaging findings
Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION H 2908 Ultrasound Findings in Patients Referred to an Endometriosis Unit in a Tertiary Centre: Does Previous Surgery Matter? Rius M,* Ros C, Escura S, deGuirior C, Gracia M, Martınez-Zamora MA, Carmona F. Hospital Clinic, Barcelona, Spain *Corresponding author. Study Objective: The objective of this study is to analyze the ultrasound findings in patients referred to an endometriosis unit with and without previous endometriosis surgeries over one-year period. Design: Retrospective study including 430 patients who had a first visit and an ultrasound scan at an endometriosis referral unit from January to December 2018. Information about surgical history and ultrasound findings was collected. Setting: Endometriosis referral unit in a tertiary hospital in Barcelona, Spain. Patients or Participants: 430 patients referred to the endometriosis unit were included. Interventions: Ultrasound scan was performed according to the protocol stablished in this unit. Measurements and Main Results: 177 patients (41.2%) had a previous history of endometriosis surgery. 72.9% of them had one previous surgery and 14.7% had two whereas 12.4% had three or more. Laparoscopy was the main route, which was used in 74.6% of them. The main procedures were endometrioma decapsulation (45.6%) followed by adnexal surgery (19.8%) and deep infiltrating endometriosis nodule excision (16%). Only 2.7% of patients had a previous bowel resection. When comparing the ultrasound findings between patients who have a previous endometriosis surgery with those without, statistically significant differences were found in the presence of ovarian adhesions, ovarian endometriomas, presence of intestinal endometriotic nodules and Douglas-blockage. Conclusion: More than 40% of patients referred to the endometriosis unit had had a previous surgery. They had a higher rate of presence of intestinal endometriotic nodules among other ultrasound findings. Thus, it reinforces the need of referral units in order to establish a precise treatment either medical or surgical with high-skilled surgeons. Virtual Poster Session 3: Endometriosis (10:20 AM − 10:30 AM) 10:20 AM: STATION I 2043 Where do Women Draw the Line? Choosing Surgery for Endometriosis After Hormonal Medication Use Islam MR,1,* Wasson MN,1 Behbehani S,2 Yi J3. 1Mayo Clinic Arizona, Phoenix, AZ; 2Gynecology, Mayo Clinic, Phoenix, AZ; 3Mayo Clinic, Phoenix *Corresponding author.