- Email: [email protected]
How Effective Is Laparoscopic Supracervical Hysterectomy in Treating Adenomyosis?
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S91–S135 Measurements and Main Results: Posterior DIE alone was found at surgery in 135 patients (87,7%), anterior DIE alone in 2 patient (1.3%), while the association of posterior and anterior DIE lesions were found in 17 patients (11,0%). A significative correlation between the mean operating time and the scoring data showed strict relationship between the score level and the surgical time (51.5 8.6 minutes score % 20; 195.7 62.5 minutes score R 60). Segmental bowel resection was performed in 35 cases, all presented a maximum diameter of the nodule ranging from 3 to 6 cm by TVS. In 39 cases an endometriotic lesion from the ureter was surgical removed. The accuracy of TVS in detecting ureteral involvement was 92.3%. Conclusion: This new ultrasound/surgically mapping system is accurate in mapping the extent of DIE and may be useful for preoperative planning and intraoperative management of symptomatic patients with DIE.
426 Diagnostic Delay for Superficial and Deep Endometriosis in the United Kingdom: A First Quantitative Study Jan H, Shakir F, Haines P, Kent A. Minimal Access Therapy Training Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, United Kingdom Study Objective: Endometriosis can have a severe impact on women, with patients often complaining of significant delays in diagnosis. This is the first quantatitive study in the UK investigating this issue. Design: A questionnaire based on a diagnostic delay study conducted in Austria and Germany (Hudlest et al 2012) was given to over 100 patients who had been confirmed as having endometriosis surgically. Data was analysed with SPSS. Setting: Royal Surrey County Hospital NHS Foundation Trust. A tertiary referral center for Endometriosis in the United Kingdom. Patients: 101 responses were completed by those with surgically diagnosed endometriosis with 5 patients declining to take part. Measurements and Main Results: Patients on average (mean) visited the general practitioner (GP) 11.6 times with a symptom to diagnosis mean time of 9.2 years. The mean GP to diagnosis time was 5.7 years with patients presenting to the GP after a mean of 3 years of symptoms. Patients with severe recto-vaginal endometriosis waited significantly longer from symptoms to diagnosis (P\0.05) with a mean time to diagnosis of 10.7 years vs 6.4 years for superficial endometriosis. 75% had severe menstrual cramps in their adolescence and 83% were told their pain was normal. 51% of patients felt their initial GP did not take their pain seriously and 23% felt their initial gynaecologist did not take their pain seriously. Misdiagnosis was widespread; examples of which include 26% labelled as IBS and 13% labelled as pelvic inflammatory disease. Conclusion: The diagnosis of endometriosis is associated with significant delays of several years with the normalisation of pain combined with doctors not taking symptoms seriously being a major contributor. Severe recto-vaginal endometriosis is associated with significantly longer delays to diagnosis than superficial endometriosis.
427 How Effective Is Laparoscopic Supracervical Hysterectomy in Treating Adenomyosis? Kongoasa N, Sinervo K, Guidone H, Albee R. Center for Endometriosis Care, Atlanta, Georgia Study Objective: Clinical outcome following laparoscopic supracervical hysterectomy for adenomyosis. Design: Retrospective study. Follow up ranges from 6 months to 12 years. Setting: Tertiary referral center which specializes in, and is dedicated to, endometriosis.
S127
Patients: All patients (n=198) who underwent laparoscopic supracervical hysterectomy as well as excision of endometriosis from 2001 to 2013. All patients have histologically proven adenomyosis. Intervention: Laparoscopic supracervical hysterectomy and excision of endometriosis. Measurements and Main Results: The primary outcome of the study is determined by comparing the symptom questionnaire that the patients completed before the surgery and the questionnaire that was sent out for the purpose of the study. Visual analog score (VAS) was used. We also analyzed the incidence of recurrent endometriosis after complete excision during the index surgery. Finally, we measured patients’ current quality of life by using the validated Endometriosis Health Profile – 30 (EHP-30) which measure the wide range of effects that endometriosis can have on women’s lives. Our results have shown significant longterm improvement in patients’ symptoms and quality of life. When compared with the available data on EHP-30, our patients scored significantly better, further indicating improved quality of life. Of the 198 patients, 18 (9%) had another surgery following the index surgery for any reason which may or may not be related to endometriosis. 7 patients (3.5%) has recurrent endometriosis found and 2 patients (1%) needed trachelectomy. Conclusion: Laparoscopic supracervical hysterectomy is effective in treating adenomyosis. This is in contrast with the widely taught belief that the removal or cervix during hysterectomy is essential for adenomyosis.
428 The Usefulness of Computed Tomographic Colonography for Evaluation of Deep Infiltrating Endometriosis: Comparison with Magnetic Resonance Imaging Lim Y,1 Hur J-Y.2 1Department of Obstetrics and Gynecology, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Korea; 2 Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul, Korea Study Objective: To assess the diagnostic value and morphologic feature of deep infiltrating endometriosis (DIE), involving rectosigmoid colon, with computed tomography (CT) colonography in comparison with magnetic resonance (MR). Design: Retrospective clinical analysis. Setting: University Hospital. Patients: Fifty patients with DIE, who had undergone CT colonography and MR imaging (MRI) before surgery, were enrolled. Among these 50 patients who underwent laparoscopic surgery with DIE, 37 patients were diagnosed as rectosigmoid involvement of endometriosis. Intervention: Image findings at CT colonography and MRI were reviewed by 2 radiologists to determine whether there are radiologic features that can help predict rectosigmoid endometriosis. Measurements and Main Results: With CT colonography, the luminal alteration of rectosigmoid colon was detected with sensitivity of 96.0% and specificity of 48.0% (P \ 0.001) in the overall rectosigmoid endometriosis and with sensitivity of 84.0% and specificity of 80.0% (P = 0.005) in the case of DIE with cul-de-sac obliteration. With MR, the sensitivity and specificity for detection of endometriosis of rectosigmoid or rectouterine space were 94.4% and 37.5% (P = 0.013), respectively. Other variables had no statistical significance. The diagnostic accuracy of CT colonography is higher than that of MRI (area under the curve, 0.786 vs 0.691; P \ 0.001), for the overall rectosigmoid endometriosis. In the evaluation of complete cul-de-sac obliteration, morphologic change of rectosigmoid colon is identified more accurately with CT colonography than that of MRI (area under the curve, 0.821 vs 0.686; P \ 0.001). Conclusion: Both CT colonography and MRI are highly sensitive to the detection of rectosigmoid endometriosis, but lack specificity. However, the depiction rate of morphologic change in rectosigmoid colon is greater with CT colonography than that of MRI, in the case of cul-de-sac obliteration. The luminal alteration significantly correlates with morphologic change in rectosigmoid endometriosis.
426 Diagnostic Delay for Superficial and Deep Endometriosis in the United Kingdom: A First Quantitative Study Jan H, Shakir F, Haines P, Kent A. Minimal Access Therapy Training Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, United Kingdom Study Objective: Endometriosis can have a severe impact on women, with patients often complaining of significant delays in diagnosis. This is the first quantatitive study in the UK investigating this issue. Design: A questionnaire based on a diagnostic delay study conducted in Austria and Germany (Hudlest et al 2012) was given to over 100 patients who had been confirmed as having endometriosis surgically. Data was analysed with SPSS. Setting: Royal Surrey County Hospital NHS Foundation Trust. A tertiary referral center for Endometriosis in the United Kingdom. Patients: 101 responses were completed by those with surgically diagnosed endometriosis with 5 patients declining to take part. Measurements and Main Results: Patients on average (mean) visited the general practitioner (GP) 11.6 times with a symptom to diagnosis mean time of 9.2 years. The mean GP to diagnosis time was 5.7 years with patients presenting to the GP after a mean of 3 years of symptoms. Patients with severe recto-vaginal endometriosis waited significantly longer from symptoms to diagnosis (P\0.05) with a mean time to diagnosis of 10.7 years vs 6.4 years for superficial endometriosis. 75% had severe menstrual cramps in their adolescence and 83% were told their pain was normal. 51% of patients felt their initial GP did not take their pain seriously and 23% felt their initial gynaecologist did not take their pain seriously. Misdiagnosis was widespread; examples of which include 26% labelled as IBS and 13% labelled as pelvic inflammatory disease. Conclusion: The diagnosis of endometriosis is associated with significant delays of several years with the normalisation of pain combined with doctors not taking symptoms seriously being a major contributor. Severe recto-vaginal endometriosis is associated with significantly longer delays to diagnosis than superficial endometriosis.
427 How Effective Is Laparoscopic Supracervical Hysterectomy in Treating Adenomyosis? Kongoasa N, Sinervo K, Guidone H, Albee R. Center for Endometriosis Care, Atlanta, Georgia Study Objective: Clinical outcome following laparoscopic supracervical hysterectomy for adenomyosis. Design: Retrospective study. Follow up ranges from 6 months to 12 years. Setting: Tertiary referral center which specializes in, and is dedicated to, endometriosis.
S127
Patients: All patients (n=198) who underwent laparoscopic supracervical hysterectomy as well as excision of endometriosis from 2001 to 2013. All patients have histologically proven adenomyosis. Intervention: Laparoscopic supracervical hysterectomy and excision of endometriosis. Measurements and Main Results: The primary outcome of the study is determined by comparing the symptom questionnaire that the patients completed before the surgery and the questionnaire that was sent out for the purpose of the study. Visual analog score (VAS) was used. We also analyzed the incidence of recurrent endometriosis after complete excision during the index surgery. Finally, we measured patients’ current quality of life by using the validated Endometriosis Health Profile – 30 (EHP-30) which measure the wide range of effects that endometriosis can have on women’s lives. Our results have shown significant longterm improvement in patients’ symptoms and quality of life. When compared with the available data on EHP-30, our patients scored significantly better, further indicating improved quality of life. Of the 198 patients, 18 (9%) had another surgery following the index surgery for any reason which may or may not be related to endometriosis. 7 patients (3.5%) has recurrent endometriosis found and 2 patients (1%) needed trachelectomy. Conclusion: Laparoscopic supracervical hysterectomy is effective in treating adenomyosis. This is in contrast with the widely taught belief that the removal or cervix during hysterectomy is essential for adenomyosis.
428 The Usefulness of Computed Tomographic Colonography for Evaluation of Deep Infiltrating Endometriosis: Comparison with Magnetic Resonance Imaging Lim Y,1 Hur J-Y.2 1Department of Obstetrics and Gynecology, The Catholic University of Korea, Bucheon-si, Gyeonggi-do, Korea; 2 Department of Obstetrics and Gynecology, Korea University School of Medicine, Seoul, Korea Study Objective: To assess the diagnostic value and morphologic feature of deep infiltrating endometriosis (DIE), involving rectosigmoid colon, with computed tomography (CT) colonography in comparison with magnetic resonance (MR). Design: Retrospective clinical analysis. Setting: University Hospital. Patients: Fifty patients with DIE, who had undergone CT colonography and MR imaging (MRI) before surgery, were enrolled. Among these 50 patients who underwent laparoscopic surgery with DIE, 37 patients were diagnosed as rectosigmoid involvement of endometriosis. Intervention: Image findings at CT colonography and MRI were reviewed by 2 radiologists to determine whether there are radiologic features that can help predict rectosigmoid endometriosis. Measurements and Main Results: With CT colonography, the luminal alteration of rectosigmoid colon was detected with sensitivity of 96.0% and specificity of 48.0% (P \ 0.001) in the overall rectosigmoid endometriosis and with sensitivity of 84.0% and specificity of 80.0% (P = 0.005) in the case of DIE with cul-de-sac obliteration. With MR, the sensitivity and specificity for detection of endometriosis of rectosigmoid or rectouterine space were 94.4% and 37.5% (P = 0.013), respectively. Other variables had no statistical significance. The diagnostic accuracy of CT colonography is higher than that of MRI (area under the curve, 0.786 vs 0.691; P \ 0.001), for the overall rectosigmoid endometriosis. In the evaluation of complete cul-de-sac obliteration, morphologic change of rectosigmoid colon is identified more accurately with CT colonography than that of MRI (area under the curve, 0.821 vs 0.686; P \ 0.001). Conclusion: Both CT colonography and MRI are highly sensitive to the detection of rectosigmoid endometriosis, but lack specificity. However, the depiction rate of morphologic change in rectosigmoid colon is greater with CT colonography than that of MRI, in the case of cul-de-sac obliteration. The luminal alteration significantly correlates with morphologic change in rectosigmoid endometriosis.