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How Many Surgeries Are Necessary for Definitively Treatment of Deep Endometriosis
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Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S71–S122 Open Communications 17dLaparoscopy (4:14 PM d 4:19 PM)
How Many Surgeries Are Necessary for Definitively Treatment of Deep Endometriosis Dibi R, Pinho de Oliveira MA, Nogueira M, Muller M, Soares T, Souza C, Crispi C. Instituto Fernandes Fighera- FIOCRUZ, Rio de Janeiro, Brazil Study Objective: Evaluate the number of surgeries required for definitive treatment of deep endometriosis in Reference Services in the State of Rio de Janeiro, Brazil. Design: Retrospective study of 110 patients submitted to laparoscopic surgical treatment of deep endometriosis between September 2000 and July 2011. Setting: Public Hospital. Canadian Task Force Classification II-3. Patients: 110 consecutive patients who had complete medical records. Intervention: A questionnaire was answered by telephone. The information was obtained from medical records. Measurements and Main Results: The variables analyzed: parity, initial clinical presentation, age at onset of symptoms and at diagnosis, number of previous surgeries performed to treat endometriosis, relief of symptoms after the first and last surgery (range 0 to 100) and need for further surgical treatment after the surgery in a Referral Center. Descriptive statistical analysis of variables was performed using SPSS, version 17. The mean age at diagnosis was 35 years and the average age of onset of symptoms was 27 years. 51% were nulliparous. Dysmenorrhea was the most frequent complaint (74.6%). Of the 110 patients evaluated, 43 (30.9%) had undergone previous surgery to treat endometriosis (minimum of one and maximum of seven surgeries). The average relief of symptoms after the first surgical treatment of 24 patients was 35.7% and after surgery in the Referral Center was 86.1 on a scale of 0 to 100. Conclusion: The complete laparoscopic excision of endometriosis performed in a Referral Center offers a good relief of symptoms, especially for patients with severe or debilitating symptoms. The excessive number of previous surgeries may be related to incomplete procedures, leading to a worse prognosis. Despite the complete surgery with expert staff, some patients have recurrence of symptoms, even with hormonal blockade, showing the inheritance of multifactorial disease. 293
Open Communications 17dLaparoscopy (4:20 PM d 4:25 PM)
Documentation of Endometriosis at Time of Cesarean Delivery Taylor JS,1 Reiss J,1 Lin S,1 Grunebaum A.2 1Obstetrics and Gynecology, New York Presbyterian-Weill Cornell Medical Center, New York, New York; 2Maternal Fetal Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, New York Study Objective: To assess how frequently the finding of endometriosis is documented at the time of cesarean delivery. Design: A retrospective chart of review of patients with pregnancies conceived by in vitro fertilization (IVF) who underwent cesarean delivery from January 1, 2009 until December 31, 2009 at a single institution. Setting: A single urban academic institution in the Northeast. Patients: Women with pregnancies conceived by IVF who underwent cesarean delivery from January 1, 2009 until December 31, 2009. Intervention: Cesarean delivery. Measurements and Main Results: Out of 2,235 cesarean deliveries during 2009, there were 394 cesarean deliveries in patients with an IVF pregnancy. Of those patients, 44 (11.2%) had a diagnosis of endometriosis from either a prior laparoscopy or a prior laparotomy. Endometriosis was only documented in one of 394 dictations or operative reports. Conclusion: It is unlikely that only one case of endometriosis was present in this high risk population. While it is possible that endometriosis may have improved during pregnancy or resolved after prior treatment we find it unlikely that this occurred in 97.7% of those with a prior diagnosis. The more likely explanation is that physicians are not documenting or looking for endometriosis at the time of cesarean delivery adequately. This is a missed opportunity for diagnosis, one which would require minimal additional time and effort from surgeons as the adnexa are already
routinely examined. Patients would benefit from a more thorough examination and documentation of endometriosis, with or without fulguration of visible lesions. 294
Open Communications 17dLaparoscopy (4:26 PM d 4:31 PM)
Total Laparoscopic Colorectal Resection with Natural Orifice Specimen Extraction (NOSE): A Technique Particularly Adapted to Bowel Endometriosis Faller E, Messori P, Albornoz J, Wattiez A. Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France Study Objective: Evaluate the possibility of a total intracorporeal anastomosis for bowel resection for deep endometriosis using the vagina like a NOSE. Design: Retrospective analysis of 41 consecutive patients between 2004 and 2011. Setting: Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France. Patients: Forty-one patients who had a bowel resection for deep endometriosis. Intervention: Surgery was performed laparoscopically by a multidisciplinary team. Classically, the andvil insertion was made extracorporealy using a minilaparotomy. To avoid enlargement of abdominal incision, some cases have been performed totally laparoscopically with less invasive approaches such as the transanal (TA) and transvaginal (TV) natural orifice specimen extraction (NOSE). Measurements and Main Results: Thirty-two patients had a standard technique using a minilaparotomy and 9 patients had a NOSE technique. Two patients had a TA approach, 5 patients had a TV approach with In 5 cases, exteriorization of the bowel through the vagina. In 2 cases, the anastomosis was intracorporeal and transanal with a specimen extraction using the vagina. There was no difference in operative time (about 220’), mean hospital stay (9,8days). There was no conversion by laparotomy in the two groups. Complication rate was the same: 2 major complications in the NOSE group (22%), and 7 complications in the abdominal group (22%). Conclusion: NOSE technique to perform colorectal anastomosis seems to be as efficient as the abdominal technique. It theoretically can avoid cosmetic damage, orifice hernia, pain or infection. Bigger study are required to attest the benefit in a long term of the use of NOSE.
295
Open Communications 17dLaparoscopy (4:32 PM d 4:37 PM)
Quality of Life and Deep Infiltrating Endometriosis: Worries about Epidemiological Quantitative Studies Using Short Form 36 and Endometriosis Health Profile 30 Aragao LC, Liberman D, Guerra CG, Sessa FV, Rodrigues MA, Costa MF, Crispi CP, Fonseca MF. Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil Study Objective: To evaluate the statistical distribution pattern of the scores from 2 questionnaires used for assessment of Quality of Life (QoL), Short Form 36 (SF-36) and Endometriosis Health Profile 30 (EHP-30), in an urban sample from Rio de Janeiro, Brazil. Design: Sectional observational study. Setting: Public teaching hospital. Patients: Women with infiltrating endometriosis diagnosed by nuclear magnetic resonance (n = 71; ages 20 to 53y). Exclusion criteria: incapability to answer the questionnaires, self-reported symptomatic pathologies/traumas or refuse. Intervention: Patient self-reported tools SF-36 (8 domains of health) and EHP-30 (5 scales and 6 supplementary modules); percentual scales denoting patient’s QoL. Measurements and Main Results: From July 2010 to March 2012, in parallel to preoperative evaluation for cytoreductive laparoscopy, patients
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S71–S122 Open Communications 17dLaparoscopy (4:14 PM d 4:19 PM)
How Many Surgeries Are Necessary for Definitively Treatment of Deep Endometriosis Dibi R, Pinho de Oliveira MA, Nogueira M, Muller M, Soares T, Souza C, Crispi C. Instituto Fernandes Fighera- FIOCRUZ, Rio de Janeiro, Brazil Study Objective: Evaluate the number of surgeries required for definitive treatment of deep endometriosis in Reference Services in the State of Rio de Janeiro, Brazil. Design: Retrospective study of 110 patients submitted to laparoscopic surgical treatment of deep endometriosis between September 2000 and July 2011. Setting: Public Hospital. Canadian Task Force Classification II-3. Patients: 110 consecutive patients who had complete medical records. Intervention: A questionnaire was answered by telephone. The information was obtained from medical records. Measurements and Main Results: The variables analyzed: parity, initial clinical presentation, age at onset of symptoms and at diagnosis, number of previous surgeries performed to treat endometriosis, relief of symptoms after the first and last surgery (range 0 to 100) and need for further surgical treatment after the surgery in a Referral Center. Descriptive statistical analysis of variables was performed using SPSS, version 17. The mean age at diagnosis was 35 years and the average age of onset of symptoms was 27 years. 51% were nulliparous. Dysmenorrhea was the most frequent complaint (74.6%). Of the 110 patients evaluated, 43 (30.9%) had undergone previous surgery to treat endometriosis (minimum of one and maximum of seven surgeries). The average relief of symptoms after the first surgical treatment of 24 patients was 35.7% and after surgery in the Referral Center was 86.1 on a scale of 0 to 100. Conclusion: The complete laparoscopic excision of endometriosis performed in a Referral Center offers a good relief of symptoms, especially for patients with severe or debilitating symptoms. The excessive number of previous surgeries may be related to incomplete procedures, leading to a worse prognosis. Despite the complete surgery with expert staff, some patients have recurrence of symptoms, even with hormonal blockade, showing the inheritance of multifactorial disease. 293
Open Communications 17dLaparoscopy (4:20 PM d 4:25 PM)
Documentation of Endometriosis at Time of Cesarean Delivery Taylor JS,1 Reiss J,1 Lin S,1 Grunebaum A.2 1Obstetrics and Gynecology, New York Presbyterian-Weill Cornell Medical Center, New York, New York; 2Maternal Fetal Medicine, New York Presbyterian-Weill Cornell Medical Center, New York, New York Study Objective: To assess how frequently the finding of endometriosis is documented at the time of cesarean delivery. Design: A retrospective chart of review of patients with pregnancies conceived by in vitro fertilization (IVF) who underwent cesarean delivery from January 1, 2009 until December 31, 2009 at a single institution. Setting: A single urban academic institution in the Northeast. Patients: Women with pregnancies conceived by IVF who underwent cesarean delivery from January 1, 2009 until December 31, 2009. Intervention: Cesarean delivery. Measurements and Main Results: Out of 2,235 cesarean deliveries during 2009, there were 394 cesarean deliveries in patients with an IVF pregnancy. Of those patients, 44 (11.2%) had a diagnosis of endometriosis from either a prior laparoscopy or a prior laparotomy. Endometriosis was only documented in one of 394 dictations or operative reports. Conclusion: It is unlikely that only one case of endometriosis was present in this high risk population. While it is possible that endometriosis may have improved during pregnancy or resolved after prior treatment we find it unlikely that this occurred in 97.7% of those with a prior diagnosis. The more likely explanation is that physicians are not documenting or looking for endometriosis at the time of cesarean delivery adequately. This is a missed opportunity for diagnosis, one which would require minimal additional time and effort from surgeons as the adnexa are already
routinely examined. Patients would benefit from a more thorough examination and documentation of endometriosis, with or without fulguration of visible lesions. 294
Open Communications 17dLaparoscopy (4:26 PM d 4:31 PM)
Total Laparoscopic Colorectal Resection with Natural Orifice Specimen Extraction (NOSE): A Technique Particularly Adapted to Bowel Endometriosis Faller E, Messori P, Albornoz J, Wattiez A. Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France Study Objective: Evaluate the possibility of a total intracorporeal anastomosis for bowel resection for deep endometriosis using the vagina like a NOSE. Design: Retrospective analysis of 41 consecutive patients between 2004 and 2011. Setting: Department of Gynecologic Surgery, Strasbourg University Hospital Hautepierre and CMCO, and IRCAD/EITS, Strasbourg, France. Patients: Forty-one patients who had a bowel resection for deep endometriosis. Intervention: Surgery was performed laparoscopically by a multidisciplinary team. Classically, the andvil insertion was made extracorporealy using a minilaparotomy. To avoid enlargement of abdominal incision, some cases have been performed totally laparoscopically with less invasive approaches such as the transanal (TA) and transvaginal (TV) natural orifice specimen extraction (NOSE). Measurements and Main Results: Thirty-two patients had a standard technique using a minilaparotomy and 9 patients had a NOSE technique. Two patients had a TA approach, 5 patients had a TV approach with In 5 cases, exteriorization of the bowel through the vagina. In 2 cases, the anastomosis was intracorporeal and transanal with a specimen extraction using the vagina. There was no difference in operative time (about 220’), mean hospital stay (9,8days). There was no conversion by laparotomy in the two groups. Complication rate was the same: 2 major complications in the NOSE group (22%), and 7 complications in the abdominal group (22%). Conclusion: NOSE technique to perform colorectal anastomosis seems to be as efficient as the abdominal technique. It theoretically can avoid cosmetic damage, orifice hernia, pain or infection. Bigger study are required to attest the benefit in a long term of the use of NOSE.
295
Open Communications 17dLaparoscopy (4:32 PM d 4:37 PM)
Quality of Life and Deep Infiltrating Endometriosis: Worries about Epidemiological Quantitative Studies Using Short Form 36 and Endometriosis Health Profile 30 Aragao LC, Liberman D, Guerra CG, Sessa FV, Rodrigues MA, Costa MF, Crispi CP, Fonseca MF. Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil Study Objective: To evaluate the statistical distribution pattern of the scores from 2 questionnaires used for assessment of Quality of Life (QoL), Short Form 36 (SF-36) and Endometriosis Health Profile 30 (EHP-30), in an urban sample from Rio de Janeiro, Brazil. Design: Sectional observational study. Setting: Public teaching hospital. Patients: Women with infiltrating endometriosis diagnosed by nuclear magnetic resonance (n = 71; ages 20 to 53y). Exclusion criteria: incapability to answer the questionnaires, self-reported symptomatic pathologies/traumas or refuse. Intervention: Patient self-reported tools SF-36 (8 domains of health) and EHP-30 (5 scales and 6 supplementary modules); percentual scales denoting patient’s QoL. Measurements and Main Results: From July 2010 to March 2012, in parallel to preoperative evaluation for cytoreductive laparoscopy, patients