[Show abstract][Hide abstract] ABSTRACT: Study oblective and design:
A retrospective evaluation of our series to evaluate feasibility and safety of laparoscopic segmental bowel resection for deep infiltrating endometriosis.
II-3 SETTING: Malzoni Clinic - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy PATIENTS: Retrospective cohort of 248 cases (between 1st of January 2011 and 31th December 2014) INTERVENTION: Laparoscopic segmental bowel resection for deep infiltrating endometriosis.
Measurements and main results:
Bowel endometriosis was histologically confirmed in 248/248 patients (100%). Mean length of the resected specimen was 11.83 ± 4.56 cm (mean± SD). Margins were free of disease in all cases and muscular layer was infiltrated up to the submucosal layer in all 248/248 cases (100%), while the mucosal layer showed signs of infiltration only in 4 cases out of 248 (1.6%). In 36 patients (36/248, 14.5%) coexistence of 2 nodules was found, while 3 nodules were found only in 8 cases (8/248, 3.2%). None of the resected bowel segments had nodules less than 3 cm in length and the majority of lesions had a longitudinal diameter between 3 and 7 cm. In the majority of cases resected segments involved the mid-low rectum (distance of the lower margin of resected segment from the anal verge between 4 and 12 cm) while in 6% of cases, ultra low resections (equal or below 4 cm) was performed. No intraoperative complications occurred and conversion to laparotomy was not required We recorded perioperative and early and late post-operative major complications in 20 cases (20/248, 8.06%) . A significant reduction of pain associated disease was observed up to 1 year follow up, irrespectively of postoperative hormonal treatment. Pelvic relapse was found in up to 50% of cases, especially in patients without hormonal suppression, but only in the form of endometriomas or adherences, with no recurrent deep lesions observed.
.This large single center series demonstrates that laparoscopic bowel resection for deep infiltrating endometriosis is a feasible technique, with low complication rates. Deep fibrotic endometriosis nodules treated by laparoscopic segmental resection is very effective in symptomatic patients in terms of reduced pain and restored bowel function. It can be considered a safe, complex surgery, requiring specific skills in laparoscopic urologic and colorectal procedures and should be performed only in specialized high volume centers by high volume surgeons.
[Show abstract][Hide abstract] ABSTRACT: This paper is a consensus statement on terms, definitions and measurements to describe and report the sonographic features of the myometrium using grayscale sonography, color/power Doppler, and three-dimensional ultrasound imaging. These terms and definitions may be relevant both for the clinician when reporting ultrasound examinations in daily practice and for clinical research. The use of the terminology when describing the two most common myometrial lesions (fibroids and adenomyosis) is presented.
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Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14806 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectivesto evaluate the possible ultrasonographic features of diffuse adenomyosis in a group of nulligravid women without endometriosis aged 18–30 years and to correlate them with dysmenorrhea and abnormal uterine bleeding.Methods
Prospective observational study including nulligravid women aged 18–30 years addressed to our University hospital for ultrasound from an outpatient center of Gynecology. Inclusion criteria were age between 18–30 years old, regular menstrual cycle and nulligravid status. Exclusion criteria were a past or current history of endometriosis, fibroids, ovarian cysts or lesions, endometrial pathology, current use of hormonal treatments or medications that would affect menstrual cycle, previous uterine surgery and history of infertility. Women underwent to a detailed clinical assessment and a 2D-3D TVS assessment. The presence of 2D-TVS features associated with diffuse adenomyosis were determined as: 1. heterogeneous myometrium; 2. hypoechoic striation in the myometrium; 3. myometrial anechoic lacunae or cysts; 4. asymmetrical myometrial thickening of the uterine walls with the presence of straight vessels, into the hypertrophic myometrium at the Power Doppler examination. The presence of associated symptomatology represted our main outcome: the amount of menstrual loss was assessed by a pictorial blood loss analysis chart (PBAC) and painful symptoms were evaluated using a visual analog scale (VAS).ResultsDuring the observation period 205 women (median 24 years, interquartile range, 23–27 years) were enrolled and 156 women met the inclusion criteria. According to the 2D-TVS criteria, diffuse adenomyosis was found in 53 women (33.9%) and the asymmetrical myometrial thickening of the uterine walls was the most common parameter. The ANOVA analysis showed a significant relation between the number of 2D-TVS features of diffuse adenomyosis and VAS score for dysmenorrhea (p = 0.005) and PBAC score for menstrual loss (p = 0.03). The 3D-TVS assessment showed that women with diffuse adenomyosis had significantly higher value of JZ max (6.38 ±2.30, p < 0.001), JZ min (2.07 ± 0.43, p = 0.002) and JZ diff (4.33 ± 1.99, p < 0.001) than in women without 2D-TVS adenomyosis features. Women with diffuse adenomyosis features were symptomatic in 83% of cases and among them dysmenorrhea was reported by 79.2%. Similarly, women with diffuse adenomyosis features showed a higher incidence of heavy bleeding than control (18.9% vs 2.9%; p = 0.001).Conclusionsdiffuse adenomyosis features and symptoms may develop earlier in reproductive life representing a possible cause of dysmenorrhea and heavy bleeding in nulligravid women.
Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14834 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the clinical history and ultrasound findings in women with decidualized endometriomas surgically removed during pregnancy.
In this retrospective study, women with a histological diagnosis of decidualized endometrioma during pregnancy who had undergone preoperative ultrasound examination were identified from the databases of seven ultrasound centers. The ultrasound appearance of the tumors was described on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) by one author from each centre using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, two authors reviewed together available digital ultrasound images and used pattern recognition to describe the typical ultrasound appearance of decidualized endometriomas.
Eighteen women were identified. Median age was 34 years, range 20-43. Median gestational age at surgical removal of the decidualized endometrioma was 18 weeks, range 11-41. Seventeen women (94%) were asymptomatic, one presented with pelvic pain. In three of the 18 women an ultrasound diagnosis of endometrioma had been made before pregnancy. The original ultrasound examiner was uncertain whether the mass was benign or malignant in ten (55%) women and suggested a diagnosis of benignity in nine (50%) women, borderline in eight women (44%), and invasive malignancy in one (6%) woman. All but one (17/18) decidualized endometrioma contained at papillary projection, and in all but one (16/17) at least one of the papillary projections was vascularized at power or color Doppler examination. The number of cyst locules varied between one (n = 11) and four. No woman had ascites. When using pattern recognition most decidualized endometriomas (14/17, 82%) were described as manifesting vascularized rounded papillary projections with a smooth contour in an ovarian cyst with one or a few cyst locules and ground glass or low level echogenicity of the cyst fluid.
Rounded vascularized papillary projections with smooth contour within an ovarian cyst with cyst contents of ground glass or low level echogenicity are typical of surgically removed decidualized endometriomas in pregnant women most of whom are asymptomatic.
Ultrasound in Obstetrics and Gynecology 09/2014; 44(3). DOI:10.1002/uog.13323 · 3.85 Impact Factor