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Rectovaginal endometriosis

J Loriau, E Petit, A Mephon, B Angliviel, E Sauvanet
Management of deep pelvic and digestive endometriosis can lead to colorectal resection and anastomosis. Colorectal anastomosis carries risks for dreaded infectious and functional morbidity. The aim of the study was to establish, regarding the published data, the role of the three most common used surgical techniques to prevent such complications: pelvic drainage, diverting stoma, epiplooplasty. Even if many studies and articles have focused on colorectal anastomotic leakage prevention in rectal cancer surgery data regarding this topic in the setting of endometriosis where lacking...
March 7, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Attila Bokor, Peter Lukovich, Noemi Csibi, Thomas D'Hooghe, Dan Lebovic, Reka Brubel, Janos Rigo
STUDY OBJECTIVE We first present a detailed description of a modified NOSE-colectomy technique. Secondly, we report the postoperative outcomes of our prospective case series when compared to conventional laparoscopic bowel resection in a relatively large series of patients. DESIGN Canadian Task Force Classification II-1. SETTING University tertiary referral center. PATIENTS Patient selection The last 90 consecutive patients in our care with DIE of the bowel are presented in this study. Patients were diagnosed at the 1st Department of OB/GYN Semmelweis Universtiy Budapest, Hungary...
February 14, 2018: Journal of Minimally Invasive Gynecology
Manuel Maria Ianieri, Daniele Mautone, Marcello Ceccaroni
Deep infiltrative endometriosis (DIE) is an enigmatic disease that typically impacts the rectovaginal septum, uterosacral ligaments, pararectal space, and vesicouterine fold but can involve the rectum, sigma, ileum, ureters, diaphragm, and other less common sites. Surgery is the treatment of choice as medical management alone commonly fails in controlling the symptoms, although recurrence is very high following surgical treatment. The goal of the current study was to review recurrence rates and identify risk factors related to recurrence following surgery for DIE...
January 18, 2018: Journal of Minimally Invasive Gynecology
C Ferrier, H Roman, Y Alzahrani, E Mathieu d'Argent, S Bendifallah, N Marty, M Perez, C Rubod, P Collinet, E Daraï, M Ballester
STUDY QUESTION: What are the fertility outcomes in women wishing to conceive after experiencing a severe complication from surgical removal of colorectal endometriosis? SUMMARY ANSWER: The pregnancy rate (PR) among women who wished to conceive after a severe complication of surgery for colorectal endometriosis was 41.2% (spontaneously for 80%, after ART procedure for 20%). WHAT IS KNOWN ALREADY: While the long-term benefit of surgery on pain and quality of life is well documented for women with colorectal endometriosis, it exposes women to the risk of severe complications...
January 5, 2018: Human Reproduction
P Vigano, M Candiani, A Monno, E Giacomini, P Vercellini, E Somigliana
Endometriosis is currently defined as presence of endometrial epithelial and stromal cells at ectopic sites. This simple and straightforward definition has served us well since its original introduction. However, with advances in disease knowledge, endometrial stromal and glands have been shown to represent only a minor component of endometriotic lesions and they are often absent in some disease forms. In rectovaginal nodules, the glandular epithelium is often not surrounded by stroma and frequently no epithelium can be identified in the wall of ovarian endometriomas...
December 1, 2017: Human Reproduction
Olivier Donnez, Horace Roman
Deep endometriosis (DE) remains the most difficult endometriotic entity to treat. Medical treatment for DE can reduce symptoms but does not cure the disease, and surgical removal of the lesion is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Although several surgical techniques such as laparoscopic bowel resection, disc excision, and rectal shaving have been described, there is no consensus regarding the choice of technique or the timing of surgery. Our review of publications reporting results and complications of surgery for rectovaginal DE reveals a relatively higher complication rate after bowel resection compared with shaving and disc excision, especially for rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization...
December 2017: Fertility and Sterility
Paolo Vercellini, Laura Buggio, Edgardo Somigliana
Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients...
December 2017: Fertility and Sterility
Stefano Guerriero, Juan Luis Alcázar, Maria Angela Pascual, Silvia Ajossa, Maura Perniciano, Alba Piras, Valerio Mais, Bruno Piras, Federica Schirru, Melis Gian Benedetto, Luca Saba
OBJECTIVES: To evaluate the diagnostic accuracy of 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasonography (US) in comparison with magnetic resonance imaging (MRI) for identification of deep infiltrating endometriosis. METHODS: In this prospective observational study, 159 premenopausal women who underwent surgery for a clinical suspicion of deep infiltrating endometriosis were prospectively enrolled. All women underwent 2DUS, 3DUS, and MRI. The following 3 locations of deep endometriosis were considered: (1) intestinal; (2) other posterior lesions (retrocervical septum, rectovaginal septum, uterosacral ligaments, and vaginal fornix); and (3) anterior...
November 30, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Gaetano Gallo, Alberto Realis Luc, Giuseppe Clerico, Mario Trompetto
BACKGROUND: Rectovaginal fistulas represent 5% of all anorectal fistulae and are a disastrous manifestation of Crohn's disease that negatively affects patients' social and sexual quality of life. Treatment remains challenging for colorectal surgeons, and the recurrence rate remains high despite the numerous available options. CASE PRESENTATION: We describe a 31-year-old female patient with a Crohn's disease-related recurrent perineo-vaginal and recto-vaginal fistulae and a concomitant mullerian anomaly...
November 21, 2017: BMC Surgery
S Guerriero, L Saba, M A Pascual, S Ajossa, I Rodriguez, V Mais, J L Alcazar
OBJECTIVES: To perform a systematic review of studies comparing the diagnostic accuracy of TVS and MRI in Deep Infiltrating Endometriosis (DIE) including only studies in which patients have been underwent both techniques. METHODS: An extensive search of papers comparing TVS and MRI in DIE was performed in Medline (Pubmed) and Web of Sciences from January 1989 to January 2016. Studies were considered eligible if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE using the surgical data as a reference standard...
November 20, 2017: Ultrasound in Obstetrics & Gynecology
Nicolas Bourdel, Aurélie Comptour, Paméla Bouchet, Anne-Sophie Gremeau, Jean-Luc Pouly, Karem Slim, Bruno Pereira, Michel Canis
Optimal surgical treatment of rectovaginal endometriosis remains a controversial topic. The objective of this study was to evaluate long term postoperative outcomes after rectal shaving or colorectal resection for rectovaginal endometriosis MATERIAL AND METHODS: 195 patients underwent surgery (172 managed by shaving, 23 by colorectal resection) between January 2000 and June 2013 for rectovaginal endometriosis (>2cm) involving at least the serosa of the rectum. Primary outcome measures were pain and fertility...
November 15, 2017: Acta Obstetricia et Gynecologica Scandinavica
Sophie Geoffron, Guillaume Legendre, Emile Daraï, Nathalie Chabbert-Buffet
CONTEXT: Endometriosis is a chronic painful disease, for which hormone therapy is usually offered as a first line option to women not willing to conceive. OBJECTIVES: To analyse and synthesize the literature, from 2006 onwards, on pain control, and disease evolution in oemn using combined hormonal contraceptives, progestins and GnRH analogs. Data on other current and future treatment perspectives is included as well. SOURCES: Medline (Pubmed), the Cochrane Library, and endometriosis treatment recommendations published by European Society of Human Reproduction and Embryology (ESHRE), National Institute for health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG), Royal College of Obstetricians and Gynaecologists (RCOG) and Société des Obstétriciens et Gynécologues du Canada (SOGC)...
December 2017: La Presse Médicale
Yunxi Zheng, Ning Zhang, Weiqi Lu, Liang Zhang, Shouxin Gu, Ying Zhang, Xiaofang Yi, Keqin Hua
Objective This study was performed to identify risk factors for postoperative rectovaginal fistula (PRF) in patients with deep infiltrating endometriosis (DIE). Methods Data were retrospectively obtained from the medical records of 104 patients with DIE, and statistical analysis was used to detect risk factors for PRF. Results Five of 104 (4.8%) patients developed PRF from 5 to 16 days postoperatively. The operative procedures included 84 (80.8%) superficial excisions, 6 (5.8%) full-thickness disc excisions, and 14 (13...
September 26, 2017: Journal of International Medical Research
Sofiane Bendifallah, Marcos Ballester, Emile Darai
Endometriosis is a benign pathology that affects 3% of the general population and about 10% of women of reproductive age. Three anatomoclinical entities are described: peritoneal, ovarian (endometrioma) and deep endometriosis characterized by the infiltration of anatomical structures or organs beyond the peritoneum. Laparoscopic surgery should be performed, as this is associated with a reduction in postoperative complications, length of hospitalization and convalescence. Several surgical techniques allow the removal of deep endometriosis with colorectal involvement: rectal shaving, anterior discoid resection, segmental resection...
December 2017: La Presse Médicale
Jonathan Cohen, Emmanuelle Mathieu d'Argent, Lise Selleret, Jean-Marie Antoine, Nathalie Chabbert-Buffet, Sofiane Bendifallah, Marcos Ballester, Emile Darai
Deep infiltrating endometriosis is the most severe form of the disease, defined by infiltration beneath the peritoneum greater than 5mm. It affects several anatomical locations including the bladder, the vesico-uterine cul-de-sac, the torus uterinum, the uterosacral ligament, rectovaginal septum and the colon-rectum. Deep infiltrating endometriosis is associated with infertility. Surgery performed for deep infiltrating endometriosis in the context of pain offers good pregnancy rates either spontaneously or after assisted reproductive technologies...
December 2017: La Presse Médicale
Sofiane Bendifallah, Horace Roman, Chrystel Rubod, Pierre Leguevaque, Antoine Watrelot, Nicolas Bourdel, Marcos Ballester, Emile Darai
National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS). METHODS: We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015...
October 24, 2017: Surgical Endoscopy
Scott W Young, Nirvikar Dahiya, Maitray D Patel, Mauricio S Abrao, Javier F Magrina, M'hamed Temkit, Rosanne M Kho
STUDY OBJECTIVE: To evaluate the diagnostic accuracy and learning curve of a sonographic mapping protocol for deep endometriosis (DE). DESIGN: Retrospective cohort study (Canadian Task Force classification II-3). SETTING: Tertiary referral center in the United States. PATIENTS: 117 consecutive patients who presented to our gynecology clinic with complaints of significant noncyclic pelvic pain of at least 6 months' duration, and/or clinical findings concerning for deep endometriosis and who were referred for transvaginal ultrasound with bowel preparation...
November 2017: Journal of Minimally Invasive Gynecology
Laura Buggio, Caterina Lazzari, Ermelinda Monti, Giussy Barbara, Nicola Berlanda, Paolo Vercellini
PURPOSE: We aim to provide a comprehensive overview of the role of the vagina as a route for drug delivery and absorption, with a particular focus on the use of vaginal hormonal compounds for the treatment of deep infiltrating symptomatic endometriosis. METHODS: A MEDLINE search through PubMed was performed to identify all published studies in English language on vaginal hormonal treatments for symptomatic endometriosis. RESULTS: Main advantages of the vaginal route include avoidance of the hepatic-first pass metabolic effect, the possibility of using lower therapeutic dosages, and the reduction of side effects compared with the oral administration...
June 29, 2017: Archives of Gynecology and Obstetrics
C Bourgioti, O Preza, E Panourgias, K Chatoupis, A Antoniou, M E Nikolaidou, L A Moulopoulos
Endometriosis is a common gynecological disorder defined by the presence of endometrial tissue outside the uterus. It is the most common cause of chronic pelvic pain and typically affects the ovaries, uterine ligaments, peritoneum, tubes, rectovaginal septum and bladder. It may, however, be found at various extrapelvic sites, including the perineum, liver, pancreas, lung or even the central nervous system, and in such cases, diagnosis may be quite challenging. Even though definitive diagnosis requires laparoscopy, preoperative identification of endometriosis is important not only to differentiate it from other diseases with similar clinical presentations but also, for accurate presurgical mapping, since complete removal of all endometriotic foci is critical for the effective treatment of the patient's symptoms...
November 2017: Diagnostic and Interventional Imaging
Chloé Chattot, Patrick Aristizabal, Sofiane Bendifallah, Emile Daraï
Uteroabdominal wall fistula (UAWF) is a very rare complication of cesarean section. We report an unusual case of a UAWF occurring in a 37-year-old woman 4 years after a cesarean section and previous radical surgery for deep infiltrating endometriosis with bowel resection. The patient presented with persistent purulent discharge of the Pfannenstiel scar and noted that the discharge was blood stained during menstruation. Magnetic resonance imaging confirmed the diagnosis of UAWF. Surgery was performed by laparotomy and was complicated by a postoperative rectovaginal fistula, which was successfully treated by the placement of a biological mesh via the vagina route...
November 2017: Journal of Minimally Invasive Gynecology
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