Impact of Laparoscopic Surgical Management of Deep Endometriosis on Pregnancy Rate

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Endometriosis and the Coronavirus (COVID-19) Pandemic: Clinical Advice and Future Considerations

The COVID-19 pandemic has led to a dramatic shift in the clinical practice of women’s health and routine care for endometriosis has been severely disrupted. Endometriosis is defined as an inflammatory disease characterized by lesions of endometrial-like tissue outside the uterus that is associated with pelvic pain and/or infertility (1). It affects ∼10% of reproductive age women worldwide, is diagnosed by surgical visualization or by radiological imaging, and is managed with hormone treatments or by laparoscopic removal of lesions (2–4). At the time of writing, under the guidance of international gynecological organizations (5–7), many centers temporarily ceased offering outpatient appointments, diagnostic imaging for nonacute pelvic pain, surgery for endometriosis, and fertility treatments. In the absence of routine care pathways and uncertainty about when health services will be available again, endometriosis sufferers are likely to feel vulnerable and that resultant stress and anxiety may contribute to a worsening of symptoms. The pandemic poses several important questions for healthcare providers on how best to deliver care within these restrictions. Herein, we present clinical advice on the management of endometriosis during the COVID-19 pandemic and future considerations

Effect of Anterior Compartment Endometriosis Excision on Infertility

Background and Objectives: Laparoscopic surgical excision of bladder nodules has been demonstrated to be effective in relieving associated painful symptoms; the data are lacking concerning the impact of anterior compartment endometriosis on infertility. We conducted this study to evaluate whether or not the surgical excision of deep endometriosis affecting the anterior compartment plays a role in restoring fertility. Methods: This multicentre, retrospective study included a group of 55 patients presenting with otherwise-unexplained infertility who had undergone laparoscopic excision of anterior compartment endometriosis with histological confirmation. Patient medical records and operative reports were reviewed. Telephone interviews were conducted for long-term followup of fertility outcomes. Results: The pregnancy rate following surgical excision of endometriotic lesions was 44% (n = 11) among those with anterior compartment involvement alone and 50% (n = 15) in case of posterior lesions association without any significant difference. The symptoms related to bladder endometriosis resolved in the 84.2% of the cases with a recurrence rate of 1.8% at the 2-year followup not requiring further surgery. Conclusion: Laparoscopic excision of anterior compartment endometriosis is effective in restoring fertility in patients with otherwise-unexplained infertility and in treating endometriosis-related symptoms

Promontofixation par voie cœlioscopique dans le traitement du prolapsus génital (série de 32 cas.)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Regarding: "Link between Endometriosis, Atherosclerotic Cardiovascular Disease, and the Health of Women Midlife"

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Regarding: "Link between Endometriosis, Atherosclerotic Cardiovascular Disease, and the Health of Women Midlife"

status: publishe

Deep endometriosis: definition, diagnosis, and treatment.

Deep endometriosis, defined as adenomyosis externa, mostly presents as a single nodule, larger than 1 cm in diameter, in the vesicouterine fold or close to the lower 20 cm of the bowel. When diagnosed, most nodules are no longer progressive. In >95% of cases, deep endometriosis is associated with very severe pain (in >95%) and is probably a cofactor in infertility. Its prevalence is estimated to be 1% -2%. Deep endometriosis is suspected clinically and can be confirmed by ultrasonography or magnetic resonance imaging. Contrast enema is useful to evaluate the degree of sigmoid occlusion. Surgery requires expertise to identify smaller nodules in the bowel wall, and difficulty increases with the size of the nodules. Excision is feasible in over 90% of cases often requiring suture of the bowel muscularis or full-thickness defects. Segmental bowel resections are rarely needed except for sigmoid nodules. Deep endometriosis often involves the ureter causing hydronephrosis in some 5% of cases. The latter is associated with 18% ureteral lesions. Deep endometriosis surgery is associated with late complications such as late bowel and ureteral perforations, and recto-vaginal and uretero-vaginal fistulas. Although rare, these complications require expertise in follow-up and laparoscopic management. Pain relief after surgery is excellent and some 50% of women will conceive spontaneously, despite often severe adhesions after surgery. Recurrence of deep endometriosis is rare. In conclusion, defined as adenomyosis externa, deep endometriosis is a rarely a progressive and recurrent disease. The treatment of choice is surgical excision, while bowel resection should be avoided, except for the sigmoid