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Research paper
Published online: 2022-12-17
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Is the presence of deep infiltrative endometriosis underestimated in the surgical management of endometriosis?

Sabahattin Anil Ari1, Ali Akdemir2, Gurdeniz Serin3, Murat Ulukus2, Fatih Sendag2
DOI: 10.5603/GP.a2022.0150
·
Pubmed: 36597750
Affiliations
  1. Department of Obstetrics and Gynaecology, Bakircay University School of Medicine, Gazi Mustafa Kemal District, Izmir, Turkey
  2. Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
  3. Departmant of Pathology, School of Medicine, Ege University, Izmir, Turkey

open access

Ahead of Print
ORIGINAL PAPERS Gynecology
Published online: 2022-12-17

Abstract

Objectives: The aim of the study was to determine the presence of deep infiltrative endometriosis (DIE) in the surgical management of endometriosis.

Material and methods: Operation notes and histopathological reports of women with endometriosis were retrospectively analyzed in the Ege University Hospital between 2008 and 2018. A total of 191 women with suspicious of endometriosis but without clinical signs of DIE were enrolled in the study. Laparoscopic diagnosis of DIE was compared with histopathological reports. There was no histopathology before surgery. Endometriosis was suspected only based on symptoms.

Results: A total of 213 lesions that were thought to be DIE were removed from 191 women with endometriosis. Among these 213 lesions, 179 specimens were reported as endometriosis and 34 lesions as fibro-adipose tissue. Forty-nine right uterosacral ligaments were excised, and endometriosis was detected in 44 out of 49 specimens. Histopathological examination of 45 left uterosacral ligaments revealed endometriosis in 35 specimens. Finally, 25 endometriotic nodules were removed from the recto-vaginal space, and 22 of these were verified as endometriosis by a pathologist. The positive predictive value of laparoscopic visualization for DIE in the group suspected of endometriosis but without any clinical findings of DIE was 84%.

Conclusions: Women with the suspicious of endometriosis, qualified to surgery, because of infertility or pain, should be prudently investigated to confirm or to exclude coexistence of DIE even if no preoperative sign of DIE was observed to provide complete resection. Otherwise, DIE continues to grow, causes pain postoperatively, and complicates subsequent surgery.

Abstract

Objectives: The aim of the study was to determine the presence of deep infiltrative endometriosis (DIE) in the surgical management of endometriosis.

Material and methods: Operation notes and histopathological reports of women with endometriosis were retrospectively analyzed in the Ege University Hospital between 2008 and 2018. A total of 191 women with suspicious of endometriosis but without clinical signs of DIE were enrolled in the study. Laparoscopic diagnosis of DIE was compared with histopathological reports. There was no histopathology before surgery. Endometriosis was suspected only based on symptoms.

Results: A total of 213 lesions that were thought to be DIE were removed from 191 women with endometriosis. Among these 213 lesions, 179 specimens were reported as endometriosis and 34 lesions as fibro-adipose tissue. Forty-nine right uterosacral ligaments were excised, and endometriosis was detected in 44 out of 49 specimens. Histopathological examination of 45 left uterosacral ligaments revealed endometriosis in 35 specimens. Finally, 25 endometriotic nodules were removed from the recto-vaginal space, and 22 of these were verified as endometriosis by a pathologist. The positive predictive value of laparoscopic visualization for DIE in the group suspected of endometriosis but without any clinical findings of DIE was 84%.

Conclusions: Women with the suspicious of endometriosis, qualified to surgery, because of infertility or pain, should be prudently investigated to confirm or to exclude coexistence of DIE even if no preoperative sign of DIE was observed to provide complete resection. Otherwise, DIE continues to grow, causes pain postoperatively, and complicates subsequent surgery.

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Keywords

deep infiltrative endometriosis; endometrioma; endometriosis surgery; laparoscopy; pelvic pain; minimal invasive surgery

About this article
Title

Is the presence of deep infiltrative endometriosis underestimated in the surgical management of endometriosis?

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2022-12-17

Page views

118

Article views/downloads

87

DOI

10.5603/GP.a2022.0150

Pubmed

36597750

Keywords

deep infiltrative endometriosis
endometrioma
endometriosis surgery
laparoscopy
pelvic pain
minimal invasive surgery

Authors

Sabahattin Anil Ari
Ali Akdemir
Gurdeniz Serin
Murat Ulukus
Fatih Sendag

References (21)
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