Adnexal surgery “fertility sparing” in deep endometriosis

Adnexal surgery “fertility sparing” in deep endometriosis

Anna Katarzyna StepniewskaOrcid, Giulia Mantovani1, Chiara Signori1, Maria Manzone1, Silvia BaggioOrcid, Paola De MitriOrcid, Marcello CeccaroniOrcid

1 – Department for the Protection of Women’s Health and Quality of Life, ISSA International School of Surgical Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Anna Katarzyna Stepniewska

stepniewska.anna@gmail.com


DOI: 10.53146/lriog1202132

Abstract

Adnexal surgery in deep endometriosis represents a significant clinical problem because the patients who suffer from it are typically of childbearing age and often, in addition to aiming for the improvement of painful sym- ptoms, have a desire for pregnancy. Endometriosis can cause infertility and the surgical removal of the disease implies a good chance of conception; at the same time surgery, in particular of endometriomas, involves the risk of a reduction in the ovarian reserve, up to its extreme consequence represented by premature menopause. For this reason, the indications for surgery must be evaluated very carefully and accompanied by an appropriate instrumental study that allows for an adequate surgical procedure; all this, in order to radically remove the disease and not expose the patient to a high risk of recurrence resulting in subsequent surgical gestures and a consequent further reduction of the ovarian reserve. Histological, anatomical aspects and hints on surgical instrumentation are presented, all useful for choosing the most appropriate surgical approach. The various traditional and innovative surgical techniques are also discussed and other additional procedures useful to reduce the risk of decreased ovarian reserve and postoperative adhesions are described.

Keywords: deep endometriosis; laparoscopic surgery; ovarian reserve; fertility.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Ultrasound diagnostic criteria for ovarian and deep endometriosis

Ultrasound diagnostic criteria for ovarian and deep endometriosis

Mara AlbaneseOrcid, Carlotta Zorzi1, Anna Katarzyna StepniewskaOrcid, Paola De MitriOrcid, Giamberto Trivella1, Silvia Baggio1Orcid, Mariangela Fornalè, Marcello Ceccaroni1– Orcid

1 – Department of Obstetrics and Gynecology, Gynecological Oncology and Mini-Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding authors: Mara Albanese, Carlotta Zorzi

mara.albanese@sacrocuore.it, carlotta.zorzi@sacrocuore.it


DOI: 10.53146/lriog1202129

Abstract

Transvaginal ultrasonography is considered the first-line imaging technique for the diagnosis of endometriosis because it allows accurate exploration of the pelvis. In the evaluation of ovarian disease, ultrasonography is useful in recognizing endometrioma and distinguishing it from other diseases. The “typical” endometrioma is a unilocular cyst with “ground glass” echogenicity. The ultrasound features of endometriotic cysts change during pregnancy due to decidualization and with advancing age. In particular, the presence of vascularized solid component should raise suspicion of malignant formation. In the evaluation of extra-ovarian disease, ultrasound is useful to identify and evaluate the extention of DIE in the pelvic structures. The transvaginal evaluation is a dynamic and interactive exam. It is essential to identify the “sliding sign” of the anterior and posterior compartments, the tenderness of the tissues and organs, the“pain mapping” that means pain induced by the probe. Transvaginal ultrasonography allows for an accurate evaluation of the vagina, particularly the areas of the posterior and lateral vaginal fornixes, the retrocervical area, the uterosacral ligaments, and the rectovaginal septum. The slightly filled bladder allows to evaluate the bladder walls and the presence of endometriotic nodules that appear as linear or spherical hypoechoic lesions protruding towards the lumen, affecting the serosa, the muscle or the (sub) mucosa of the bladder. Deep rectal nodules appear as hypoechoic lesions with regular or irregular borders, poorly or non-vascularized on Color Doppler, which infiltrate the intestinal wall distorting its normal structure. An adequate ultrasound diagnosis is essential to perform adequate patient management.

Keywords: pelvic ultrasound; endometrioma; deep endometriosis; ovarian cyst.


Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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