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Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

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Role and evolution of nerve-sparing surgery for the treatment of deep infiltrating endometriosis

Marcello Ceccaroni1 – Orcid, Roberto Clarizia1, Giovanni Roviglione1, Francesco Bruni1, Daniele Mautone1 – Orcid, Giacomo Ruffo2 – 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

2 – Department of General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Marcello Ceccaroni

marcello.ceccaroni@sacrocuore.it

DOI: 10.53146/lriog1202140

Abstract

Nerve-Sparing (NS) surgery is a technique which, in the last decades, has shown to be highly effective in order to significantly reduce intestinal, vesical and sexual dysfunctions without reducing surgical results in eradicating Deep Infiltrating Endometriosis (DIE). Following a correct and standardized anatomo-surgical approach, NS technique for DIE can be reproducible by the pelvic surgeon who desires to face surgery for DIE and can lead, for what is possible in severe cases, to an optimal preservation of the majority of the visceral nerve fibers of the pelvis. This approach has shown not to have a negative impact over recurrence rates, which are similar to those related to the classical technique, such as the rates of efficacy over chronic pelvic pain.

Keywords: deep infiltrating endometriosis; laparoscopy; nerve-sparing; radical surgery; surgical anatomy.

Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283

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The role of a reference center in the multidisclipinary and interdisciplinary treatment of pelvic endometriosis

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The role of a reference center in the multidisclipinary and interdisciplinary treatment of pelvic endometriosis 

Daniele Mautone1 – Orcid, Simone Orlandi1 – Orcid, Giuseppe Caleffi1 – Orcid, Giuseppe Deledda1 – Orcid, Giovanni Foti1– Orcid, Elena Rossato1– Orcid, Stefano Cavalleri1, Giacomo Ruffo1 – Orcid, Luca Garriboli1 – Orcid,  Marcello Ceccaroni1– Orcid

1 – IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona

Corresponding Author: Daniele Mautone

daniele.mautone@sacrocuore.it

DOI: 10.53146/lriog1202130

Abstract

Endometriosis is a chronic hormone-dependent disease affecting approximately 25-30% of women in the third and fourth decade. Despite its frequency, it is often detected late. The aim of this article was to present a standardized treatment algorithm for an interdisciplinary endometriosis consultation considering medical and surgical approaches. Despite the frequency of endometriosis and a high number of publications dealing with the disease there is a lack of evidence in literature for standardized treatment algorithms allowing a rational diagnostic, medical, multiprofessional and therapeutic approach. The diagnosis includes a structured medical history with the identification of endometriosis-typical symptoms and a gynecological rectovaginal examina- tion, if necessary additional examinations. The treatment algorithm is essentially divided into the phase of diagnosis and the phase of therapy as well as the prevention of recurrence or long-term treatment. A multi-professional team of gynaecology, visceral surgery, vascular surgery ,urology, nutritional medicine, physiatry, gastroenterology, physiotherapy, psychology and psychiatry can be consulted for support. The treatment of endometriosis should be multiprofessional, standardized and reproducible during specialized consultations at certified centers.

Keywords: endometriosis; referral center; endometriosis unit; interdisciplinary approach.

Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283

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Treatment of complication after colo-rectal surgery for endometriosis

Editor , , ArticlesLRIOG 2021-3 , , , , .
Treatment of complication after colo-rectal surgery for endometriosis

Roberto Rossini1 – Orcid, Elisa Bertocchi1 – Orcid, Giacomo Ruffo1 – Orcid

1 – U.O.C. General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona

Corresponding Author: Roberto Rossini

roberto.rossini@sacrocuore.it

DOI: 10.53146/lriog1202136

Abstract

Background: endometriosis is a chronic benign disease, characterized by the presence of endometrial glands and stroma outside the uterine cavity. It can frequently affect the intestinal tract, the rectum and the sigmoid colon are often interested. Surgery is a valid option in case of infertility, chronic pelvic pain, intestinal obstruction and worsening of quality of life. Postoperative outcome is often favourable. Most frequent complication are colorectal and recto-vaginal fistulas. Aim of our study is to review our datas and present our experience in the treatment of colo-rectal complication after surgery for endometriosis
Methods: we retrospectively included 3054 cases of colorectal surgery for intestinal endometriosis performed from 2001 to 2020 in our institution. On the basis of the postoperative outcome we included 543 complications for the segmental resection and 50 for the disc resection.
Results: major colo-rectal complications such as anastomotic leackage and recto-vaginal fistula were 218 (8.3%) and 43 (1,6 %) respectively. Other intestinal complications were: 23 (0.9%) bowel occlusions, 15 (0.3%) intestinal perforations and 132 (5.0%) anastomotic strictures. We also had 76 (2.9%) haemoperitoneum and 36 (1.4%) urinary tract injuries. The group of disc resection only had 47 (11.3%) intraluminal bowel bleeding and 3 (0.7%) perforations.
Conclusion: when conservative treatment fails surgery represents a safe and feasible approach for bowel deep infiltrating endometriosis, resulting in an improvement of pain, fertility and quality of life. The rate of complications after bowel resection appear to be acceptable and often reversible. To achieve this goal surgeons, gynecologist, urologist and all other professionals of the multidisciplinary team from high volume centers need to work together.

Keywords: endometriosis; colorectal resection; complications; anastomotic leackage; recto-vaginal fistula.

Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283

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Laparoscopic diagnosis and treatment of intestinal endometriosis

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Laparoscopic diagnosis and treatment of intestinal endometriosis

Roberto Clarizia1, Giovanni Roviglione1 – Orcid, Francesco Bruni1, Daniele Mautone1 – Orcid, Carlo Tricolore1, Matteo Ceccerello1, Paola De Mitri1 – Orcid, Giacomo Ruffo2 – Orcid, Marcello Ceccaroni1 – Orcid

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

2 – Department of General Surgery, IRCCS “Sacro Cuore – Don Calabria” Hospital, Negrar di Valpolicella, Verona

Corresponding Author: Roberto Clarizia

roberto.clarizia@sacrocuore.it

DOI: 10.53146/lriog1202134

Abstract

The diagnosis and treatment of intestinal infiltrating endometriosis represents one of the most difficult challenges for an Endometriosis Unit, where such patients should be mandatorily referred. It is a condition that can be both asymptomatic and debilitating the quality of life of affected women, and which intersects with crucial issues such as reproductive desire and pelvic visceral functions. Correct treatment can indeed lead to a significant improvement in the quality of life but is not without long-term risk in terms of rectal, bladder and sexual dysfunctions, as well as peri-operative surgical complications.
The techniques of shaving, discoid resection and segmental resection should not be considered alternatives but distinct and each finds specific indications for specific subsets of patients taking into account on the size of the lesion, the depth of infiltration and patients symptoms.

Keywords: endometriosis; bowel resection; laparoscopy; bowel shaving; discoid resection.

Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283

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