Adnexal surgery “fertility sparing” in deep endometriosis

01/09/202122/11/2021 Editor Anna Katarzyna Stepniewska, Chiara Signori, Giulia Mantovani, Marcello Ceccaroni, Maria Manzone, Paola De Mitri, Silvia Baggio ArticlesLRIOG 2021-3 deep endometriosis, fertility, laparoscopic surgery, ovarian reserve.

Adnexal surgery “fertility sparing” in deep endometriosis

Anna Katarzyna Stepniewska¹– , Giulia Mantovani¹, Chiara Signori¹, Maria Manzone¹, Silvia Baggio¹– , Paola De Mitri¹– , Marcello Ceccaroni¹–

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

01/09/202122/11/2021 Editor Anna Katarzyna Stepniewska, Carlotta Zorzi, Giamberto Trivella, Mara Albanese, Marcello Ceccaroni, Mariangela Fornalè, Paola De Mitri, Silvia Baggio ArticlesLRIOG 2021-3 deep endometriosis, endometrioma, ovarian cyst, pelvic ultrasound.

Ultrasound diagnostic criteria for ovarian and deep endometriosis

Mara Albanese¹– , Carlotta Zorzi¹, Anna Katarzyna Stepniewska¹– , Paola De Mitri¹– , Giamberto Trivella¹, Silvia Baggio¹– , Mariangela Fornalè,Marcello Ceccaroni¹–

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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Epidemiology and social impact of endometriosis today

01/09/202122/11/2021 Editor Giulia Mantovani, Marcello Ceccaroni, Maria Manzone, Matteo Ceccarello, Paola De Mitri, Silvia Baggio ArticlesLRIOG 2021-3 burden, costs, diagnostic delay, Endometriosis, epidemiology, quality of life.

Epidemiology and social impact of endometriosis today

Silvia Baggio¹– , Giulia Mantovani¹, Paola De Mitri¹– , Matteo Ceccarello¹– , Maria Manzone¹, Marcello Ceccaroni¹–

Corresponding author: Silvia Baggio

silvia.baggio@sacrocuore.it

DOI: 10.53146/lriog1202128

Abstract

Endometriosis is a chronic, persistent, recurrent pelvic disease that can cause debilitating symptoms and infertility or be completely asymptomatic. It is a very common disease among women of childbearing age, with a prevalence of around 2% in the low-risk population, from more than 40% in women with chronic pelvic pain and up to 50-60% in infertile women. It is believed that 176 million are the women affected worldwide, but the true prevalence rates are not fully known yet, mainly because the symptoms are often underestimated by primary care doctors and gynecologists, causing an average diagnostic delay of about 4-6 years. This delay is often the cause of an irrecoverable impairment of the quality of life of women, both physically, psychically and socially /relationally, as well as of an important loss of productivity and health costs soaring, making Endometriosis deserve the title of “social disease”. Understanding Endometriosis and its prevalence and improving the knowledge of its risk factors could help physicians to promptly recognize it or at least suspect it, and therefore direct the affected women to Specific Referral Centers, thus allowing an early taking charge with subsequent benefit for the single and for the society.

Keywords: endometriosis; epidemiology; burden; quality of life; costs; diagnostic delay.

Available in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283

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Laparoscopic diagnosis and treatment of intestinal endometriosis

01/09/202122/11/2021 Editor Carlo Tricolore, Daniele Mautone, Francesco Bruni, Giacomo Ruffo, Giovanni Roviglione, Marcello Ceccaroni, Matteo Ceccerello, Paola De Mitri, Roberto Clarizia ArticlesLRIOG 2021-3 bowel resection, bowel shaving, discoid resection, Endometriosis, laparoscopy.

Laparoscopic diagnosis and treatment of intestinal endometriosis

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

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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