Diaphragmatic endometriosis: diagnosis and laparoscopic treatment

Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guide-lines about its treatment. In fact, Literature reports a plenty of single-center small series or case-reports about case treated for DE, thus, still nowadays a general consensus for diagnosis or treatment of DE does not exist. However, Our Institution has collected the largest case-series of patient treated for DE, reporting high-effective surgical results and proposing laparoscopy as its ideal tool, for its high cost-benefits relationship and its low morbidity.
A proposal of algorithm for diagnosis and treatment of DE has recently been published by Our Institution with the aim to standardize the surgical appro- ach according to the type of lesion, and finally reducing the rate of under- or over-treatments and intra or post-operative complications.
Conclusions: this kind of surgery should be performed in a Referral Center by a gynecologic surgeon with onco-gynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist.

Keywords: diaphragmatic endometriosis; thoracic endometriosis; extrapelvic endometriosis; laparoscopy; radical surgery.