Chirurgia Annessiale “fertility sparing” nell’endometriosi profonda

Chirurgia Annessiale “fertility sparing” nell’endometriosi profonda

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

1 – Dipartimento per la Tutela della Salute e della Qualità di Vita della Donna, ISSA International School of Surgical Anatomy, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Criteri diagnostici ecografici per endometriosi ovarica profonda

Criteri diagnostici ecografici per endometriosi ovarica profonda

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

1 – Dipartimento di Ostetricia e Ginecologia, Oncologia Ginecologica e Chirurgia Pelvica Mini-Invasiva, International School of Surgical Anatomy, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

Autori di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Epidemiologia ed impatto sociale dell’endometriosi oggi

Epidemiologia ed impatto sociale dell’endometriosi oggi

Silvia BaggioOrcid, Giulia Mantovani1, Paola De MitriOrcid, Matteo CeccarelloOrcid, Maria Manzone1, Marcello Ceccaroni1– Orcid

1 – Dipartimento di Ostetricia e Ginecologia, Oncologia Ginecologica e Chirurgia Pelvica Mini-Invasiva, International School of Surgical Anatomy, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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Diagnosi e trattamento laparoscopico dell’endometriosi intestinale

Diagnosi e trattamento laparoscopico dell’endometriosi intestinale

Roberto Clarizia1, Giovanni RoviglioneOrcid, Francesco Bruni1, Daniele MautoneOrcid, Carlo Tricolore1, Matteo Ceccerello1, Paola De MitriOrcid, Giacomo RuffoOrcid, Marcello Ceccaroni1 – Orcid

1 – Dipartimento di Ostetricia e Ginecologia, Oncologia Ginecologica e Chirurgia Pelvica Mini- Invasiva, International School of Surgical Anatomy, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

2 – Dipartimento di Chirurgia Generale, IRCCS Ospedale “Sacro Cuore – Don Calabria”, Negrar di Valpolicella, Verona

Autore di riferimento: 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.


Presente in LRIOG Nr.3 – 2021

e-ISSN: 1824-0283


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