Prise en charge chirurgicale de l’endométriose profonde avec atteinte digestive, RPC Endométriose CNGOF-HAS

Ballester M, Marcos Ballester, M Ballester, Horace Roman, H Roman, Roman H
Gynecologie, obstetrique, fertilite & senologie · 2018 · vol. 46(3) , pp. 290–295 · doi:10.1016/j.gofs.2018.02.003 · PMID:29534879 · W2790327869
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This paper discusses the surgical management of deep endometriosis with digestive involvement based on the CNGOF-HAS Endometriosis guidelines.

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Abstract

Deep endometriosis with colorectal involvement is considered one of the most severe forms of the disease due to its impact on patients' quality of life and fertility but also by the difficulties encountered by the clinicians when proposing a therapeutic strategy. Although the literature is very rich, evidence based medicine remains poor explaining the great heterogeneity concerning the management of such patients. Surgery therefore remains a therapeutic option. It improves the intensity of gynecological, digestive and general symptoms and the quality of life. Concerning the surgical approach, it appears that laparoscopy should be the first option; the laparoscopic robot-assisted route can also be proposed. The techniques of rectal shaving, discoid resection and segmental resection are the three techniques used for surgical excision of colorectal endometriosis. The parameters taken into account for the use of either technique are: the surgeon's experience, the depth of infiltration of the lesion within the rectosigmoid wall, the lesion size and circumference, multifocality and the distance of the lesion from the anal margin. In the case of deep endometriosis with colorectal involvement, performing an incomplete surgery increases the rate of pain recurrence and decreases postoperative fertility. In case of surgery for colorectal endometriosis, pregnancy rates are similar to those obtained after ART in non-operated patients. Existing data are insufficient to formally recommend first line surgery or ART in infertile patients with colorectal endometriosis. The surgery for colorectal endometriosis exposes to a risk of postoperative complications and recurrence of which the patients should be informed preoperatively.

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Condition tags

dyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Colonic Diseases Endometriosis Rectal Diseases Colonic Diseases Colonic Diseases Dyspareunia Dyspareunia Dyspareunia Endometriosis Endometriosis Female Fertility Humans Laparoscopy Pelvic Pain Pelvic Pain Pelvic Pain Quality of Life Rectal Diseases Rectal Diseases

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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Cited by (10)

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