[Nerve sparing techniques in deep endometriosis surgery to prevent urinary or digestive functional disorders: Techniques and results: CNGOF-HAS Endometriosis Guidelines]

B. Rabischong, Rabischong B, R. Botchorishvili, Nicolas Bourdel, N Bourdel, Bourdel N, S. Curinier, Curinier S, S. Campagne-Loiseau, Campagne-Loiseau S, Jean Luc Pouly, J L Pouly, Pouly JL, Michel Canis, M Canis
Gynecologie, obstetrique, fertilite & senologie · 2018 · vol. 46(3) , pp. 309–313 · doi:10.1016/j.gofs.2018.02.031 · PMID:29551299 · W2790832631
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This paper reviews technical approaches for nerve preservation during deep endometriosis surgery to prevent urinary and digestive functional deficits.

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Abstract

OBJECTIVES: To evaluate the feasibility and functional urinary and digestive results of nerve sparing techniques in endometriosis surgery. METHODS: A research on the medline/pubmed database using specific keywords (nerve sparing, endometriosis, pelvic nerves) identified 7 publications among about 50 whose purpose was to describe the feasibility, the techniques and the functional results of nerve preservation in this indication. Among them there are: 2 uncontrolled retrospective studies, 3 prospective non-randomized studies, a meta-analysis and a review of the literature. RESULTS: Nerve preservation requires a perfect knowledge of the anatomy of the pelvic autonomic system. The laparoscopic approach is preferred by the different authors due to its anatomical advantage. The feasibility of this technique seems to be demonstrated despite certain limitations in the different studies and depending of the retroperitoneal extension of the lesions. When feasible, it is likely to significantly improve postoperative urinary function (urinary retention) compared to a conventional technique. It is observed no difference regarding digestive function. CONCLUSIONS: Nerve sparing in this indication is a technique the feasibility of which has been demonstrated and is subject to the topography and extent of the disease. In the absence of invasion or entrapment of pelvic autonomic nerves by endometriosis, this technique improves postoperative voiding function (NP3). During pelvic surgery for endometriosis, it is recommended to identify and preserve autonomic pelvic nerves whenever possible (GradeC).

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Peripheral Nerve Injuries Endometriosis Endometriosis Female Female Humans Humans Hypogastric Plexus Hypogastric Plexus Laparoscopy Laparoscopy Organ Sparing Treatments Organ Sparing Treatments Pelvis Pelvis Pelvis Peripheral Nerve Injuries Peripheral Nerve Injuries Urination Disorders

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License: CC0 · commercial use OK