Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

Yoshiaki Ota, M. Andou, Masaaki Andou, Ikuko Ota
Asian journal of endoscopic surgery · 2018 · vol. 11(1) , pp. 7–14 · doi:10.1111/ases.12464 · PMID:29444547 · W2790824467
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This paper describes laparoscopic surgical techniques for deep infiltrating endometriosis involving urinary tract reconstruction and bowel resection, detailing classification systems and operative procedures.

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Abstract

Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.

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Outcome instruments

Enzian

Condition tags

mesh:D004715mesh:D017699endometriosisdie_deep_infiltratingbowel_endometriosischronic_pelvic_paindysmenorrheadyspareunia

MeSH descriptors

Endometriosis Endometriosis Intestinal Diseases Laparoscopy Urologic Diseases Urologic Diseases Adult Endometriosis Endometriosis Female Humans Intestinal Diseases Intestinal Diseases Intestinal Diseases Laparoscopy Pelvic Pain Pelvic Pain Pelvic Pain Prognosis Randomized Controlled Trials as Topic

Citation neighborhood

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References (76)

Cited by (7)

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