L’endométriose thoracique : une expérience à propos de 27 cas opérés

Objective: To report our experience in the surgical management of thoracic endometriosis, describing our diagnostic and therapeutic approach and the results obtained. Patients and methods: This was a monocentric, 22-year retrospective study of 27 patients with an average age of 32 years (range 19 to 49 years) who were operated on for thoracic endometriosis. These patients were divided into 2 groups according to the surgical approach taken. Group 1, from January 1994 to June 2006, consisted of 6 patients and Group 2, from July 2006 to December 2016, consisted of 21 patients. Clinical, para-clinical, therapeutic and evolutionary parameters were studied. Results: In Group 1, 5 patients had catamenial pneumothorax and 1 had catamenial hemothorax. In Group 2, there were 13 cases of catamenial pneumothorax, 7 cases of catamenial hemothorax and 1 case with a hemoptysic pulmonary pseudotumor. All patients except one (presenting with the pulmonary pseudotumor) were nulliparous with a history of dysmenorrhea. Twenty-two patients were suffering at least their third recurrence and six of them had confirmed pelvic endometriosis. The standard radiograph of the thorax was systematic. A thoracic CT scan was performed in 12 cases. Lesions were right (n = 24) or bilateral (n = 2). The pseudotumor sat in the upper left lobe. Surgical exploration in Group 1 was performed by mini thoracotomy in all cases, including 5 times during menstruation, while in Group 2 the surgery was performed by mini thoracotomy (n = 19) and videothoracoscopy (n = 2) during menstruation. Diaphragmatic endometriosis plaques were observed in 22 cases and blebs in 6 cases. The surgical procedures in Group 1 consisted of a resection-suture of the plaques of endometriosis in 6 cases, completed by a resection-suture of the blebs in 4 cases, and a pleurodesis by abrasion. In Group 2, a phrenoplasty of diaphragmatic fenestration was performed 16 times, associated in two cases with resection of the blebs, and pleurodesis by abrasion (n = 2) or talcage (n = 19). An upper left lobectomy was performed in the case of the pseudotumor, bilateral lesions were performed at an average of 7 month intervals. Endometriosis was confirmed on pathologic examination 14 times, in other cases the diagnosis was based on gynecological history, the coincidence of the clinical signs with the menses, or the peroperative discovery of endometriosis plaques. A 6-month complementary hormone therapy (triptoreline) was prescribed. The outcome was good in 19 patients. Five recurrences (3 in Group 1 and 2 in Group 2) were noted. The first three were resumed. Mortality was nil in both groups. Conclusion: The surgery, by overlapping diaphragmatic fenestrations and pleurodesis, when performed during menstruation and in combination with immediate suppressive hormone therapy, resulted in a low rate of recurrence, better comfort and nil mortality.