Minimally invasive treatment of diaphragmatic endometriosis: a 15-year single referral center’s experience on 215 patients

Background Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guidelines about its treatment.

We describe a consecutive series of patients with DE managed by laparoscopy and videothoracoscopy (VATS) in our referral center in a period of 15 years. We developed a flow-chart classifying DE implants in foci, plaques and nodules and proposing an algorithm with the aim of standardizing the surgical approach.

215 patients were treated for DE. Lesions were almost always localized on the right hemidiaphragm (91%), and the endometriotic implants were distributed as: foci in 133 (62%), plaques in 24 (11%) and nodules in 58 patients (27%), respectively. In all cases of isolated pleural involvement, concomitant diaphragmatic hernia or lesions of the thoracic side of the diaphragm VATS was performed, alone or combined with laparoscopy, resulting in a total of 26 procedures. Following the proposed algorithm, specific surgical techniques were identified as the better approaches for the different types of the lesion, such as Argon Beam Coagulation and diathermocoagulation for diaphragmatic foci, peritoneal stripping for plaques, and nodulectomy or full-thickness resection of diaphragm for nodules.

It is crucial to standardize the surgical approach of DE, according to the type of lesion, thus reducing the rate of under- or over-treatments and intra or postoperative complications. This kind of surgery should be performed in a Referral Center by a gynecologic surgeon with oncogynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist. Similar content being viewed by others Change history 13 January 2021 A Correction to this paper has been published: https://doi.org/10.1007/s00464-021-08300-9

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J Turk Ger Gynecol Assoc 19(3):116–121 Roman H, Darwish B, Provost D, Baste JM (2016) Laparoscopic management of diaphragmatic endometriosis by three different approaches. Fertil Steril 106(2):e1 Author information Authors and Affiliations Corresponding author Ethics declarations Disclosures Marcello Ceccaroni, Giovanni Roviglione, Antonino Farulla, Pietro Bertoglio, Roberto Clarizia, Andrea Viti, Daniele Mautone, Matteo Ceccarello, Anna Stepniewska, and Alberto Claudio Terzi declare that they have no conflict of interest. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article was updated to correct the author listing, where given names and surnames were reversed. Rights and permissions About this article Cite this article Ceccaroni, M., Roviglione, G., Farulla, A. et al. Minimally invasive treatment of diaphragmatic endometriosis: a 15-year single referral center’s experience on 215 patients. Surg Endosc 35, 6807–6817 (2021). https://doi.org/10.1007/s00464-020-08186-z Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00464-020-08186-z