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This paper is a consensus recommendation from an ESGE/ESHRE/WES working group on how surgery for deep endometriosis should be performed in women of reproductive age. It reviews technical aspects across preoperative assessment and surgical steps, discussing different operative approaches according to disease location and extent, including uterosacral ligaments and the rectovaginal septum (with or without rectal involvement), and considerations for urinary tract or extrapelvic disease, as well as management of frozen pelvis and the role of hysterectomy. A key limitation explicitly stated is that, because evidence is limited, most recommendations rely on clinical expertise rather than high-quality data. This paper is centrally about endometriosis — specifically providing technical recommendations for surgical treatment of deep endometriosis.
Abstract
STUDY QUESTION\nHow should surgery for endometriosis be performed?\n\nSUMMARY ANSWER\nThis document provides recommendations covering technical aspects of different methods of surgery for deep endometriosis in women of reproductive age.\n\nWHAT IS KNOWN ALREADY\nEndometriosis is highly prevalent and often associated with severe symptoms. Yet compared to equally prevalent conditions, it is poorly understood and a challenge to manage. Previously published guidelines have provided recommendations for (surgical) treatment of deep endometriosis, based on the best available evidence, but without technical information and details on how to best perform such treatment in order to be effective and safe.\n\nSTUDY DESIGN, SIZE, DURATION\nA working group of the European Society for Gynaecological Endoscopy (ESGE), ESHRE and the World Endometriosis Society (WES) collaborated on writing recommendations on the practical aspects of surgery for treatment of deep endometriosis.\n\nPARTICIPANTS/MATERIALS, SETTING, METHODS\nThis document focused on surgery for deep endometriosis and is complementary to a previous document in this series focusing on endometrioma surgery.\n\nMAIN RESULTS AND THE ROLE OF CHANCE\nThe document presents general recommendations for surgery for deep endometriosis, starting from preoperative assessments and first steps of surgery. Different approaches for surgical treatment are discussed and are respective of location and extent of disease; uterosacral ligaments and rectovaginal septum with or without involvement of the rectum, urinary tract or extrapelvic endometriosis. In addition, recommendations are provided on the treatment of frozen pelvis and on hysterectomy as a treatment for deep endometriosis.\n\nLIMITATIONS, REASONS FOR CAUTION\nOwing to the limited evidence available, recommendations are mostly based on clinical expertise. Where available, references of relevant studies were added.\n\nWIDER IMPLICATIONS OF THE FINDINGS\nThese recommendations complement previous guidelines on management of endometriosis and the recommendations for surgical treatment of ovarian endometrioma.\n\nSTUDY FUNDING/COMPETING INTEREST(S)\nThe meetings of the working group were funded by ESGE, ESHRE and WES. Dr Roman reports personal fees from ETHICON, PLASMASURGICAL, OLYMPUS and NORDIC PHARMA, outside the submitted work; Dr Becker reports grants from Bayer AG, Volition Rx, MDNA Life Sciences and Roche Diagnostics Inc. and other relationships or activities from AbbVie Inc., and Myriad Inc, during the conduct of the study; Dr Tomassetti reports non-financial support from ESHRE, during the conduct of the study; and non-financial support and other were from Lumenis, Gedeon-Richter, Ferring Pharmaceuticals and Merck SA, outside the submitted work. The other authors had nothing to disclose.
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Journal article
Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis
- Abstract:
- STUDY QUESTION How should surgery for endometriosis be performed? SUMMARY ANSWER This document provides recommendations covering technical aspects of different methods of surgery for deep endometriosis in women of reproductive age. WHAT IS KNOWN ALREADY Endometriosis is highly prevalent and often associated with severe symptoms. Yet compared to equally prevalent conditions, it is poorly understood and a challenge to manage. Previously published guidelines have provided recommendations for (surgical) treatment of deep endometriosis, based on the best available evidence, but without technical information and details on how to best perform such treatment in order to be effective and safe. STUDY DESIGN, SIZE, DURATION A working group of the European Society for Gynaecological Endoscopy (ESGE), ESHRE and the World Endometriosis Society (WES) collaborated on writing recommendations on the practical aspects of surgery for treatment of deep endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS This document focused on surgery for deep endometriosis and is complementary to a previous document in this series focusing on endometrioma surgery. MAIN RESULTS AND THE ROLE OF CHANCE The document presents general recommendations for surgery for deep endometriosis, starting from preoperative assessments and first steps of surgery. Different approaches for surgical treatment are discussed and are respective of location and extent of disease; uterosacral ligaments and rectovaginal septum with or without involvement of the rectum, urinary tract or extrapelvic endometriosis. In addition, recommendations are provided on the treatment of frozen pelvis and on hysterectomy as a treatment for deep endometriosis. LIMITATIONS, REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical expertise. Where available, references of relevant studies were added. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on management of endometriosis and the recommendations for surgical treatment of ovarian endometrioma. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the working group were funded by ESGE, ESHRE and WES. Dr Roman reports personal fees from ETHICON, PLASMASURGICAL, OLYMPUS and NORDIC PHARMA, outside the submitted work; Dr Becker reports grants from Bayer AG, Volition Rx, MDNA Life Sciences and Roche Diagnostics Inc. and other relationships or activities from AbbVie Inc., and Myriad Inc, during the conduct of the study; Dr Tomassetti reports non-financial support from ESHRE, during the conduct of the study; and non-financial support and other were from Lumenis, Gedeon-Richter, Ferring Pharmaceuticals and Merck SA, outside the submitted work. The other authors had nothing to disclose.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 2.7MB, Terms of use)
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- Publisher copy:
- 10.1093/hropen/hoaa002
Authors
- Publisher:
- Oxford University Press
- Journal:
- Human Reproduction Open More from this journal
- Volume:
- 2020
- Issue:
- 1
- Publication date:
- 2020-02-12
- Acceptance date:
- 2020-01-13
- DOI:
- EISSN:
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2399-3529
- Language:
-
English
- Keywords:
- Pubs id:
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1100678
- Local pid:
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pubs:1100678
- Deposit date:
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2020-04-18
- ARK identifier:
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- Copyright holder:
- Keckstein et al.
- Copyright date:
- 2020
- Rights statement:
- © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work properly cited. For commercial re-use, please contact [email protected]
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