OP12.03: Creating the surgical platform for patients with deep infiltrating endometriosis: results from the first sonovaginography centre in Western Australia

To assess the accuracy of preoperative sonovaginography for mapping of deep infiltrating endometriosis (DIE) lesions by correlating ultrasound findings with MRI and laparoscopic findings. A retrospective review was done of patients who had undergone sonovaginography at our specialist Ultrasound Centre over a period of 5 years. Ethical approval was obtained prior to undertaking this review. Once there was suggestion of DIE on initial pelvic scan, sonovaginography following bowel preparation was performed for a detailed assessment to map out all the lesions. Statistical analysis of ultrasound findings was done assessing sensitivity, specificity, positive and negative predictive values, correlating with gold standard surgical findings. There were 270 patients with evidence of DIE on sonovaginography, of which 124 patients underwent subsequent surgery. The mean age of the cohort was 38 yrs. In 58 patients there was history of previous diagnosis of endometriosis at a diagnostic laparoscopy, of whom 30 had had unsuspected finding of severe endometriosis. Amongst the rest of the patients, in 45 there were clinical symptoms suggestive of endometriosis where as in 20 patients the very first suspicion of endometriosis was raised at a routine pelvic scan done at our clinic for various other indications. Of these 20 unsuspected cases, 15 had DIE on subsequent sonovaginography as well as at surgery and the rest had stage1-2 endometriosis at laparoscopy as predicted at sonovaginography. The agreement between Sonovaginography and MRI findings and their individual correlation with surgical findings were statistically significant. Sonovaginography is a valuable tool in detailed preoperative mapping of endometriosis lesions. In planning surgical management, knowledge of extent of disease as outlined on sonovaginography assists in planning multidisciplinary surgical care including colorectal surgery and urology thus limiting the requirement of repeated surgeries. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.