Surgical management of diaphragmatic and thoracic endometriosis’: A French multicentric descriptive study

Alexia Wetzel, Wetzel A, Charles-André Philip, Charles‐André Philip, Philip CA, François Golfier, Francois Golfier, Golfier F, Pierre-Emmanuel Bonnot, Bonnot PE, Pierre‐Emmanuel Bonnot, Cotte E, Eddy Cotte, Pierre-Yves Brichon, Brichon PY, Benjamin Darnis, Darnis B, G. Chêne, Chene G, Gautier Chene, T. Michy, Thierry Michy, Michy T, P. Hoffmann, Pascale Hoffmann, Hoffmann P, François Tronc, Francois Tronc, Tronc F, Gil Dubernard, Dubernard G
Journal of gynecology obstetrics and human reproduction · 2021 · vol. 50(8) , pp. 102147 · doi:10.1016/j.jogoh.2021.102147 · PMID:33862264 · W3154263024
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This multicentric study describes the surgical management of diaphragmatic and thoracic endometriosis based on French practices.

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Abstract

IntroductionSurgical management of Diaphragmatic and thoracic endometriosis (DTE) is still controversial, a thoracic or an abdominal approach can be proposed.MethodsWe conducted a multicentric retrospective study in 8 thoracic, gynecology or digestive surgery units in 5 French university hospitals. The main objective was to review the current management of DTE.Results50 patients operated for DTE from 2010 to 2017 were included: 26 with a thoracic approach and 24 with an abdominal approach. Preoperative pelvic endometriosis (PE) concerned 25 patients. In 38 patients, DTE diagnosis was made on clinical symptoms (pneumothorax (n = 19), chronic or catamenial chest pain (n = 18) or hemopneumothorax (n = 1)). Median time from onset of symptoms to diagnosis was 47 months (0-212). PE surgery concurrently occurred in 22 patients. We report diaphragmatic nodules, pleuropulmonary nodules and diaphragmatic perforations in 42, 5 and 22 women respectively. Lesions were right-sided in 45 patients. Nodules were destructed in 12 cases and resected in 38 cases. When a diaphragmatic reconstruction was needed (n = 31), a simple suture was performed in 26 patients, while 5 patients needed a mesh repair. Pleural symphysis was performed for all patients who received a thoracic approach. DTE resection was considered complete in 46 patients. Three patients had severe 30-days complications of DTE surgery. Median follow-up was 20 months (range 1-69). Recurrence occurred in 10 patients.ConclusionThe results emphasize the importance of systematically looking for chest pain in patients suffering from PE and underline the lack of a standardized procedure and treatment in DTE.

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Condition tags

endometriosisthoracic_endometriosis

MeSH descriptors

Diaphragm Endometriosis Thoracic Diseases Adult Diaphragm Diaphragm Endometriosis Endometriosis Endometriosis Female France France Hospitals, University Hospitals, University Hospitals, University Humans Middle Aged Recurrence Retrospective Studies Thoracic Diseases

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