Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification

Charles Chapron, C. Chapron, Arnaud Fauconnier, A. Fauconnier, M. Vieira, Marco Vieira, H. Barakat, Habib Barakat, B Dousset, V. Pansini, Valeria Pansini, Vittorio Pansini, M.-C. Vacher-Lavenu, M C Vacher-Lavenu, Jean Dubuisson, J B Dubuisson
Human Reproduction · 2003 · vol. 18(1) , pp. 157–161 · doi:10.1093/humrep/deg009 · PMID:12525459 · W2170625386
article OA: bronze CC0 ⤵ 500 in-corpus citations
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This study analyzed 344 deeply infiltrating endometriosis lesions in 241 patients, finding uterosacral ligaments to be most common, and proposed a classification highlighting multifocality and surgical implications for different locations.

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Abstract

BACKGROUND: Deeply infiltrating endometriosis (DIE) is recognized as a specific entity responsible for pain. The distribution of locations and their contribution to surgical management has not been previously studied. METHODS: Medical, operative and pathological reports of 241 consecutive patients with histologically proven DIE were analysed. DIE lesions were classified as: (i). bladder, defined as infiltration of the muscularis propria; (ii). uterosacral ligaments (USL), as DIE of the USL alone; (iii). vagina, as DIE of the anterior rectovaginal pouch, the posterior vaginal fornix and the retroperitoneal area in between, and (iv). intestine, as DIE of the muscularis propria. RESULTS: A total of 241 patients presented 344 DIE lesions: USL (69.2%; 238); vaginal (14.5%; 50); bladder (6.4%; 22); intestinal (9.9%; 34). The proportion of isolated lesions differed significantly according to the DIE location: 83.2% (198) for USL DIE; 56.0% (28) for vaginal DIE; 59.0% (13) for bladder DIE; 29.4% (10) for intestinal DIE (P < 0.0001). The total number of DIE lesions varied significantly according to the location (P < 0.0001). In 39.1% of cases (9/23) intestinal lesions were multifocal. Only 20.6% (seven cases) of intestinal DIE were isolated and unifocal. CONCLUSIONS: Multifocality must be considered during the pre-operative work-up and surgical treatment of DIE. We propose a surgical classification based on the locations of DIE. Operative laparoscopy is efficient for bladder, USL and vaginal DIE. However, indications for laparotomy still exist, notably for bowel lesions.

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Condition tags

mesh:D004715mesh:D017699endometriosisdie_deep_infiltrating

MeSH descriptors

Adnexal Diseases Endometriosis Intestinal Diseases Urinary Bladder Diseases Vaginal Diseases Adnexal Diseases Adnexal Diseases Adnexal Diseases Adult Endometriosis Endometriosis Endometriosis Endometriosis Female Humans Intestinal Diseases Intestinal Diseases Intestinal Diseases Middle Aged Pelvic Pain

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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