Endometriosis Involving the Diaphragm: A Patient‐Tailored Minimally Invasive Surgical Treatment

Andrea Viti, Viti A, Pietro Bertoglio, Giovanni Roviglione, Roviglione G, Roberto Clarizia, Clarizia R, Ruffo G, Giacomo Ruffo, Marcello Ceccaroni, Alberto C Terzi, Terzi AC, Alberto Terzi
World journal of surgery · 2019 · vol. 44(4) , pp. 1099–1104 · doi:10.1007/s00268-019-05320-4 · PMID:31820061 · W2992753635
article OA: closed CC0 ⤵ 10 in-corpus citations
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This study describes the feasibility and safety of a minimally invasive video-assisted thoracic surgery (VATS) approach for treating diaphragmatic endometriosis, demonstrating reduced postoperative pain and improved cosmetic outcomes compared to open surgery.

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Abstract

BACKGROUND: Diaphragmatic endometriosis is a rare presentation of endometriosis and no standardized technique for surgical treatment is available so far. We aim to verify and describe feasibility, safety and post-operative outcomes of patients affected by diaphragmatic endometriosis treated with a minimally invasive video-assisted thoracic approach. METHODS: We prospectively collected data of all patients we operated on at our Institution for diaphragmatic endometriosis between 2015 and 2019. We included all patients with a previous histological diagnosis of pelvic or abdominal endometriosis who have complained chronic thoracic pain or who had two or more episodes of pneumothorax with or without radiological evidence of pleural and diaphragmatic endometriosis. RESULTS: During the study period, we operated on 22 patients, 20 on the right side, one on the left side and one bilaterally. Indication for surgery was based on symptoms and/or radiological evidence of diaphragmatic disease. Diaphragm was resected and reconstructed according to intraoperative findings; in 11 cases, an additional mesh was used to reinforce the suture. According to our experience with VATS, we shift from an open approach to a uniportal VATS technique. CONCLUSIONS: Surgery for diaphragmatic endometriosis can be safely performed using a minimally invasive VATS approach, which is feasible and safe even when more extensive diaphragmatic resections are required, and it allows a lower post-operative pain compared to the open approach. Moreover, uniportal VATS approach guarantees similar outcomes with better cosmetic results.

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Condition tags

endometriosisthoracic_endometriosis

MeSH descriptors

Diaphragm Endometriosis Minimally Invasive Surgical Procedures Muscular Diseases Thoracic Surgery, Video-Assisted Adult Diaphragm Endometriosis Female Humans Minimally Invasive Surgical Procedures Muscular Diseases Prospective Studies Thoracic Surgery, Video-Assisted

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