Endometriosis profunda infiltrante: seguimiento a un año luego de tratamiento laparoscópico

Juan D. Castañeda, Luis A. Almanza, Juan Carlos Muñoz, Adriana Arango, José F. De Los Ríos, Eduardo Serna, Gustavo A. Calle, Ricardo Vásquez
In: Revista Colombiana de Obstetricia y Ginecología · 2010 · vol. 61(2) , pp. 129–135 · doi:10.18597/rcog.281 · W1490580184
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Laparoscopic treatment of deep infiltrating endometriosis resulted in significantly decreased pain symptoms, with only one complication and 12% recurrence at one year.

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The paper studied 24 patients with deeply infiltrating endometriosis who underwent laparoscopic surgical treatment in Medellín between September 2007 and February 2008, evaluating demographics, pain symptoms, lesion characteristics and anatomic location, treatment details, surgical time, and complications over a one-year follow-up. It reported statistically significant decreases in painful symptoms, with rectal lesion as the only noted complication (4.1%), and 3 patients (12%) experiencing recurrence within the year. The authors’ main caveat is that this was a small, single-cohort series without an explicit control group and with follow-up limited to one year. This paper is centrally about endometriosis — it provides one-year outcomes after laparoscopic treatment of deeply infiltrating endometriosis.

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Abstract

Objetivo: conocer la evolución a un año de las pacientes a quienes se les ha realizado tratamiento quirúrgico laparoscópico de la endometriosis profunda infiltrante.Metodología: cohorte de 24 pacientes con edades comprendidas entre 22 y 51 años a quienes se les realizó tratamiento quirúrgico de la endometriosis profunda infiltrante en la Unidad de Endoscopia Ginecológica de la Clínica del Prado y Profamilia, en Medellín, entre septiembre del 2007 y febrero del 2008. Se evaluaron las variables sociodemográficas, síntomas dolorosos, localización anatómica de la endometriosis profunda infiltrante, características de la lesión, tratamiento, tiempo quirúrgico, complicaciones.Resultados: se presentó una lesión de recto como única complicación en esta serie (4,1%). Hubo una disminución estadísticamente significativa de los síntomas dolorosos. Tres pacientes (12%) tuvieron recurrencias al año de seguimiento.Conclusión: el tratamiento laparoscópico de la endometriosis profunda infiltrante surge como una alternativa para el tratamiento de la endometriosis infiltrativa profunda.
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Endometriosis profunda infiltrante: seguimiento a un año luego de tratamiento laparoscópico DOI: https://doi.org/10.18597/rcog.281Palabras clave: endometriosis profunda infiltrante, laparoscopia, síntomas dolorosos, complicacionesResumen Objetivo: conocer la evolución a un año de las pacientes a quienes se les ha realizado tratamiento quirúrgico laparoscópico de la endometriosis profunda infiltrante. Metodología: cohorte de 24 pacientes con edades comprendidas entre 22 y 51 años a quienes se les realizó tratamiento quirúrgico de la endometriosis profunda infiltrante en la Unidad de Endoscopia Ginecológica de la Clínica del Prado y Profamilia, en Medellín, entre septiembre del 2007 y febrero del 2008. Se evaluaron las variables sociodemográficas, síntomas dolorosos, localización anatómica de la endometriosis profunda infiltrante, características de la lesión, tratamiento, tiempo quirúrgico, complicaciones. Resultados: se presentó una lesión de recto como única complicación en esta serie (4,1%). Hubo una disminución estadísticamente significativa de los síntomas dolorosos. Tres pacientes (12%) tuvieron recurrencias al año de seguimiento. Conclusión: el tratamiento laparoscópico de la endometriosis profunda infiltrante surge como una alternativa para el tratamiento de la endometriosis infiltrativa profunda. Biografía del autor/a Juan D. Castañeda Luis A. Almanza Juan C. Muñoz Adriana Arango José F. De Los Ríos Eduardo Serna Gustavo A. Calle Ricardo A. Vásquez Referencias bibliográficas Koninckx PR, Martin D. Treatment of deeply infiltrating endometriosis. Curr Opin Obstet Gynecol 1994;6:231-41. Vercellini P, Frontino G, Pietropaolo G, Gattei U, Daguati R, Crosignani PG. Deep endometriosis: definition, pathogenesis and clinical management. J Am Assoc Gynecol Laparosc 2004;11:153-61. Martin D, Hubert G, Levy B. Depth of infiltration of endometriosis. J Gynecol Surg 1989;5:55-60. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 1991;55:759-65. Redwine DB. Laparoscopic en bloc resection for treatment of the obliterated cul-de-sac in endometriosis. J Reprod Med 1992;37:695-8. Camagna O, Dhainaut C, Dupuis O, Soncini E, Martin B, Palazzo L, et al. Surgical management of rectovaginal septum endometriosis from a continuous series of 50 cases. Gynecol Obstet Fertil 2004;32:199-209. Delpy R, Barthet M, Gasmi M, Berdah S, Shojai R, Desjeux A, et al. Value of endorectal ultrasonography for diagnosing rectovaginal septal endometriosis infiltrating the rectum. Endoscopy 2005;37:357-61. Chapron C, Barakat H, Fritel X, Dubuisson J, Bréart G, Fauconnier A. Presurgical diagnosis of posterior deep infiltrating endometriosis based on a standardized questionnaire. Hum Reprod 2005;20:507-13. Koninckx PR, Martin D. Surgical treatment of deeply infiltrating endometriosis. En: Shaw RW, editor. Endometriosis, current understanding and management. Oxford: Blackwell; 1995. p. 264-81. Dumontier I, Roseau G, Vincent B, Chapron C, Dousset B, Chaussade S, et al. Comparison of endoscopic ultrasound and magnetic resonance imaging in severe pelvic endometriosis. Gastroenterol Clin Biol 2000;24:1197-204. Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini B, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 2003;18:157-61. Koh CH, Janik GM. The surgical management of deep rectovaginal endometriosis. Curr Opin Obstet Gynecol 2002;14:357-64. Chapron C, Dubbison JB. Laparoscopic treatment of deep endometriosis located on the uterosacral ligaments. Human Reproduction 1996;11:868-73. Chapron C, Dubbisson JB, Fritel X, Fernandez B, Poncelet C, Béguin S, et al. Operative management of deep endometriosis infiltrating the uterosacral ligaments. J Am Assoc Gynecol Laparosc 1999;6:31-7. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 1991;55:759-65. Brosens IA, Verleyen A, Cornillie F. The morphologic effect of short-term medical therapy of endometriosis. Am J Obstet Gynecol 1987;157:1215-21. Nisolle-Pochet M, Casanas-Roux F, Donnez J. Histologic study of ovarian endometriosis after hormonal therapy. Fertil Steril 1988;49:423-6. Nezhat C, Nezhat F, Pennington E. Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser. Br J Obstet Gynaecol 1992;99:664-7. Crosignani PG, Vercellini P, Biffignandi F, Costantini W, Cortesi I, Imparato E. Laparoscopy versus laparotomy in conservative surgical treatment for severe endometriosis. Fertil Steril 1996;66:706-11. Koninckx PR, Oosterlynck D, D'Hooghe T, Meuleman C. Deeply infiltrating endometriosis is a disease whereas mild endometriosis can be considered a nondisease. Ann NY Acad Sci 1994;734:333-41. Maher P, Wood C, Hill D. Excision of endometriosis in the pouch of Douglas by combined laparovaginal surgery using the Maher abdominal elevator. J Am Assoc Gynecol Laparosc 1995;2:199-202. Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod 2003;18:1922-7. Angioni S, Peiretti M, Zirone M, Palomba M, Gomel V, Melis GB. Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up. Hum Reprod 2006;21:1629-34. Kwok A, Lam A, Ford R. Deeply infiltrating endometriosis:implications. Diagnosis and management. Obstet Gynecol Surv 2005;56:168-77. Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: Histology and clinical significance. Fertil Steril 1990; 53:978-83. Donnez J, Nisolle M, Gillerot S, Smets M, Bassil S, Casanas-Roux F. Rectovaginal septum adenomyotic nodules: a series of 500 cases. Br J Obstet Gynaecol 1997;104:1014-8. Redwine DB. Conservative laparoscopic excision of endometriosis by sharp dissection: Life-table analysis of reoperation and persistant or recurrent disease. Fertil Steril 1991;56:628-34. Wheeler JM, Malinak LR. Recurrent endometriosis. Contrib Gynecol Obstet 1987;16:13-21. Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005;12:508-13. Barton-Smith P, Kent ASH, Yousef W, Rockall T. Surgical treatment of rectovaginal endometriosis -retrospective results for the first 45 patients treated at the MATTU, Guildford, United Kingdom. J Minim Invasive Gynecol 2007;14:S10-S11. Cómo citar Descargas Descargas Publicado Número Sección Licencia Derechos de autor 2010 Revista Colombiana de Obstetricia y Ginecología Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0. | Estadísticas de artículo | | |---|---| | Vistas de resúmenes | | | Vistas de PDF | | | Descargas de PDF | | | Vistas de HTML | | | Otras vistas |

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