Abdominal wall endometriosis occurring after cesarean section: an underestimated complication

W Y Wang, B Wei, Bojun Wei, Y X Cao, Ye‐Xuan Cao, X Xie, Xie Xiao-dong, C Q Li, Yingying Xu, Y J Xu
Clinical and experimental obstetrics & gynecology · 2016 · vol. 43(5) , pp. 678–684 · doi:10.12891/ceog3118.2016 · PMID:30074318 · W3010981725
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This study analyzed 95 patients with abdominal wall endometriosis after cesarean section, finding lesion size, symptom duration, CA125 levels, and depth of invasion influenced the need for mesh repair.

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Abstract

The aim of the study was to review patients characteristics, describe the exact anatomic locations and size of the endometriosis in the abdominal wall, and discuss the factors that may contribute to mesh use during abdominal wall endometriosis (AWE) resection. MATERIALS AND METHODS: Patients diagnosed with AWE in their surgical scars from January 2008 to December 2014 were documented. Descriptive data was collected and analyzed. RESULTS: A total of 95 patients with an age ranging from 26 to 48 years, with a mean age of 33.5 ?5.0 years at the time of excision were analyzed. The mean diameter of the mass was 3.25 cm in the present series with an average of 4.97 cm in the mesh group by ultrasound. A total of 18 patients had mesh therapy for fascia defect compared with 77 non-mesh therapy patients. The size of the lesions, the mean duration of symptoms for painful mass, and level of the serum CA125 were statistically different between mesh group and non-mesh group (p < 0.05). Cases of endometriosis lesions limited to the adipose layer had significant lower chance of using mesh (p < 0.05). However, adipose layer endometriosis lesions that had penetrated through the fascia layer and invaded into rectus abdominis muscle layer with/without peritoneum layer had significant higher chance of using mesh (p < 0.05). CONCLUSIONS: The more common position for scar endometriosis may be in the adipose layer at the corner of the surgical scar. Mesh therapy should be considered before surgery when the diameter of the abdominal wall mass detected by ultrasound is more than five em and/or when the lesions invade into rectus abdominis muscle with/without peritoneum tissues from adipose and fascia layers.
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Abstract

The aim of the study was to review patients characteristics, describe the exact anatomic locations and size of the endometriosis in the abdominal wall, and discuss the factors that may contribute to mesh use during abdominal wall endometriosis (AWE) resection. Materials and Methods: Patients diagnosed with AWE in their surgical scars from January 2008 to December 2014 were documented. Descriptive data was collected and analyzed. Results: A total of 95 patients with an age ranging from 26 to 48 years, with a mean age of 33.5 ±5.0 years at the time of excision were analyzed. The mean diameter of the mass was 3.25 cm in the present series with an average of 4.97 cm in the mesh group by ultrasound. A total of 18 patients had mesh therapy for fascia defect compared with 77 non-mesh therapy patients. The size of the lesions, the mean duration of symptoms for painful mass, and level of the serum CA125 were statistically different between mesh group and non-mesh group (p < 0.05). Cases of endometriosis lesions limited to the adipose layer had significant lower chance of using mesh (p < 0.05). However, adipose layer endometriosis lesions that had penetrated through the fascia layer and invaded into rectus abdominis muscle layer with/without peritoneum layer had significant higher chance of using mesh (p < 0.05). Conclusions: The more common position for scar endometriosis may be in the adipose layer at the corner of the surgical scar. Mesh therapy should be considered before surgery when the diameter of the abdominal wall mass detected by ultrasound is more than five cm and/or when the lesions invade into rectus abdominis muscle with/without peritoneum tissues from adipose and fascia layers.

Keywords

- Abdominal wall endometriosis - Surgical scar - Mesh - CA 125

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Abdominal Wall Cesarean Section Endometriosis Postoperative Complications Abdominal Wall Adult CA-125 Antigen CA-125 Antigen Cesarean Section Child, Preschool Cicatrix Cicatrix Endometriosis Endometriosis Female Humans Membrane Proteins Membrane Proteins Middle Aged Postoperative Complications

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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