Geburtshilfe Frauenheilkd 2013; 73(9): 918-923
DOI: 10.1055/s-0033-1350890
DGGG Review
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Surgical Therapy of Endometriosis: Challenges and Controversies

Herausforderungen und Kontroversen bei der operativen Therapie der Endometriose
S. Rimbach
1   Gynäkologie und Geburtshilfe, Landeskrankenhaus Feldkirch, Feldkirch, Austria
,
U. Ulrich
2   Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin
,
K. W. Schweppe
3   Endometriose-Zentrum Ammerland, Westerstede
› Author Affiliations
Further Information

Publication History

received 04 August 2013
revised 04 September 2013

accepted 04 September 2013

Publication Date:
11 October 2013 (online)

Abstract

Endometriosis is one of the most common disorders encountered in surgical gynaecology. The laparoscopic technique, the planning of the surgical intervention, the extent of information provided to patients and the interdisciplinary coordination make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms. However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgical strategies. Thus, the excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to nerve structures during resection of the uterosacral ligaments, the parametrium, the rectovaginal septum or the vaginal cuff to treat deep infiltrating endometriosis can lead to serious functional impairments such as voiding disorders. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach.

Zusammenfassung

Die Endometriose gehört zu den häufigsten Krankheitsbildern in der operativen Gynäkologie mit erheblichen Herausforderungen an die laparoskopische Technik, aber auch die OP-Planung, Patientinnenaufklärung und Interdisziplinarität. Ziel im Hinblick auf eine bestmögliche Symptomkontrolle ist die vollständige Entfernung der erkennbaren Krankheitsherde, die aber limitiert wird durch nachweisliche Grenzen der Detektierbarkeit und die Risiken radikaler Operationsstrategien. So kann die Exzision ovarieller Endometriome zu einer signifikanten Beeinträchtigung der Ovarialfunktion, die Läsion nervaler Strukturen bei der Resektion tief-infiltrierender Endometriose der Sakrouterinligamente, der Parametrien, des Septum rectovaginale und des Vaginalpols zu schwerwiegenden Funtionsbeeinträchtigungen wie Blasenentleerungsstörungen führen. Eine gründliche Nutzen-Risiko-Abwägung muss daher symptomorientiert erfolgen und in einem individualisierten Vorgehen resultieren.

 
  • References

  • 1 Deguara CS, Pepas L, Davis C. Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life?. Curr Opin Obstet Gynecol 2012; 24: 241-244
  • 2 AWMF. Diagnostik und Therapie der Endometriose. AWMF Leitlinien Register 015/045. awmf.org/leitlinien/detail/ll/015-045.html
  • 3 Wattiez A, Puga M, Albornoz J et al. Surgical strategy in endometriosis. Best Pract Res Clin Obstet Gynaecol 2013; 27: 381-392
  • 4 Kondo W, Bourdel N, Zomer MT et al. Surgery for deep infiltrating endometriosis: technique and rationale. Front Biosci (Elite Ed) 2013; 5: 316-332
  • 5 Berkes E, Bokor A, Rigó jr. J. Current treatment of endometriosis with laparoscopic surgery. Orv Hetil 2010; 151: 1137-1144
  • 6 Fritzer N, Tammaa A, Salzer H et al. Effects of surgical excision of endometriosis regarding quality of life and psychological well-being: a review. Womens Health (Lond Engl) 2012; 8: 427-435
  • 7 Koninckx PR, Ussia A, Adamyan L et al. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril 2012; 98: 564-571
  • 8 Pandis GK, Saridogan E, Windsor AC et al. Short-term outcome of fertility-sparing laparoscopic excision of deeply infiltrating pelvic endometriosis performed in a tertiary referral center. Fertil Steril 2010; 93: 39-45
  • 9 Minelli L, Ceccaroni M, Ruffo G et al. Laparoscopic conservative surgery for stage IV symptomatic endometriosis: short-term surgical complications. Fertil Steril 2010; 94: 1218-1222
  • 10 Schonman R, Dotan Z, Weintraub AY et al. Deep endometriosis inflicting the bladder: long-term outcomes of surgical management. Arch Gynecol Obstet 2013; DOI: 10.1007/s00404-013-2917-6.
  • 11 Kovoor E, Nassif J, Miranda-Mendoza I et al. Endometriosis of bladder: outcomes after laparoscopic surgery. J Minim Invasive Gynecol 2010; 17: 600-604
  • 12 Taylor E, Williams C. Surgical treatment of endometriosis: location and patterns of disease at reoperation. Fertil Steril 2010; 93: 57-61
  • 13 Lessey BA, Higdon 3rd HL, Miller SE et al. Intraoperative detection of subtle endometriosis: a novel paradigm for detection and treatment of pelvic pain associated with the loss of peritoneal integrity. J Vis Exp 2012; DOI: 10.3791/4313.
  • 14 Alkatout I, Mettler L, Beteta C et al. Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial. J Minim Invasive Gynecol 2013; 20: 473-481
  • 15 Vercellini P, Somigliana E, Consonni D et al. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. Hum Reprod 2012; 27: 3450-3459
  • 16 Vercellini P, Frattaruolo MP, Somigliana E et al. Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: effect on sexual functioning, psychological status and health-related quality of life. Hum Reprod 2013; 28: 1221-1230
  • 17 Porpora MG, Pallante D, Ferro A et al. Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 2010; 93: 716-721
  • 18 Hayasaka S, Ugajin T, Fujii O et al. Risk factors for recurrence and re-recurrence of ovarian endometriomas after laparoscopic excision. J Obstet Gynaecol Res 2011; 37: 581-585
  • 19 Uncu G, Kasapoglu I, Ozerkan K et al. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod 2013; 28: 2140-2145
  • 20 Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012; 97: 3146-3154
  • 21 Streuli I, de Ziegler D, Gayet V et al. In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery. Hum Reprod 2012; 27: 3294-3303
  • 22 Urman B, Alper E, Yakin K et al. Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve. Reprod Biomed Online 2013; 27: 212-216
  • 23 Celik HG, Dogan E, Okyay E et al. Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimüllerian hormone levels. Fertil Steril 2012; 97: 1472-1478
  • 24 Canis M, Kondo W, Botchorishvili R et al. Surgical arrows should be identified on the cyst wall. Fertil Steril 2013; 99: e7
  • 25 Donnez J, Squifflet J, Jadoul P et al. Fertility preservation in women with ovarian endometriosis. Front Biosci (Elite Ed) 2012; 4: 1654-1662
  • 26 Bourdel N, Roman H, Mage G et al. Surgery for the management of ovarian endometriomas: from the physiopathology to the pre-, peri- and postoperative treatment. Gynecol Obstet Fertil 2011; 39: 709-721
  • 27 Somigliana E, Benaglia L, Viganoʼ P et al. Surgical measures for endometriosis-related infertility: a plea for research. Placenta 2011; 32 (Suppl. 03) S238-S242
  • 28 Hart RJ, Hickey M, Maouris P et al. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2008; (2) CD004992
  • 29 Dan H, Limin F. Laparoscopic ovarian cystectomy versus fenestration/coagulation or laser vaporization for the treatment of endometriomas: a meta-analysis of randomized controlled trials. Gynecol Obstet Invest 2013; 76: 75-82
  • 30 Litta P, DʼAgostino G, Conte L et al. Anti-Müllerian hormone trend after laparoscopic surgery in women with ovarian endometrioma. Gynecol Endocrinol 2013; 29: 452-454
  • 31 Ferrero S, Venturini PL, Gillott DJ et al. Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol 2012; 19: 722-730
  • 32 Ruiz-Flores FJ, Garcia-Velasco JA. Is there a benefit for surgery in endometrioma-associated infertility?. Curr Opin Obstet Gynecol 2012; 24: 136-140
  • 33 Kössi J, Setälä M, Mäkinen J et al. Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis 2013; 15: 102-108
  • 34 Setälä M, Härkki P, Matomäki J et al. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand 2012; 91: 692-698
  • 35 Bassi MA, Podgaec S, Dias jr. JA et al. Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement. J Minim Invasive Gynecol 2011; 18: 730-733
  • 36 Ruffo G, Sartori A, Crippa S et al. Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results. Surg Endosc 2012; 26: 1035-1040
  • 37 Maytham GD, Dowson HM, Levy B et al. Laparoscopic excision of rectovaginal endometriosis: report of a prospective study and review of the literature. Colorectal Dis 2010; 12: 1105-1112
  • 38 Koh CE, Juszczyk K, Cooper MJ et al. Management of deeply infiltrating endometriosis involving the rectum. Dis Colon Rectum 2012; 55: 925-931
  • 39 Borghese B, Santulli P, Streuli I et al. [Recurrence of pain after surgery for deeply infiltrating endometriosis: How does it happen? How to manage?]. J Gynecol Obstet Biol Reprod (Paris) 2012; DOI: 10.1016/j.jgyn.2012.11.009.
  • 40 Meuleman C, Tomassetti C, Wolthuis A et al. Clinical outcome after radical excision of moderate-severe endometriosis with or without bowel resection and reanastomosis: a prospective cohort study. Ann Surg 2013; Apr 10 [Epub ahead of print]; PMID: 23579578
  • 41 Dubuisson J, Pont M, Roy P et al. Female sexuality after surgical treatment of symptomatic deep pelvic endometriosis. Gynecol Obstet Fertil 2013; 41: 38-44
  • 42 Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 2010; 25: 1949-1958
  • 43 Boesgaard-Kjer DH, Boesgaard-Kjer D, Kjer JJ. Well-leg compartment syndrome after gynecological laparoscopic surgery. Acta Obstet Gynecol Scand 2013; 92: 598-600
  • 44 Tomassetti C, Meuleman C, Vanacker B et al. Lower limb compartment syndrome as a complication of laparoscopic laser surgery for severe endometriosis. Fertil Steril 2009; 92: 2038.e9-2038.e12
  • 45 Brouwer R, Woods RJ. Rectal endometriosis: results of radical excision and review of published work. ANZ J Surg 2007; 77: 562-571
  • 46 Canon B, Collinet P, Piessen G et al. Segmentary rectal resection and rectal shaving by laparoscopy for endometriosis: peri-operative morbidity. Gynecol Obstet Fertil 2013; 41: 275-281
  • 47 Roman H, Loisel C, Resch B et al. Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: giving patients an informed choice. Hum Reprod 2010; 25: 890-899
  • 48 Daraï E, Touboul C, Chéreau E et al. Segmental resection for colorectal endometriosis: are there alternatives?. Gynecol Obstet Fertil 2012; 40: 116-120
  • 49 Roman H, Vassilieff M, Gourcerol G et al. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 2011; 26: 274-281
  • 50 Zilberman S, Ballester M, Touboul C et al. Partial colpectomy is a risk factor for urologic complications of colorectal resection for endometriosis. J Minim Invasive Gynecol 2013; 20: 49-55
  • 51 Deffieux X, Raibaut P, Hubeaux K et al. Voiding dysfunction after surgical resection of deeply infiltrating endometriosis: pathophysiology and management. Gynecol Obstet Fertil 2007; 35 (Suppl. 01) S8-S13
  • 52 Dubernard G, Rouzier R, Piketty M et al. Assessment of the urinary side effects after surgery for deep pelvic endometriosis. Gynecol Obstet Fertil 2007; 35 (Suppl. 01) S1-S7
  • 53 Ceccaroni M, Clarizia R, Roviglione G et al. Neuro-anatomy of the posterior parametrium and surgical considerations for a nerve-sparing approach in radical pelvic surgery. Surg Endosc 2013; DOI: 10.1007/s00464-013-3043-2.
  • 54 Possover M, Chiantera V, Baekelandt J. Anatomy of the sacral roots and the pelvic splanchnic nerves in women using the LANN technique. Surg Laparosc Endosc Percutan Tech 2007; 17: 508-510
  • 55 Ceccaroni M, Clarizia R, Bruni F et al. Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. Surg Endosc 2012; 26: 2029-2045
  • 56 Seracchioli R, Mabrouk M, Manuzzi L et al. Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis. J Minim Invasive Gynecol 2008; 15: 435-439
  • 57 Kondo W, Branco AW, Trippia CH et al. Retrocervical deep infiltrating endometriotic lesions larger than thirty millimeters are associated with an increased rate of ureteral involvement. J Minim Invasive Gynecol 2013; 20: 100-103
  • 58 Mereu L, Gagliardi ML, Clarizia R et al. Laparoscopic management of ureteral endometriosis in case of moderate-severe hydroureteronephrosis. Fertil Steril 2010; 93: 46-51
  • 59 Miranda-Mendoza I, Kovoor E, Nassif J et al. Laparoscopic surgery for severe ureteric endometriosis. Eur J Obstet Gynecol Reprod Biol 2012; 165: 275-279
  • 60 Brosens I, Gordts S, Benagiano G. Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod 2013; 28: 2026-2031
  • 61 Janssen EB, Rijkers AC, Hoppenbrouwers K et al. Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Hum Reprod Update 2013; 19: 570-582
  • 62 Yeung jr. P, Sinervo K, Winer W et al. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary?. Fertil Steril 2011; 95: 1909-1912 1912.e1
  • 63 Tandoi I, Somigliana E, Riparini J et al. High rate of endometriosis recurrence in young women. J Pediatr Adolesc Gynecol 2011; 24: 376-379
  • 64 Vercellini P, Barbara G, Abbiati A et al. Repetitive surgery for recurrent symptomatic endometriosis: what to do?. Eur J Obstet Gynecol Reprod Biol 2009; 146: 15-21
  • 65 Berlanda N, Vercellini P, Fedele L. The outcomes of repeat surgery for recurrent symptomatic endometriosis. Curr Opin Obstet Gynecol 2010; 22: 320-325