Surgical management of endometriosis-associated pain

Philippe R Koninckx, Anastasia Ussia, Maria G Porpora, Maria Grazia Porpora, Mario Malzoni, Leila Adamyan, L.V. Adamyan, Arnaud Wattiez
Minerva obstetrics and gynecology · 2021 · vol. 73(5) , pp. 588–605 · doi:10.23736/s2724-606x.21.04864-8 · PMID:33978353 · W3160278437
article OA: closed CC0 ⤵ 8 in-corpus citations
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This paper describes surgical techniques and indications for managing endometriosis-associated pain, emphasizing lesion excision and adhesiolysis while considering pain mechanisms and diagnostic challenges.

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Abstract

Endometriosis and pelvic pain are associated. However, only half of the subtle and typical, and not all cystic and deep lesions are painful. The mechanism of the pain is explained by cyclical trauma and repair, an inflammatory reaction, activation of nociceptors up to 2.7 cm distance, painful adhesions and neural infiltration. The relationship between the severity of lesions and pain is variable. Diagnosis of the many causes requires laparoscopy and expertise. Imaging cannot exclude endometriosis. Surgical removal is the treatment of choice. Medical therapy without a diagnosis risks missing pathology and chronification of pain if not 100% effective. Indications and techniques of surgery are described as expert opinion since randomised controlled trials were not performed for ethical reasons, since not suited for multimorbidity while a control group is poorly accepted. Subtle endometriosis needs destruction since some cause pain or progress to more severe disease. Typical lesions need excision or vaporisation since depth can be misjudged by inspection. Painful cystic ovarian endometriosis needs adhesiolysis and either destruction of the lining or excision of the cyst wall, taking care to avoid ovarian damage. Cysts larger than 6 cm need a two-step technique or an ovariectomy. Excision of deep endometriosis is difficult and complication prone surgery involving bladder, ureter, and bowel surgery varying from excision and suturing, disc excision with a circular stapler and resection anastomosis. Completeness of excision, prevention of postoperative adhesions and recurrences of endometriosis, and the indication to explore large somatic nerves will be discussed.

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Condition tags

mesh:D004715mesh:D017699endometriosis

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Female Humans Neoplasm Recurrence, Local Pelvic Pain Pelvic Pain Tissue Adhesions Tissue Adhesions

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.

References (100)

Cited by (8)

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License: CC0 · commercial use OK