TY - JOUR
T1 - Anatomical distribution of deeply infiltrating endometriosis
T2 - Surgical implications and proposition for a classification
AU - Chapron, Charles
AU - Fauconnier, Arnaud
AU - Vieira, Marco
AU - Barakat, Habib
AU - Dousset, B.
AU - Pansini, Valeria
AU - Vacher-Lavenu, M. C.
AU - Dubuisson, J. B.
PY - 2003/1/1
Y1 - 2003/1/1
N2 - Background: Deeply infiltrating endometriosis (DIE) is recognized as a specific entity responsible for pain. The distribution of locations and their contribution to surgical management has not been previously studied. Methods: Medical, operative and pathological reports of 241 consecutive patients with histologically proven DIE were analysed. DIE lesions were classified as: (i) bladder, defined as infiltration of the muscularis propria; (ii) uterosacral ligaments (USL), as DIE of the USL alone; (iii) vagina, as DIE of the anterior rectovaginal pouch, the posterior vaginal fornix and the retroperitoneal area in between, and (iv) intestine, as DIE of the muscularis propria. Results: A total of 241 patients presented 344 DIE lesions: USL (69.2%; 238); vaginal (14.5%; 50); bladder (6.4%; 22); intestinal (9.9%; 34). The proportion of isolated lesions differed significantly according to the DIE location: 83.2% (198) for USL DIE; 56.0% (28) for vaginal DIE; 59.0% (13) for bladder DIE; 29.4% (10) for intestinal DIE (P <0.0001). The total number of DIE lesions varied significantly according to the location (P <0.0001). In 39.1% of cases (9/23) intestinal lesions were multifocal. Only 20.6% (seven cases) of intestinal DIE were isolated and unifocal. Conclusions: Multifocality must be considered during the pre-operative work-up and surgical treatment of DIE. We propose a surgical classification based on the locations of DIE. Operative laparoscopy is efficient for bladder, USL and vaginal DIE. However, indications for laparotomy still exist, notably for bowel lesions.
AB - Background: Deeply infiltrating endometriosis (DIE) is recognized as a specific entity responsible for pain. The distribution of locations and their contribution to surgical management has not been previously studied. Methods: Medical, operative and pathological reports of 241 consecutive patients with histologically proven DIE were analysed. DIE lesions were classified as: (i) bladder, defined as infiltration of the muscularis propria; (ii) uterosacral ligaments (USL), as DIE of the USL alone; (iii) vagina, as DIE of the anterior rectovaginal pouch, the posterior vaginal fornix and the retroperitoneal area in between, and (iv) intestine, as DIE of the muscularis propria. Results: A total of 241 patients presented 344 DIE lesions: USL (69.2%; 238); vaginal (14.5%; 50); bladder (6.4%; 22); intestinal (9.9%; 34). The proportion of isolated lesions differed significantly according to the DIE location: 83.2% (198) for USL DIE; 56.0% (28) for vaginal DIE; 59.0% (13) for bladder DIE; 29.4% (10) for intestinal DIE (P <0.0001). The total number of DIE lesions varied significantly according to the location (P <0.0001). In 39.1% of cases (9/23) intestinal lesions were multifocal. Only 20.6% (seven cases) of intestinal DIE were isolated and unifocal. Conclusions: Multifocality must be considered during the pre-operative work-up and surgical treatment of DIE. We propose a surgical classification based on the locations of DIE. Operative laparoscopy is efficient for bladder, USL and vaginal DIE. However, indications for laparotomy still exist, notably for bowel lesions.
KW - Deep endometriosis
KW - Deeply infiltrating endometriosis
KW - Operative laparoscopy
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=0037249839&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037249839&partnerID=8YFLogxK
U2 - 10.1093/humrep/deg009
DO - 10.1093/humrep/deg009
M3 - Article
C2 - 12525459
AN - SCOPUS:0037249839
VL - 18
SP - 157
EP - 161
JO - Human Reproduction
JF - Human Reproduction
SN - 0268-1161
IS - 1
ER -