Pagano, Flavia; Schwander, Adriana; Vaineau, Cloé; Knabben, Laura; Nirgianakis, Konstantinos; Imboden, Sara; Mueller, Michael D (2023). True Prevalence of Diaphragmatic Endometriosis and its Association with Severe Endometriosis: a Call for Awareness and Investigation. Journal of minimally invasive gynecology, 30(4), pp. 329-334. Elsevier 10.1016/j.jmig.2023.01.006
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STUDY OBJECTIVE
To identify characteristics indicating preoperatively the presence of diaphragmatic endometriosis (DE).
DESIGN
Comparison of characteristics of patients with DE with characteristics of patients with abdominal endometriosis without diaphragmatic involvement, in a prospective cohort study.
SETTING
Tertiary referral center; endometriosis center.
PATIENTS
1372 patients with histologically proven endometriosis.
INTERVENTIONS
Surgery performed laparoscopically under general anesthesia. All patients with suspected endometriosis underwent a complete bilateral inspection of the diaphragm.
MEASUREMENTS
Demographic and clinical pathologic characteristics were evaluated using basic descriptive statistics (comparison of the groups using the chi-square test and the Mann-Whitney t-test). A logistic regression analysis was performed to evaluate the relationship (hazard ratio) between symptoms and the presence of DE.
MAIN RESULTS
DE was diagnosed in 4.7% of the patients (65/1372). There was no significant difference between the two groups (patients with abdominal endometriosis with or without DE) with regard to typical endometriosis pain (dysmenorrhea, dyschezia, dysuria, and/or dyspareunia). However, in the DE group, diaphragmatic pain was present significantly more often pre-operatively (27.7% vs 1.8% p<.001). Four DE patients (6.1 %) were asymptomatic (with infertility the indication for surgery). In the DE group, 78.4 % had advanced stages of endometriosis (rAFS III° or IV°); the left lower pelvis was affected in more patients (73.8%). In cases of ovarian endometriosis, patients with DE showed a significantly higher prevalence of left ovaries involvement (left 63% vs right 35.7%, p<.001). Patients with DE had a significantly higher rate of infertility (49.2% vs 28.7%, p<.05).
CONCLUSION
Patients with shoulder pain, infertility, and/or endometriosis in the left pelvis have a significant higher risk of DE and therefore need specific preoperative counseling and if indicated surgical treatment.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology |
UniBE Contributor: |
Pagano, Flavia, Rigling-Schwander, Adriana, Vaineau-Bemilli, Cloé Juliette, Knabben, Laura Michelle Tatjana, Nirgianakis, Konstantinos |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1553-4650 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
26 Jan 2023 13:51 |
Last Modified: |
18 Jan 2024 00:25 |
Publisher DOI: |
10.1016/j.jmig.2023.01.006 |
PubMed ID: |
36669679 |
Uncontrolled Keywords: |
Abdominal endometriosis diaphragmatic endometriosis diaphragmatic pain endometrial lesions menstrual reflux theory ovarian endometriosis shoulder pain |
BORIS DOI: |
10.48350/177748 |
URI: |
https://boris.unibe.ch/id/eprint/177748 |
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