Coagulation-Induced Diaphragm Fenestrations after Laparoscopic Excision of Diaphragmatic Endometriosis.

Nirgianakis, Konstantinos; Lanz, Susanne; Imboden, Sara; Worni, Mathias; Mueller, Michael (2018). Coagulation-Induced Diaphragm Fenestrations after Laparoscopic Excision of Diaphragmatic Endometriosis. Journal of minimally invasive gynecology, 25(5), pp. 771-772. Elsevier 10.1016/j.jmig.2017.10.028

	Text 1-s2.0-S1553465017312645-main.pdf__tid=33d2dc48-f94c-11e7-b81c-00000aab0f26&acdnat=1515949314_e853d1c2bc2d0daba0cf054538d7061b - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (330kB)
	Video 1-s2.0-S1553465017312645-mmc1.mp4 - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (47MB)

STUDY OBJECTIVE

To present an unusual consequence of laparoscopic treatment of diaphragmatic endometriosis, to discuss the possible etiologies, and to propose proper management.

DESIGN

A step-by-step explanation of 2 surgeries of the same patient using intraoperative video sequences (Canadian Task Force classification III).

SETTING

University hospital.

PATIENT

A 32-year-old woman.

INTERVENTIONS

Two Laparoscopic surgeries.

MEASUREMENTS AND MAIN RESULTS

Endometriosis is estimated to affect 11% of the population [1,2], with an estimated 12% of these patients having extrapelvic endometriosis [3]. When the diaphragm is involved, the disease potentially causes severe and debilitating symptoms such as catamenial chest or shoulder pain. Serious complications may involve pneumothorax and hemopneumothorax [4-6]. Diaphragmatic endometriosis is more common than realized and has been shown to occur simultaneously in 50% to 80% of cases with pelvic endometriosis [7,8]. A 32-year-old woman was admitted to our hospital with severe disabling dysmenorrhea and right shoulder pain. Despite progestin, nonsteroidal anti-inflammatory drug, and opioid treatment, pain relief remained inadequate. A laparoscopy was performed revealing diaphragmatic endometriosis, which was completely excised. A revision was necessary 14 months later because of pain recurrence in the right hemithorax and suspicion of new or persistent endometriotic lesions. The laparoscopy revealed small diaphragm fenestrations that were closed after exclusion of recurrent diaphragmatic or pleural endometriosis. No chest tube was placed, and the postoperative course was uneventful. Hormonal suppressive treatment was continued. Since the operation the patient has been pain free. Institutional Review Board/Ethics Committee ruled that approval was not required for this study (Req-2017-00415).

CONCLUSION

The diaphragm fenestrations were possibly the result of tissue necrosis caused by thermocoagulation after excision of deep endometriotic lesions during the first surgery. Using a CO2 laser for the vaporization of superficial lesions is favorable because of the smaller depth of penetration compared with electrocautery and better access to hard to reach areas [9,10]. Endometriotic lesions involving the entire thickness of the diaphragm should be completely excised and the defect repaired with either sutures or staples [11-13].

Interest & Impact

Downloads

3 since deposited on 05 Mar 2018
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item