STANDARDIZATION OF ORGAN PRESERVING LAPAROSCOPIC TREATMENT OF WOMEN WITH PAIN SYNDROME ASSOCIATED WITH DEEP ENDOMETRIOSIS
DOI:
https://doi.org/10.11603/24116-4944.2024.2.15083Keywords:
deep endometriosis, surgical treatment, laparoscopic surgery, #Enzian, pain syndromeAbstract
The aim of the study – to improve the indicators of surgical treatment of deep endometriosis in women of reproductive age with pain syndrome by creating an algorithm for surgical intervention.
Materials and Methods. A prospective observational single-center cohort study was conducted at our center, which included 210 women of reproductive age with pain syndrome who were operated on for deep endometriosis according to the new method of standardization of surgical treatment of deep endometriosis for the period from January 2020 to December 2023. Classification of all cases was conducted according to #Enzian. Intraoperative, early and long-term postoperative indicators were studied.
Results and Discussion. We obtained a statistically significant improvement in pain scores 6 months after surgery on the VAS scale from 0 to 10 (chronic pelvic pain before surgery 6.87+/-1.41, while after 6 months – 2.41+/-1.59 (p<0.001), dysmenorrhea – 8.46+/-1.16 before and 2.08+/-1.36 after (p<0.001), dyspareunia – 7.42+/-1.07 before and 2.22+/-1.69 after (p<0.001), dyschezia – 3.2+/-3.6 before and 0.8+/-2.0 after (p<0.001), dysuria – 1.2+/-2.6 before and 0.4+/-1.4 after (p=0.026)). Deep endometriosis is by far the most severe form of endometriosis and it is defined as the growth of endometrial-like tissue over and under the surface of the peritoneum; these are nodes that can penetrate into neighboring structures and are associated with fibrosis and disruption of normal anatomy, which makes the surgical treatment of this disease difficult. Damage to organs and tissue structures leads to changes in anatomy with the elimination of organ contours and significant distortion of the operative field, which is a serious problem in surgical treatment even for experienced surgeons. This, of course, must be taken into account at the pre- and intraoperative stage. Currently, there are no regulated documents in the world regarding the surgical treatment of deep endometriosis, namely, standardized approaches to such surgical intervention and an unequivocal opinion about the degree of radicality of the operations. Regarding surgery for deep endometriosis, we have a single document ESGE, ESHRE and WES 2020, but it is devoted to some technical features of the operation and does not contain the strategy of the operation, which is very necessary for the surgeon. Therefore, each surgeon operates on patients with deep endometriosis based on his/her own judgment, such treatment can be too subjective and not always beneficial to patients, so we believe that the time has come to standardize the surgical treatment of deep endometriosis. Our next study will be a retrospective comparison of surgical indicators in patients who were operated on according to the new standardized technique and according to generally accepted methods.
Conclusions. The algorithm of standardized surgical intervention should improve the indicators of surgical intervention of deep endometriosis, namely intraoperative, early and long-term postoperative results, greatly facilitate the work of surgeons and objectify such treatment.
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