Publications by authors named "Simona Del Forno"

31 Publications

Comparison of perioperative outcomes between standard laparoscopic and robot-assisted approach in patients with rectosigmoid endometriosis.

Acta Obstet Gynecol Scand 2021 May 17. Epub 2021 May 17.

Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

Introduction: Robot-assisted laparoscopic surgery (RALS) has gained widespread application in several surgical specialties. Previous studies on the feasibility and safety of RALS versus standard laparoscopy (S-LPS) for rectosigmoid endometriosis are limited and reported conflicting data. This study aims to compare S-LPS and RALS in patients with rectosigmoid endometriosis in terms of perioperative surgical and clinical data.

Material And Methods: This is a multicentric, observational, prospective cohort study including 44 patients affected by rectosigmoid endometriosis referred to two tertiary referral centers for endometriosis from September 2018 to September 2019. Patients were divided into two groups: 22 patients underwent S-LPS, and 22 underwent RALS. Our primary outcome was to compare operative time (from skin incision to suture) between the two groups. Secondary outcomes included: operative room time (patient entry into operative room and patient out), estimated blood loss, laparotomic conversion rate, length of hospital stay, perioperative complications, and evaluation of endometriosis-related symptoms at 12-month follow up.

Results: The two groups were comparable regarding preoperative and surgical data, except for higher rates of hysterectomies and bilateral uterosacral ligament removal procedures in the RALS group. Also after adjusting for these discrepancies, operative time was similar between S-LPS and RALS. Operative room time was statistically longer in the RALS group compared with that of S-LPS. No statistically significant difference was found concerning other study outcomes. Pain and bowel symptoms improved in both groups at 12-month follow up.

Conclusions: If performed by expert teams, RALS provides similar perioperative outcomes compared with S-LPS in rectosigmoid endometriosis surgical treatment, except for longer operative room time.
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http://dx.doi.org/10.1111/aogs.14170DOI Listing
May 2021

Endometriosis, the hidden enemy: multivariable fractional polynomial approach for evaluation of preoperative risk factors in the absence of ureteral dilation.

Fertil Steril 2021 May 4. Epub 2021 May 4.

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Objective: To determine whether it is possible to predict the risk of ureteral endometriosis (UE) using a mathematical model based on preoperative findings.

Design: Prospective observational study conducted between January 2017 and April 2020.

Setting: Tertiary-level academic referral center.

Patient(s): Three hundred consecutive women of reproductive age with a diagnosis of posterior deep infiltrating endometriosis (DIE) scheduled for laparoscopic surgery.

Intervention(s): Before surgery, anamnestic data and the severity of endometriosis-related symptoms were evaluated, and all patients underwent a complete gynecological examination. Transvaginal and transabdominal ultrasound were performed to map the endometriotic lesion. Ureteral involvement was surgically and histologically confirmed.

Main Outcome Measure(s): To select important risk factors for UE and determine a suitable functional form for continuous predictors, we used the multivariable fractional polynomial.

Results: UE was surgically found in 145 women (48.3%). Based on our multivariable polynomial mathematical model, UE was significantly associated with adenomyosis, parametrial involvement, and previous surgery for endometriosis. A posterior DIE nodule with a transverse diameter >1.8 cm was associated with a higher probability of ureteral involvement.

Conclusions: Posterior DIE nodule with a transverse diameter >1.8 cm, adenomyosis, parametrial involvement, and previous surgery for endometriosis appear to be good predictors of UE.
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http://dx.doi.org/10.1016/j.fertnstert.2021.03.027DOI Listing
May 2021

Long-Term Medical Therapy after Laparoscopic Excision of Ovarian Endometriomas: Can We Reduce and Predict the Risk of Recurrence?

Gynecol Obstet Invest 2021 13;86(1-2):170-176. Epub 2021 Apr 13.

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

Objectives: Up to 32% of women experience anatomic recurrence after conservative surgery for endometriomas, while pain recurs in 10-40% of cases. Long-term postoperative hormonal therapy is recommended to prevent disease recurrence. We evaluated the efficacy of long-term therapy with estroprogestins (EPs) or progestins (Ps) in preventing endometrioma recurrence, as identifiable cysts and subjective symptoms, after laparoscopic excision.

Design: This retrospective cohort study included 375 women submitted to laparoscopic endometrioma excision. Women were followed up at 6 and 12 months and then yearly after surgery. Based on postoperative medical therapy, women were divided into 4 groups: nonusers, cyclic EP users, continuous EP users, and progestogen users. Materials, Setting, Methods: Anamnestic and anthropometric characteristics were collected as well as clinical and surgical data. Gynecological examination, and transvaginal and transabdominal ultrasound scans were performed. Pain (numerical rating score >5) and endometrioma recurrence at ultrasound (ovarian cyst with typical sonographic features ≥10 mm in mean diameter) were recorded at each examination. The reoperation rate in women with recurrence was investigated.

Results: The median follow-up was 3.7 years with a maximum of 16.7 years. Most patients used EPs (119 cyclic and 61 continuous users), 95 used P, and 100 were nonusers. In 135 women (36%), endometriotic cyst recurrence was diagnosed, with a mean diameter of 18.7 ± 10.8 mm (range 10-55 mm). The median recurrent cyst-free time was 7.9 years (95% CI 5.8-10.8). Dysmenorrhea was the first symptom to reappear, affecting 162 patients (43.2%). Upon multivariable regression analysis, continuous users had a lower risk of relapse (OR 0.56, 95% CI 0.32-0.99), in terms of both cysts and symptom recurrence, than patients who received no medications. The reoperation rate was 16.2%.

Limitations: The main limitation of this study is its retrospective design. Also, women switching therapies throughout the follow-up period were sorted into one of the study groups based on the longest treatment taken, without considering the discontinuation rates.

Conclusions: Long-term EPs, administered in a continuous regimen and starting immediately after conservative surgery for endometriomas, seem to reduce the disease recurrence risk.
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http://dx.doi.org/10.1159/000514310DOI Listing
April 2021

Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis-A Feasibility Study.

J Minim Invasive Gynecol 2021 Jun 11;28(6):1225-1230. Epub 2021 Jan 11.

Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors).

Study Objective: To evaluate feasibility of near-infrared (NIR)-indocyanine green (ICG) imaging for bowel vascularization assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE).

Design: This is a prospective, single-center, preliminary study on consecutive patients who were symptomatic submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of the anastomotic line from May 2018 to January 2020.

Setting: Tertiary university hospital.

Patients: Thirty-two women with RSE meeting eligibility criteria were included for study analysis.

Interventions: NIR-ICG evaluation of anastomotic line vascularization after RSE removal.

Measurements And Main Results: Fluorescence degree of the anastomotic line was assessed with a 0 to 2 Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (not uniform distribution or weak fluorescence), and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). In all the patients included in the study (100%), NIR-ICG imaging allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time (median, 4 [range, 3-5] minutes). Excellent interoperator agreement was observed. Most of the patients (31 of 32, 96.9%) showed regular fluorescence on the anastomotic line; in 1 patient with irregular fluorescence at NIR-ICG after discoid excision, the anastomotic suture was reinforced through interrupted stitches. We had 1 case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation.

Conclusion: NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe, and reproducible method.
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http://dx.doi.org/10.1016/j.jmig.2020.12.017DOI Listing
June 2021

Comparison of fertility outcomes after laparoscopic myomectomy for barbed versus nonbarbed sutures.

Fertil Steril 2021 01 12;115(1):248-255. Epub 2020 Sep 12.

Gynaecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), S. Orsola Hospital, University of Bologna, Bologna, Italy.

Objective: To assess the impact on women's reproductive outcomes of barbed sutures to repair uterine breaches during laparoscopic myomectomy compared with traditional smooth sutures.

Design: Retrospective, monocentric cohort study, with information on subsequent pregnancies prospectively acquired for some women.

Setting: Tertiary-level academic referral center.

Patient(s): Women older than 18 years who had undergone a laparoscopic myomectomy and had sought pregnancy afterward, divided into two groups based on type of suture used to repair the uterine wall: group A (nonbarbed) and group B (barbed).

Intervention(s): Laparoscopic removal of FIGO types 3, 4, 5, and 6 uterine leiomyomas by use of either only barbed sutures or only traditional smooth sutures to reconstruct the uterine defect.

Main Outcome Measure(s): Pregnancy achievement rates, delivery modes, main pregnancy complications, perioperative complications for both kinds of suture, and the trend of the use of barbed sutures over time at our center.

Result(s): Of 164 patients included, 83 were in group A and 81 in group B. Ninety-one patients (55.5%) experienced at least one postoperative pregnancy, with no differences between the groups (group A 60.5%; group B 50.6%). Of the 103 recorded postoperative pregnancies, 70 (68%) resulted in live births, 29 (28.1%) in first-trimester miscarriages, and 4 (3.9%) were ongoing.

Conclusion(s): Barbed sutures have a similar impact on reproductive outcomes as smooth conventional threads, both in terms of pregnancy and obstetric complication rates, after laparoscopic myomectomy.
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http://dx.doi.org/10.1016/j.fertnstert.2020.07.036DOI Listing
January 2021

Transperineal Ultrasound Visual Feedback Assisted Pelvic Floor Muscle Physiotherapy in Women With Deep Infiltrating Endometriosis and Dyspareunia: A Pilot Study.

J Sex Marital Ther 2020 24;46(7):603-611. Epub 2020 Jun 24.

Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.

A prospective study with the aim to evaluate the effects of pelvic floor physiotherapy was conducted among women with deep infiltrating endometriosis (DIE) and associated dyspareunia. At initial evaluation superficial and deep dyspareunia were assessed using a numerical rating scale, and levator hiatus area (LHA) was assessed with 3-D/4-D transperineal ultrasound. Women underwent five individual sessions of ultrasound visual feedback assisted pelvic floor physiotherapy. One month after the therapy, dyspareunia and LHA were reassessed and compared with pre-therapy data. Pelvic floor physiotherapy seems to improve both superficial and deep dyspareunia and pelvic floor muscle relaxation in women with DIE.
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http://dx.doi.org/10.1080/0092623X.2020.1765057DOI Listing
May 2021

Adenomyosis and endometriosis in adolescents and young women with pelvic pain: prevalence and risk factors.

Minerva Pediatr 2020 Jun 16. Epub 2020 Jun 16.

Gynecology and Human Reproduction Pathophysiology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.

Aim: To evaluate the prevalence of ultrasound diagnosis of adenomyosis and endometriosis in young women complaining of pelvic pain and to find the symptoms and clinical characteristics associated with these diseases in young women.

Methods: Cross-sectional study, including 100 young women (14-24 years) with a history of chronic pelvic pain. Women were asked detailed medical hystory and pain symptoms scores (Visual Analogue Scale) and underwent gynecological examination and ultrasound evaluation.

Results: The prevalence of endometriosis and adenomyosis in young women amounted to 25.0% and 46.0%, respectively. A significant correlation was found between ovarian endometriosis and adenomyosis. Dysmenorrhea and dyspareunia were risk factors for adenomyosis. Dyschezia, dyspareunia, chronic pelvic pain, presence of sonographic soft markers suggestive of pelvic adhesions, being a worker and having a previous surgery were risk factors for endometriosis. Young women (20-24 years) had a higher incidence of both adenomyosis and endometriosis than adolescents (14-19 years).

Conclusions: Our outcomes strengthen the hypothesis of a progressive and common course of the natural history of endometriosis, which initially may manifest with symptoms, then with signs of pelvic adhesions and finally as adenomyosis, ovarian endometriomas or deep infiltrating endometriosis.
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http://dx.doi.org/10.23736/S0026-4946.20.05842-9DOI Listing
June 2020

Feasibility and safety of laparoscopic approach in obese patients with endometriosis: a multivariable regression analysis.

Arch Gynecol Obstet 2020 09 6;302(3):665-670. Epub 2020 Jun 6.

Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Massarenti, 13, 40138, Bologna, Italy.

Purpose: To evaluate the feasibility and safety of laparoscopic excision of endometriotic lesions in obese women.

Methods: Retrospective analysis of prospectively collected data involving consecutive women scheduled for complete laparoscopic removal of macroscopic endometriotic lesions between January 2012 and November 2018. Operative time, laparotomic conversion rates, complication rates, and length of hospital stay were recorded.

Results: One thousand two hundred thirty women were enrolled and divided into two main groups, according to the World Health Organization classification of obesity, obese (body mass index ≥ 30 kg/m) and non-obese (body mass index < 30 kg/m). During the study period, 91 (7.4% of overall study cohort) obese women underwent surgery. At univariate analyses, significant differences between the two groups were found in terms of age, rates of severe endometriosis, American Society of Anesthesiologists physical status classification ≥ III, and different surgical procedures. Significant differences in terms of median operative time [125 (interquartile range (IQR) 85-165) in obese group vs 110 min (IQR 75-155) in non-obese group, P = 0.04] were observed. There were no significant differences between the obese and non-obese groups with respect to the other variables of interest. After adjusted multivariable regression models for potential confounders, difference in operating time (coefficient of 13.389; 95% CI 1.716, 25.060) was still found to be significant.

Conclusion: In our tertiary care referral center, laparoscopic removal of endometriosis is feasible and safe, except for a slight increase of operative time and conversion rate.
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http://dx.doi.org/10.1007/s00404-020-05629-9DOI Listing
September 2020

Rectosigmoid Endometriosis Vascular Patterns at Intraoperative Indocyanine Green Angiography and their Correlation with Clinicopathological Data.

Surg Innov 2020 Oct 5;27(5):474-480. Epub 2020 Jun 5.

Gynecology and Human Reproduction Physiopathology, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), 18508Sant'Orsola Hospital, University of Bologna, Italy.

The objective of the study was to evaluate the presence of different rectosigmoid endometriosis (RSE) vascular patterns using intraoperative indocyanine green (ICG) angiography and their correlation with clinicopathological data. A prospective pilot study on 30 consecutive symptomatic women affected by RSE and scheduled for minimally invasive surgery between May 2018 and January 2019. ICG was used for the intraoperative evaluation of RSE vascularization. Perfusion grade was classified as follows: 0-1 = no or low fluorescence (hypovascular pattern); 2 = regular fluorescence, similar to healthy surrounding rectosigmoid tract (isovascular pattern); and 3-4 = diffuse or abundant fluorescence (hypervascular pattern). Thirty women were intravenously injected with ICG after nodule exposure. No adverse effects related to ICG use were noted. After a 5- to 50-s latency from ICG injection, the real-time direct visualization of RSE perfusion showed diffuse or abundant fluorescence in 12/30 (40%) women, while in the remaining 18/30 (60%), fluorescence was poor or absent. No statistical differences were observed between the 2 groups regarding preoperative, intraoperative, and histological variables analyzed, except for a maximum diameter of bowel lesions and microvessel density (MVD). Hypovascular nodules had a larger maximum diameter (39.5 ± 15.6 mm vs 30.3 ± 11.4 mm, < .05) and lower MVD (154.6+/43.6 vs 281.1+/-77.4, < .05) than hypervascular ones. ICG angiography is a feasible and safe technique to intraoperatively assess RSE vascularization. The majority (60%) of endometriotic nodule presented a hypovascular pattern. The hypovascular pattern seems to be associated with a larger nodule size and lower MVD.
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http://dx.doi.org/10.1177/1553350620930147DOI Listing
October 2020

Use of Indocyanine Green for Intraoperative Perfusion Assessment in Women with Ureteral Endometriosis: A Preliminary Study.

J Minim Invasive Gynecol 2021 01 10;28(1):42-49. Epub 2020 Apr 10.

Unit of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, S. Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Raimondo, Borghese, Arena, Ambrosio, Del Forno, Degli Esposti, Casadio, Mattioli, Mastronardi, and Seracchioli).

Study Objective: To evaluate the feasibility, safety, and potential usefulness of near-infrared imaging (NIR) with indocyanine green (ICG) to assess ureteral perfusion after conservative surgery (ureterolysis or nodule removal) for ureteral endometriosis. Any changes to the surgical plan regarding intraoperative ureteral stent placement after NIR-ICG evaluation and early postoperative outcomes were recorded.

Design: Prospective case series study.

Setting: Tertiary level referral center for endometriosis and minimally invasive gynecology.

Patients: Consecutive symptomatic women scheduled for laparoscopic conservative ureteral surgery for ureteral endometriosis.

Interventions: After ureterolysis or nodule removal, residual perfusion of the ureters with regular caliber and peristalsis was evaluated through NIR-ICG imaging. Ureteral perfusion grade was defined as absent, irregular, or regular. Time required for NIR-ICG assessment, interoperator agreement regarding ureteral perfusion grade, any changes to the surgical plan after NIR-ICG evaluation, perioperative complications, and clinical-radiologic outcomes at early follow-up were recorded.

Measurements And Main Results: A total of 31 ureters were examined with NIR-ICG imaging after conservative ureteral procedures. ICG assessment required 5.4 + 2.3 minutes. No complications related to fluorescence imaging were observed. Local ischemia supporting ureteral stent placement was suspected in 5 ureters (16.1%) at white light. Of these, 2 (40.0%) presented regular fluorescence; thus, ureteral stent placement was avoided. In the remaining 3 (60.0%), NIR-ICG confirmed irregular or absent fluorescence, requiring ureteral stent placement. Interoperator agreement regarding NIR-ICG evaluation was high. At a 3-month follow-up, all procedures were clinically and radiologically successful.

Conclusion: NIR-ICG imaging after conservative surgery for ureteral endometriosis seems to be a feasible, safe, and useful tool to assess ureteral perfusion and guide surgical decision, together with other visual cues at white light. However, this approach needs to be validated by further larger and controlled studies.
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http://dx.doi.org/10.1016/j.jmig.2020.04.004DOI Listing
January 2021

Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis: A Prospective Validation.

J Ultrasound Med 2020 Jul 7;39(7):1405-1412. Epub 2020 Feb 7.

Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy.

Objectives: To evaluate the diagnostic accuracy of the classic ultrasound (US) signs of adenomyosis, the question mark sign and transvaginal ultrasound (TVUS) uterine tenderness, in the diagnosis of adenomyosis.

Methods: This was a prospective study including 78 patients waiting for hysterectomy for uterine benign diseases and undergoing preoperative US examinations to evaluate all criteria for US diagnosis of adenomyosis as reported by the consensus statement of the Morphological Uterus Sonographic Assessment group. A US diagnosis of adenomyosis was made in the presence of 2 or more Morphological Uterus Sonographic Assessment features. Moreover, the question mark sign and TVUS uterine tenderness were evaluated. Ultrasound features were compared with the histologic examination, which was considered the reference standard for the diagnosis of adenomyosis. The Cohen κ coefficient was used to measure the accordance between US and histologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each US feature were calculated.

Results: The prevalence of adenomyosis in the sample was 33.3%. The sensitivity, specificity, PPV, NPV, and accuracy of TVUS in the diagnosis of adenomyosis were 77%, 96%, 91%, 89%, and 90%, respectively. Myometrial heterogeneity was the most frequently encountered feature (100%) but showed low specificity (7%). The question mark sign and TVUS uterine tenderness showed sensitivity, specificity, PPV, NPV, and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81%, and 67%.

Conclusions: The question mark sign and TVUS uterine tenderness are useful tools for the diagnosis of adenomyosis.
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http://dx.doi.org/10.1002/jum.15237DOI Listing
July 2020

Frequency and clinical impact of Dolichocolon in women submitted to surgery for rectosigmoid endometriosis.

J Gynecol Obstet Hum Reprod 2020 Apr 1;49(4):101697. Epub 2020 Feb 1.

Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Italy.

Introduction: Rectosigmoid endometriosis and Dolichocolon can both present with a triad of chronic abdominal pain, constipation and bloating. The relationship between these two pathologies is unknown. The present study aims to determine the frequency of DC in women with rectosigmoid endometriosis and its possible impact on pre- and post-operative symptoms.

Material And Methods: We conducted a retrospective cohort study on 113 consecutive patients submitted to magnetic resonance imaging enema and subsequent complete surgical removal for symptomatic rectosigmoid endometriosis between June 2015 to June 2018. Dolichocolon is an anatomic variant characterized by redundancies and lengthening of the colon. We divided our study population according to its presence or absence. The two groups were compared in terms of demographic data, surgical findings and pre- and post-operative clinical variables. Pain symptoms were assessed through numerical rating scale from 0 to 10. Bowel complaints included constipation, bloating and diarrhea.

Results: Thirty-five patients (31 %) presented a dolichocolon at magnetic resonance imaging enema. The two groups were comparable in terms of demographic data, pre-operative clinical variables and surgical findings. At 6-month follow-up, there was a significant improvement of symptoms, except for constipation and bloating in dolichocolon group. In particular, we observed with a statistical difference (p < .05) the persistence of constipation and bloating in dolichocolon group compared to non-dolichocolon group.

Conclusions: Dolichocolon was observed in one third patients with rectosigmoid endometriosis and could influence surgical outcomes for rectosigmoid endometriosis in terms of relief of bowel symptoms.
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http://dx.doi.org/10.1016/j.jogoh.2020.101697DOI Listing
April 2020

Impact of Temporary Protective Ileostomy on Intestinal Function and Quality of Life after a 2-Year Follow-up in Patients Who Underwent Colorectal Segmental Resection for Endometriosis.

J Minim Invasive Gynecol 2020 Sep - Oct;27(6):1324-1330. Epub 2019 Oct 28.

From the Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), Sant'Orsola Hospital, University of Bologna, Bologna, Italy (all authors).

Study Objective: To compare 2-year follow-up intestinal function and quality of life (QoL) between women with temporary protective ileostomy (PI) and recanalization and women without PI after colorectal segmental resection for deep infiltrating endometriosis (DIE).

Design: Prospective observational exploratory study.

Setting: Tertiary level referral center for minimally invasive gynecologic surgery.

Patients: Consecutive patients who underwent laparoscopic colorectal resection and PI because of DIE between January 2015 and January 2018; an equal number of women without PI were matched according to age and anamnestic findings to serve as controls.

Interventions: Realization of a PI or immediate recanalization in patients who underwent laparoscopic colorectal resection.

Measurements And Main Results: Thirty-six patients were considered for the analyses: 18 in the PI group and 18 in the non-PI group. Baseline intestinal function and QoL were evaluated using 2 validated questionnaires. The main reasons for ileostomy were colpotomy (66.7%), ultralow bowel anastomosis (27.8%), concomitant ureteroneocystostomy, and positive Michelin test result (5.6%). The mean interval between first and second surgery in the PI group was 3.7 ± 1.7 months. Perioperative severe complications included 1 stenosis of colorectal anastomosis in 1 woman in the PI group and 1 perianastomotic abscess in the non-PI group; overall the complications were comparable between the 2 groups. At the 2-year follow-up from recanalization, bowel function and QoL improved from baseline, with no statistical differences between the groups (Knowles-Eccersley-Scott-Symptom delta: 5.9 ± 9.3 in the PI group vs 7.7 ± 10.2 in the non-PI group, p = .6; Gastrointestinal Quality of Life Index delta: 16.0 ± 27.5 vs 19.2 ± 24.7, p = .7).

Conclusion: Temporary PI after colorectal resection for DIE does not seem to influence patients' bowel function and QoL at a median follow-up from recanalization at 2 years.
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http://dx.doi.org/10.1016/j.jmig.2019.10.017DOI Listing
February 2021

Liver function, tolerability and satisfaction during treatment with ulipristal acetate in women with fibroids: a single center experience.

Gynecol Endocrinol 2020 May 24;36(5):445-447. Epub 2019 Oct 24.

Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital University of Bologna, Bologna, Italy.

The aim of the study was to evaluate liver function in women treated with ulipristal acetate (UPA) and to assess the tolerability and satisfaction during treatment. This Cross-sectional study included women with symptomatic uterine fibroids subjected to one or more 3-month treatment courses of 5 mg UPA daily. Following European Medical Agency's prescriptions, women were asked about symptoms potentially related to liver damage and had blood tests done, to assess serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Data on side effects, tolerability and satisfaction with the therapy were obtained during a phone interview. A total of 162 women completed the study with a mean treatment duration of 1.8 ± 0.9 cycles. No increased AST and ALT serum levels were detected and no woman reported symptoms suggestive of liver injury. The majority of women reported improvement of fibroids-related symptoms and a high degree of satisfaction with treatment. More than half of women had side effects, in most cases not as severe as to discontinue therapy. Ulipristal acetate did not worsen liver function or cause severe organ injury and showed high tolerability and satisfaction profiles. Therefore, we believe that it can still be considered a valuable option in the treatment of uterine fibroids.
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http://dx.doi.org/10.1080/09513590.2019.1680626DOI Listing
May 2020

Painful Love: Superficial Dyspareunia and Three Dimensional Transperineal Ultrasound Evaluation of Pelvic Floor Muscle in Women with Endometriosis.

J Sex Marital Ther 2020 15;46(2):187-196. Epub 2019 Oct 15.

Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.

We conducted an observational study between March 2015 and March 2018 in our academic center. Symptomatic, sexually active women with clinical and sonographic diagnosis of deep infiltrating endometriosis (DIE) or isolated ovarian endometriosis were enrolled. Women were asked to rank endometriosis-related symptoms, especially superficial and deep dyspareunia. Moreover, 3D transperineal ultrasound was performed to assess the levator hiatus area (LHA) evaluating pelvic floor muscle (PFM) morphometry. Women with endometriosis seem to have a high prevalence of superficial dyspareunia and three-dimensional transperineal ultrasound seems to be a viable technique to assess PFM morphometry in these women.
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http://dx.doi.org/10.1080/0092623X.2019.1676852DOI Listing
November 2020

First Impressions Can Be Deceiving: Surgical Outcomes of Laparoscopic Myomectomy in Patients Pretreated with Ulipristal Acetate.

J Minim Invasive Gynecol 2020 Mar - Apr;27(3):633-638. Epub 2019 Aug 13.

Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Hospital, University of Bologna (Drs. Frascá, Arena, Degli Esposti, Raimondo, Del Forno, Moro, Zanello, Mabrouk, and Seracchioli), Italy.

Study Objective: To compare enucleation time, total operative time, and perioperative complications during laparoscopic myomectomy in patients pretreated with ulipristal acetate (UPA) compared with untreated patients.

Design: Prospective, observational pilot study.

Setting: Tertiary referral center of minimally invasive gynecologic surgery, Sant'Orsola Academic Hospital, Bologna, Italy.

Patients: Seventy-four of 108 patients scheduled for laparoscopic myomectomy from January to November 2017 were enrolled.

Interventions: Laparoscopic myomectomy following pretreatment with UPA or no hormonal pretreatment therapy.

Measurements And Main Results: Of the 74 patients who were enrolled, 29 were pretreated with UPA (UPA group), and 45 did not receive any hormonal therapy before surgery (control group). Surgeons, blinded to patient pre-operative treatment, completed a 3-item questionnaire after each procedure to evaluate surgical difficulty. Based on surgeon response, myomas in the UPA group appeared softer and more difficult to enucleate because of less clear cleavage planes than the control group. The overall difficulty of myoma detachment from the myometrium was judged considerably higher in the UPA group. Despite this, enucleation time, total operative time, and perioperative complications were not statistically different in the 2 groups.

Conclusion: Myomas in patients pretreated with UPA are subjectively less easy to enucleate; however, surgical times and perioperative outcomes are not affected by pretreatment with UPA.
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http://dx.doi.org/10.1016/j.jmig.2019.04.026DOI Listing
October 2020

Dienogest or Norethindrone acetate for the treatment of ovarian endometriomas: Can we avoid surgery?

Eur J Obstet Gynecol Reprod Biol 2019 Jul 2;238:120-124. Epub 2019 May 2.

Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Italy.

Objective: To compare the effects of Dienogest (D) and Norethindrone acetate (N) in symptomatic women with ovarian endometriomas, analyzing the efficacy in reducing endometrioma size and symptom relief and drug tolerability.

Study Design: Retrospective study including 135 symptomatic women with ultrasonographic diagnosis of ovarian endometrioma. Women were divided into two groups: 1) women who received D 2 mg/day (group D); 2) women who received N 2.5 mg/day (group N). Women were evaluated at therapy prescription and after 6 and 12 months of treatment: transvaginal ultrasound was performed to assess the mean diameter of endometriomas, a Visual Analogue Scale was used to rank endometriosis related symptoms (dysmenorrhea, dyspareunia, chronic pelvic pain). The main outcome measure was the comparison between the 2 groups in terms of variations in endometrioma size and endometriosis related symptoms during the follow-up. Drug tolerability was also analyzed in terms of side effects.

Results: A reduction in ovarian endometrioma size was observed during treatment in both groups, with no significant differences between groups D and N. Endometriosis related symptoms decreased in both groups, but the decrease was significantly higher in group D than in group N for all symptoms, both at 6 and 12 months of treatment. Regarding drug tolerability, uterine bleeding/spotting and weight gain were reported more frequently by women in the group N than women in the group D, both at 6 and 12 months of treatment.

Conclusion: Progestin therapy with D or N appears to be effective in reducing the size of endometriomas and related symptoms, with a greater effect on symptoms relief and higher tolerability in women treated with D.
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http://dx.doi.org/10.1016/j.ejogrb.2019.04.010DOI Listing
July 2019

Pelvic floor dysfunction at transperineal ultrasound and voiding alteration in women with posterior deep endometriosis.

Int Urogynecol J 2019 09 2;30(9):1527-1532. Epub 2019 May 2.

Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Massarenti, 13, 40138, Bologna, Italy.

Introduction And Hypothesis: Posterior deep infiltrating endometriosis (DIE) has been associated with pelvic floor muscle (PFM) alteration and voiding dysfunction (VD). The aim of this study is to evaluate the correlation between the presence of VD and altered PFM morphometry, objectively evaluated using 3D/4D transperineal ultrasound at rest and during dynamic maneuvers, in patients with posterior DIE.

Methods: A prospective study was conducted on 108 symptomatic women scheduled for surgical removal of posterior DIE. The study population was divided in two groups according to presence or absence of VD on the Bristol Female Lower Urinary Tract Symptoms (BFLUTS). A 3D/4D transperineal ultrasound was performed to compare the following PFM morphometric parameters: levator hiatus area (LHA), antero-posterior (AP) and left-right (LR) diameters and levator ani muscle (LAM) coactivation. LAM coactivation was defined as the paradoxical contraction of the pelvic floor muscle during the Valsalva maneuver causing a smaller LHA than in the resting state.

Results: Forty-eight (45.2%) women presented VD, while 60 (54.8%) women did not report any voiding complaints. Baseline characteristics did not significantly differ between the two groups. We did not find any significant statistical differences in PFM parameters between the two groups, except for a higher rate of levator ani muscle coactivation in women with VD compared with women without VD [64.6% (31/48) versus 31.7% (19/60), respectively; p = < 0.001].

Conclusions: In women affected by posterior DIE, LAM coactivation at 3D/4D transperineal ultrasound seems to be more frequent in patients with than without VD.
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http://dx.doi.org/10.1007/s00192-019-03963-4DOI Listing
September 2019

Endometriosis of the Appendix: When to Predict and How to Manage-A Multivariate Analysis of 1935 Endometriosis Cases.

J Minim Invasive Gynecol 2020 01 5;27(1):100-106. Epub 2019 Mar 5.

Department of Obstetrics and Gynecology, Dipartimento di Scienze Mediche e Chirurgiche, S Orsola Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Mastronardi, Del Forno, Arena, Sutherland, Borgia, Mattioli, Terzano, and Seracchioli).

Study Objective: To evaluate appendiceal endometriosis (AE) prevalence and risk factors in endometriotic patients submitted to surgery.

Design: A retrospective cohort study.

Setting: A tertiary level referral center, university hospital.

Patients: One thousand nine hundred thirty-five consecutive patients who underwent surgical removal for symptomatic endometriosis.

Interventions: Electronic medical records of patients submitted to surgery over a 12-year period were reviewed. We assessed any correlation between demographic, clinical, and surgical variables and AE. In our center, appendectomy was performed using a selective approach. Appendix removal was performed in case of gross abnormalities of the organ, such as enlargement, dilation, tortuosity, or discoloration of the organ or the presence of suspected endometriotic implants.

Measurements And Main Results: AE prevalence was 2.6% (50/1935), with only 1 false-positive case at gross intraoperative evaluation. In multivariate analysis using a stepwise logistic regression model, independent risk factors for AE were adenomyosis (adjusted odds ratio [aOR] = 2.48; 95% confidence interval [CI], 1.32-4.68), right endometrioma (aOR = 8.03; 95% CI, 4.08-15.80), right endometrioma ≥5 cm (aOR = 13.90; 95% CI, 6.63-29.15), bladder endometriosis (aOR = 2.05; 95% CI, 1.05-3.99), deep posterior pelvic endometriosis (aOR = 5.79; 95% CI, 2.82-11.90), left deep lateral pelvic endometriosis (aOR = 2.11; 95% CI, 1.10-4.02), and ileocecal involvement (aOR = 12.51; 95% CI, 2.07-75.75).

Conclusion: Among patients with endometriosis submitted to surgery, AE was observed in 2.6%, and it was associated with adenomyosis, large right endometrioma, bladder endometriosis, deep posterior pelvic endometriosis, left deep lateral pelvic endometriosis, and ileocecal involvement.
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http://dx.doi.org/10.1016/j.jmig.2019.02.015DOI Listing
January 2020

Anatomic Cartography of the Hypogastric Nerves and Surgical Insights for Autonomic Preservation during Radical Pelvic Procedures.

J Minim Invasive Gynecol 2019 Nov - Dec;26(7):1340-1345. Epub 2019 Jan 29.

Department of Obstetrics and Gynecology, Functional Pelvic Surgery and Neuropelveology, University of Toronto, Toronto, Ontario, Canada (Dr. Lemos); Department of Gynecology, Pelvic Neurodysfunction Unit, Federal University of São Paulo, São Paulo, Brazil. (Dr. Lemos).

Study Objective: To clarify the relationship of hypogastric nerves (HNs) with several pelvic anatomic landmarks and to assess any anatomic differences between the 2 sides of the pelvis, both in cadaveric and in vivo dissections.

Design: Prospective observational study.

Setting: An anatomic theater for cadaveric dissections and a university hospital for in vivo laparoscopy.

Patients: Five nulliparous female cadavers underwent laparotomic dissection; 10 nulliparous patients underwent laparoscopic surgery for rectosigmoid endometriosis without posterolateral parametrial infiltration.

Interventions: Measurements of the closest distance between HNs and ureters, the midsagittal plane, the midcervical plane, and uterosacral ligaments on both hemipelvises. A comparison of anatomic data of the 2 hemipelvises was conducted.

Measurements And Main Results: The right and left HNs were identified in all specimens, both on cadavers and in vivo dissections. A wide anatomic variability was reported. Regarding the differences between the 2 hemipelvises, we found that the right HN was significantly (p <.001) farther to the ureter (mean = 14.5 mm; range, 10-25 mm) than the left one (mean = 8.6 mm; range, 7-12 mm). The HN was closer to the midsagittal plane on the right side (mean = 14.6 mm; range, 12-17 mm) than on the left side (mean = 21.6 mm; range, 19-25 mm). The midcervical plane was found 2.7 mm (range, 2-4 mm) to the left of the midsagittal one. The right HN was found to be nonsignificantly closer to the midcervical plane and the uterosacral ligament on the right side than on the left side (p >.05).

Conclusions: Despite a wide anatomic variability of position and appearance, the HNs are reproducibly identifiable using an "interfascial" technique and considering the ureters and uterosacral ligaments as anatomic landmarks.
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http://dx.doi.org/10.1016/j.jmig.2019.01.010DOI Listing
May 2020

Surgical, Clinical, and Functional Outcomes in Patients with Rectosigmoid Endometriosis in the Gray Zone: 13-Year Long-Term Follow-up.

J Minim Invasive Gynecol 2019 Sep - Oct;26(6):1110-1116. Epub 2018 Nov 9.

Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Polyclinic Hospital, University of Bologna, Bologna, Italy (Drs. Mabrouk, Raimondo, Altieri, Arena, Del Forno, Moro, Mattioli, and Seracchioli).

Study Objective: To compare long-term surgical, clinical, and functional outcomes between conservative and radical surgery in patients with rectosigmoid endometriosis (RSE) and preoperative intermediate risk of segmental resection.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Endometriosis tertiary level referral center, St. Orsola Academic Hospital, Bologna, Italy.

Patients: Three hundred and ninety-two patients with RSE presented for complete macroscopic surgical excision between January 2004 and January 2017.

Intervention: Assessment of laparoscopic bowel shaving, discoid excision, or segmental resection for the treatment of RSE.

Measurements And Main Results: The 392 patients were divided into 3 groups according to surgical technique: shaving (n = 297; 75.8%), discoid excision (n = 33; 8.4%), and segmental resection (n = 62; 15.8%). Preoperative characteristics, surgical data, short- and long-term complications, and rates of proven and suspected recurrence were assessed. The segmental resection group had a higher rate of short-term complications compared with the discoid and shaving groups (17.7% vs 9.1% vs 5.4%, respectively; p = .004). The median follow-up time was 43 months (range, 12-163 months). Suspected and proven RSE recurrence rates showed no statistically significant differences among the 3 groups. There also were no significant differences concerning the rate of de novo chronic constipation and urinary retention.

Conclusion: To date, there is no consensus regarding the choice between radical (segmental resection) or conservative (shaving, discoid excision) surgical management for RSE, particularly for patients with preoperative intermediate risk of bowel segmental resection (the gray zone). Our data suggest that conservative surgery is preferred over radical surgery in patients with RSE in the gray zone risk category, resulting in similar suspected and proven RSE recurrence rates and associated with fewer short-term complications.
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http://dx.doi.org/10.1016/j.jmig.2018.08.031DOI Listing
May 2020

Transvaginal and transperineal ultrasound follow-up after laparoscopic correction of uterine retrodisplacement in women with posterior deep infiltrating endometriosis.

Aust N Z J Obstet Gynaecol 2019 04 23;59(2):288-293. Epub 2018 Aug 23.

Gynaecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy.

Background: Retrodisplacement of the uterus (retroflexion and/or retroversion) may be associated with pelvic pain symptoms and posterior deep infiltrating endometriosis (DIE). Previous studies in symptomatic women with retrodisplacement of the uterus showed the efficacy of hysteropexy in terms of pain symptoms improvement.

Aim: To evaluate sonographic, clinical and surgical outcomes of a hysteropexy technique MATERIALS AND METHODS: Laparoscopic round ligament plication and tilting of the uterine fundus in women with uterine retrodisplacement and posterior deep infiltrating endometriosis was performed. Forty-two symptomatic women were enrolled and the sonographic data of each (angle of uterine version and uterine flexion, uterine mobility) was assessed before and after surgery with transvaginal and transperineal approaches. Women were also evaluated at 1, 6 and 12 months after surgery for pain symptoms with a numerical rating scale (dysmenorrhoea, dyspareunia and chronic pelvic pain), intraoperative data and surgical complications.

Results: The additional mean operative time of hysteropexy procedure was 8 ± 3 min. At early follow-up both the uterine angles were significantly (P < 0.001) reduced. At 12-month follow-up, seven patients (16.7%) presented a retroverted uterus, while 12 (28.6%) presented a retroflexed uterus; the sliding sign remained negative in four patients (9.5%). A significant improvement of symptoms (P < 0.001) was observed during the follow-up.

Conclusion: Laparoscopic hysteropexy appears as an effective additional surgical procedure, which can temporarily correct the uterine position in order to reduce the risk of postoperative adhesions.
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http://dx.doi.org/10.1111/ajo.12882DOI Listing
April 2019

Short-term histopathological effects of dienogest therapy on ovarian endometriomas: in vivo, nonrandomized, controlled trial.

Gynecol Endocrinol 2018 May 21;34(5):399-403. Epub 2017 Nov 21.

a Gynecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences , DIMEC, S. Orsola Hospital, University of Bologna , Bologna , Italy.

Ovarian endometriosis is a common gynecological disorder. To date, progestins are recommended as the first-line medical treatment for symptomatic ovarian endometriosis. The aim of this study was to evaluate the main histopathological effects of short-term dienogest therapy in patients with ovarian endometriomas scheduled for surgery. A prospective, nonrandomized controlled trial, including 70 symptomatic women with single ovarian endometriotic cyst (diameter between 30-50 mm) was conducted. Women scheduled for surgery were divided into two groups, depending on the treatment established at enrollment: 36 women received progestin therapy with dienogest (P group) and 34 women received no therapy (C group). At histopathological examination necrosis, inflammation, decidualization, glandular atrophy and angiogenesis were blindly evaluated. At tissue level, decidualization was significantly more frequent in P group compared to C group (p = .001). A nonsignificant tendency (p = .29) towards a slight decreased inflammation in P group was found. No significant differences were observed between the two groups in terms of necrosis, glandular atrophy and angiogenesis. The study suggests that high decidualization rate and the tendency to reduced inflammatory reaction in the short-term administration of dienogest might contribute to its therapeutic efficacy.
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http://dx.doi.org/10.1080/09513590.2017.1405932DOI Listing
May 2018

Comparison of transvaginal sonography and computed tomography-colonography with contrast media and urographic phase for diagnosing deep infiltrating endometriosis of the posterior compartment of the pelvis: a pilot study.

Jpn J Radiol 2017 Sep 12;35(9):546-554. Epub 2017 Jul 12.

Gynecology and Human Reproduction Physiopathology, DIMEC, S. Orsola Hospital, University of Bologna, Massarenti, 13, 40138, Bologna, Italy.

Purpose: To compare the diagnostic accuracy of transvaginal sonography (TVS) and computed tomography-colonography with contrast media and urographic phase (CTCU) in the preoperative detection of deep infiltrating endometriosis (DIE).

Materials And Methods: Forty-seven patients with clinical suspicion of DIE underwent preoperative TVS and CTCU. Imaging data were compared with histopathologic analysis. Sensitivity, specificity, positive and negative predictive values and test accuracies of the two modalities were calculated.

Results: For diagnosing intestinal DIE, TVS and CTCU had a sensitivity of 98 and 71%, specificity of 33 and 50%, positive predictive value of 91 and 91%, negative predictive value of 67 and 20%, accuracy of 89 and 68%, respectively. For diagnosing ureteral DIE, TVS and CTCU had a sensitivity of 10 and 60%, specificity of 94.8 and 70.2% on the right; sensitivity of 28.5 and 57.1%, specificity of 96.3 and 76.9% on the left, respectively.

Conclusion: TVS should be regarded as an accurate, radiation-free first-line diagnostic modality for patients with suspicion of posterior endometriosis. CTCU should be regarded as a complementary imaging modality, particularly for sigmoid or ureteral endometriosis.
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http://dx.doi.org/10.1007/s11604-017-0665-4DOI Listing
September 2017

Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis.

Pediatr Ann 2016 Sep;45(9):e332-5

Dysmenorrhea, cyclic pelvic pain, and acyclic pelvic pain are common in adolescent girls, and at least 10% of these girls are at risk for subsequent development of endometriosis. In this article we highlight practical tips for the management of dysmenorrhea and chronic pelvic pain and how to diagnose endometriosis as early as possible and detect patients at risk for developing the disease in the future. We suggest five practical rules for managing adolescents with dysmenorrhea and chronic pelvic pain: (1) Never underestimate the pain; (2) Always consider endometriosis as a possible cause of severe cyclic pain; (3) Obtain a detailed and accurate history before performing clinical evaluation and pelvic sonography; (4) Treat the pain with hormonal therapies (combined oral contraceptives or progestogen-only pill) and analgesics (acetaminophen and nonsteroidal anti-inflammatory drugs); and (5) Plan frequent follow-up visits to re-evaluate the patient. [Pediatr Ann. 2016;45(9):e332-e335.].
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http://dx.doi.org/10.3928/19382359-20160727-03DOI Listing
September 2016

What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis?

J Sex Med 2012 Mar 9;9(3):770-8. Epub 2012 Feb 9.

Minimally Invasive Gynecological Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.

Introduction: Deep infiltrating endometriosis (DIE) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface. It is a chronic disease which can impair women's sexual function. There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE.

Aims: The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives (COC) administration on sexual function in patients with DIE and to compare sexual function outcomes of women submitted to intestinal resection and nodule excision.

Methods: It is a prospective cohort study in a tertiary care university hospital on 106 sexually active women, with histologically confirmed DIE, managed by laparoscopy and subsequent COC therapy for 6 months. Patients filled preoperatively and 6-month postoperatively a quality of sexual life questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) and they ranked their symptom intensity using a 10-point visual analogue scale (VAS).

Main Outcome Measures: Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores. Intraoperative details, type of intervention and perioperative complications were noted.

Results: Six months after surgery and postoperative COC treatment, a significant improvement was observed in the SHOW-Q domains of pelvic problem interference, sexual satisfaction and desire (P<0.05). Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning (P=0.7). No significant difference was found in SHOW-Q scores between patients submitted to intestinal resection and patients submitted to intestinal nodule excision (P>0.05).

Conclusions: Sexual desire, satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy. No difference in sexual outcomes was detected between patients submitted to intestinal resection and nodule excision.
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http://dx.doi.org/10.1111/j.1743-6109.2011.02593.xDOI Listing
March 2012

A new oral contraceptive regimen for endometriosis management: preliminary experience with 24/4-day drospirenone/ethinylestradiol 3 mg/20 mcg.

Gynecol Endocrinol 2012 Jun 1;28(6):451-4. Epub 2011 Dec 1.

The Minimally Invasive Gynaecological Surgery Unit, Gynaecology Department, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

We report our preliminary experience with the use of a low-dose oral contraceptive containing Drospirenone/Ethinylestradiol 3 mg/20 mcg, both in cyclic and continuous regimen for endometriosis management. A total of 93 women were retrospectively included: 52 were treated by medical therapy (exclusive combined oral contraceptives (COC)-users), while 41 were submitted to surgery followed by postoperative therapy (postoperative COC-users). A clinical examination was performed at baseline and at 6-months follow-up. Presence and intensity of endometriosis-related symptoms were assessed by a visual analogue scale. Presence and dimension of endometriotic lesions were evaluated by transvaginal ultrasonography. Adverse effects and tolerability were analysed. In exclusive COC-users, significant reductions in dysmenorrhoea and dyspareunia scores and in endometrioma mean diameter were observed at follow-up. In postoperative COC-users, anatomical and symptom recurrence rates at follow-up were 4.9% and 17%, respectively. The most frequent adverse effects were spotting and headache. No difference between cyclic and continuous regimen in terms of symptom relief, lesion progression and tolerability was observed. From our preliminary experience, Drospirenone/Ethinylestradiol 3 mg/20 mcg seems to be promising in endometriosis management.
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http://dx.doi.org/10.3109/09513590.2011.634936DOI Listing
June 2012

Does laparoscopic management of deep infiltrating endometriosis improve quality of life? A prospective study.

Health Qual Life Outcomes 2011 Nov 6;9:98. Epub 2011 Nov 6.

Minimally Invasive Gynaecological Surgery Unit, S.Orsola Hospital, University of Bologna, Italy.

Background: Deep infiltrating endometriosis (DIE) can affect importantly patients' quality of life (QOL). The aim of this study is to evaluate the impact of the laparoscopic management of DIE on QOL after six months from treatment.

Methods: It is a prospective cohort study. In a tertiary care university hospital, between April 2008 and December 2009, 100 patients underwent laparoscopic management of DIE and completed preoperatively and 6-months postoperatively a QOL questionnaire, the short form 36 (SF-36).Quality of life was measured through the SF-36 scores. Intra-operative details of disease site, number of lesions, type of intervention, period of hospital stay and peri-operative complications were noted.

Results: Six months postoperatively all the women had a significant improvement in every scale of the SF-36 (p < 0,0005). Among patients with intestinal DIE, significant differences in postoperative scores of SF-36 were not detected between patients submitted to nodule shaving and segmental resection (p > 0.05). There was no significant difference in the SF-36 scores at 6 months from surgery between patients who received postoperative medical treatment and patients who did not (p > 0.05).

Conclusions: Laparoscopic excision of DIE lesions significantly improves general health and psycho-emotional status at six months from surgery without differences between patients submitted to intestinal segmental resection or intestinal nodule shaving.
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http://dx.doi.org/10.1186/1477-7525-9-98DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3247061PMC
November 2011

Mixed adenocarcinoma of the rectovaginal septum associated with endometriosis and endometrial carcinoma: a case report.

Case Rep Oncol 2011 Jan 18;4(1):149-54. Epub 2011 Mar 18.

Minimally Invasive Gynecological Surgery Unit, Department of Gynaecology, Bologna University, Bologna, Italy.

Purpose: To present a case of primary mixed (clear cell and endometrioid type) adenocarcinoma of the rectovaginal septum, probably arising from endometriosis and associated with a highly differentiated, early-stage endometrioid endometrial carcinoma. The case was managed by a minimally invasive approach and postoperative adjuvant chemotherapy.

Results: The patient underwent clinical/instrumental follow-up and a second-look laparoscopy after the primary surgery as well as adjuvant chemotherapy. No evidence of disease could be observed after the treatment.

Conclusion: Surgery with postoperative chemotherapy can be recommended for the treatment of mixed adenocarcinoma of the rectovaginal septum.
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http://dx.doi.org/10.1159/000326067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114620PMC
January 2011

Mixed adenocarcinoma of the rectovaginal septum associated with endometriosis and endometrial carcinoma: a case report.

Case Rep Oncol 2011 Jan 18;4(1):149-54. Epub 2011 Mar 18.

Minimally Invasive Gynecological Surgery Unit, Department of Gynaecology, Bologna University, Bologna, Italy.

Purpose: To present a case of primary mixed (clear cell and endometrioid type) adenocarcinoma of the rectovaginal septum, probably arising from endometriosis and associated with a highly differentiated, early-stage endometrioid endometrial carcinoma. The case was managed by a minimally invasive approach and postoperative adjuvant chemotherapy.

Results: The patient underwent clinical/instrumental follow-up and a second-look laparoscopy after the primary surgery as well as adjuvant chemotherapy. No evidence of disease could be observed after the treatment.

Conclusion: Surgery with postoperative chemotherapy can be recommended for the treatment of mixed adenocarcinoma of the rectovaginal septum.
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http://dx.doi.org/10.1159/000326067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114620PMC
January 2011