Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;35(12):6807-6817.
doi: 10.1007/s00464-020-08186-z. Epub 2021 Jan 4.

Minimally invasive treatment of diaphragmatic endometriosis: a 15-year single referral center's experience on 215 patients

Marcello Ceccaroni  1 , Giovanni Roviglione  2 , Antonino Farulla  3 , Pietro Bertoglio  4 , Roberto Clarizia  1 , Andrea Viti  4 , Daniele Mautone  1 , Matteo Ceccarello  1 , Anna Stepniewska  1 , Alberto Claudio Terzi  4
Affiliations

Minimally invasive treatment of diaphragmatic endometriosis: a 15-year single referral center's experience on 215 patients

Marcello Ceccaroni et al. Surg Endosc. 2021 Dec.

Erratum in

Abstract

Background: Diaphragmatic endometriosis (DE) is a rare and often misdiagnosed condition. Most of the times it is asymptomatic and due to the low accuracy of diagnostic tests, it is almost always detected during surgery for pelvic endometriosis. Its management is challenging and, until now, there are not guidelines about its treatment.

Methods: We describe a consecutive series of patients with DE managed by laparoscopy and videothoracoscopy (VATS) in our referral center in a period of 15 years. We developed a flow-chart classifying DE implants in foci, plaques and nodules and proposing an algorithm with the aim of standardizing the surgical approach.

Results: 215 patients were treated for DE. Lesions were almost always localized on the right hemidiaphragm (91%), and the endometriotic implants were distributed as: foci in 133 (62%), plaques in 24 (11%) and nodules in 58 patients (27%), respectively. In all cases of isolated pleural involvement, concomitant diaphragmatic hernia or lesions of the thoracic side of the diaphragm VATS was performed, alone or combined with laparoscopy, resulting in a total of 26 procedures. Following the proposed algorithm, specific surgical techniques were identified as the better approaches for the different types of the lesion, such as Argon Beam Coagulation and diathermocoagulation for diaphragmatic foci, peritoneal stripping for plaques, and nodulectomy or full-thickness resection of diaphragm for nodules.

Conclusions: It is crucial to standardize the surgical approach of DE, according to the type of lesion, thus reducing the rate of under- or over-treatments and intra or postoperative complications. This kind of surgery should be performed in a Referral Center by a gynecologic surgeon with oncogynecologic expertise and skills, with the eventual support of a laparoscopic general surgeon, a specialized thoracic surgeon and a trained anesthesiologist.

Keywords: Diaphragm; Endometriosis; Laparoscopy; Minimally invasive surgery; Thoracoscopy.

PubMed Disclaimer

References

    1. Nezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, Nezhat C (2019) Thoracic endometriosis syndrome: a review of diagnosis and management. J Soc Laparoendosc Surg 23(3):e2019.00029 - DOI
    1. Veeraswamy A, Lewis M, Mann A, Kotikela S, Hajhosseini B, Nezhat C (2010) Extragenital endometriosis. Clin Obstet Gynecol 53:449–466 - DOI
    1. Markham SM, Carpenter SE, Rock JA (1989) Extrapelvic endometriosis. Obstet Gynecol Clin North Am 16:193–219 - DOI
    1. Joseph J, Sahn SA (1996) Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 100:164–170 - DOI
    1. Andres MP, Arcoverde FV, Souza CC, Fernandes LF, Abrao MS, Kho RM (2020) Extrapelvic endometriosis: a systematic review. J Minim Invasive Gynecol 27(2):373–389. https://doi.org/10.1016/j.jmig.2019.10.004 - DOI - PubMed

LinkOut - more resources