Cargando…
Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery
BACKGROUND: Surgery for deep endometriosis often requires input from urological surgeons. This study aims to determine pre-operative and intra-operative factors that influence the need for urological input in laparoscopic resection of rectovaginal endometriosis and to assess the usefulness of a scor...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Universa Press
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897523/ https://www.ncbi.nlm.nih.gov/pubmed/31824632 |
_version_ | 1783476973171900416 |
---|---|
author | Fisher, G Smith, RD Saridogan, E Vashisht, A Allen, S Arumuham, V Cutner, A |
author_facet | Fisher, G Smith, RD Saridogan, E Vashisht, A Allen, S Arumuham, V Cutner, A |
author_sort | Fisher, G |
collection | PubMed |
description | BACKGROUND: Surgery for deep endometriosis often requires input from urological surgeons. This study aims to determine pre-operative and intra-operative factors that influence the need for urological input in laparoscopic resection of rectovaginal endometriosis and to assess the usefulness of a scoring system to predict this. METHODS: We conducted a retrospective cohort study of 230 patients undergoing laparoscopic excision of deep endometriosis, at a tertiary referral centre for endometriosis in London UK, 2011 to 2015. Data from pre-operative assessment, surgery and post-operative follow up were analysed and patients were categorised according to their pre-operative and intra-operative risk factors. The primary outcome measure was the requirement of intra-operative input by urological surgeons. RESULTS: The median age was 35 years. In addition to the excision of endometriosis, 19.6% patients (45 patients) underwent hysterectomy, 14.8% (34 patients) required JJ stent placement, 6.1% (14 patients) had bowel resections and 2.6% (6 patients) required an ileostomy. 93.9% (216 patients) were considered normal-risk pre-operatively, of whom 89.4% (193/216) did not require any intra-operative urological input. 10.6% of this normal-risk group (23/216) required JJ stents, of whom 69.6% (16/23) also required a hysterectomy or bowel resection. Post operative complications occurred in 0.9% (2/216) of normal-risk patients, with none having required intra-operative urological reconstruction. Six percent (14 patients) were deemed to be increased-risk pre-operatively, of whom 78.6% (11/14) required JJ stent insertion. Thirty-six percent of increased-risk patients (5/14) had pre-operative renal dysfunction demonstrated on MAG3/DMSA and 80.0% of these (4/5) required intra-operative ureteric reconstruction. CONCLUSIONS: Patients considered normal-risk pre-operatively, planned for excision, without hysterectomy or bowel resection, can be safely managed without specific urology input. Patients with risk-features are highly likely to require urological input, particularly for JJ stent insertion. Patients with pre-operative renal dysfunction, demonstrated on MAG3/DMSA, have a high chance of requiring intra-operative ureteric reconstruction and are best managed with pre-planned reconstructive urologist input. |
format | Online Article Text |
id | pubmed-6897523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Universa Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-68975232019-12-10 Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery Fisher, G Smith, RD Saridogan, E Vashisht, A Allen, S Arumuham, V Cutner, A Facts Views Vis Obgyn Original Paper BACKGROUND: Surgery for deep endometriosis often requires input from urological surgeons. This study aims to determine pre-operative and intra-operative factors that influence the need for urological input in laparoscopic resection of rectovaginal endometriosis and to assess the usefulness of a scoring system to predict this. METHODS: We conducted a retrospective cohort study of 230 patients undergoing laparoscopic excision of deep endometriosis, at a tertiary referral centre for endometriosis in London UK, 2011 to 2015. Data from pre-operative assessment, surgery and post-operative follow up were analysed and patients were categorised according to their pre-operative and intra-operative risk factors. The primary outcome measure was the requirement of intra-operative input by urological surgeons. RESULTS: The median age was 35 years. In addition to the excision of endometriosis, 19.6% patients (45 patients) underwent hysterectomy, 14.8% (34 patients) required JJ stent placement, 6.1% (14 patients) had bowel resections and 2.6% (6 patients) required an ileostomy. 93.9% (216 patients) were considered normal-risk pre-operatively, of whom 89.4% (193/216) did not require any intra-operative urological input. 10.6% of this normal-risk group (23/216) required JJ stents, of whom 69.6% (16/23) also required a hysterectomy or bowel resection. Post operative complications occurred in 0.9% (2/216) of normal-risk patients, with none having required intra-operative urological reconstruction. Six percent (14 patients) were deemed to be increased-risk pre-operatively, of whom 78.6% (11/14) required JJ stent insertion. Thirty-six percent of increased-risk patients (5/14) had pre-operative renal dysfunction demonstrated on MAG3/DMSA and 80.0% of these (4/5) required intra-operative ureteric reconstruction. CONCLUSIONS: Patients considered normal-risk pre-operatively, planned for excision, without hysterectomy or bowel resection, can be safely managed without specific urology input. Patients with risk-features are highly likely to require urological input, particularly for JJ stent insertion. Patients with pre-operative renal dysfunction, demonstrated on MAG3/DMSA, have a high chance of requiring intra-operative ureteric reconstruction and are best managed with pre-planned reconstructive urologist input. Universa Press 2019-06 2019-10-03 /pmc/articles/PMC6897523/ /pubmed/31824632 Text en Copyright © 2019 Facts, Views & Vision http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Paper Fisher, G Smith, RD Saridogan, E Vashisht, A Allen, S Arumuham, V Cutner, A Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
title | Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
title_full | Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
title_fullStr | Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
title_full_unstemmed | Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
title_short | Case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
title_sort | case selection for urological input in planned laparoscopic rectovaginal endometriosis surgery |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897523/ https://www.ncbi.nlm.nih.gov/pubmed/31824632 |
work_keys_str_mv | AT fisherg caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery AT smithrd caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery AT saridogane caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery AT vashishta caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery AT allens caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery AT arumuhamv caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery AT cutnera caseselectionforurologicalinputinplannedlaparoscopicrectovaginalendometriosissurgery |