Dijkstra, M. (2012) Radical laparoscopic surgery in women with deeply infiltrating endometriosis. thesis, Medicine.
Full text available on request.Abstract
Introduction: Endometriosis is a benign gynecologic disease which is present in approximately 10% of women in the fertile age. A distinction can be made between internal endometriosis (adenomyosis) and external endometriosis. Adenomyosis is a disease in which endometrial tissue invades into the underlying myometrium while in external endometriosis endometrial tissue is present outside the uterine cavity. In this a distinction between superficial and deeply infiltrating endometriosis (DIE) can be made. DIE can be defined as endometriosis that grows more than 5 mm under the peritoneal surface. This type of endometriosis can infiltrate in intra-abdominal organs and pelvic structures, consequently leading to severe pain symptoms, a decrease in quality of life (QoL) and a reduction of fertility. Various medical treatments are available, but discontinuation will eventually lead to recurrence of symptoms. Therefore the cause of symptoms should be eliminated. Excision of the endometrioitic lesions by laparotomy has proven to be effective but can cause complications. Laparoscopic surgery is a less invasive method to remove endometriotic lesions. In the University Medical Center Groningen (UMCG) laparoscopic surgery is performed by a multidisciplinary team, with a radical approach to remove all palpable and visible lesions in order to restore normal female pelvic anatomy. Aim: In our knowledge the UMCG is the only medical center in The Netherlands with a radical laparoscopic approach. The radicality of the laparoscopic resection of DIE in a multidisciplinary team makes this treatment different from management in other hospitals. In this thesis the influence of radical laparoscopic surgery in women with DIE on pain, quality of life and fertility is analyzed. These outcome measures were used to investigate which factors most strongly influenced patient satisfaction. Materials and methods: From the period of 2005-2011 data of 126 patients were available. Only files of patients who underwent primary laparoscopic surgery of with conversion to laparotomy were included (n=121). All of these patients (n=121) received post-operatively a questionnaire about symptoms, QoL and fertility. Non-parametric tests were used to analyze the acquired data. Linear regression was used to analyze the influence of pain on satisfaction. The Kruskal-Wallis test was used to analyze determinants of QoL and fertility on satisfaction. Jonkheere’s-Terpstra test was used to reveal trends in the determinants of satisfaction. Results: 82.6% (100/121) patients returned the completed questionnaire. All pain scores showed a significant decrease after radical laparoscopic surgery. All variables of QoL improved significantly and as well as fertility. A high proportion of patients were satisfied with the surgery with a median score of 8 out of 10. Pain turned out to be an important determinant for satisfaction with the best independent predictors being chronic abdominal pain pre-operatively, differences between pre- and post-operative chronic abdominal pain, pain during ovulation and pain in the flanks during menstruation. Similarly, QoL-factors also showed influence on satisfaction. Fertility variables did not significantly affect satisfaction. Discussion and conclusion: Radical laparoscopic resection for DIE has proven to decrease pain symptoms, to improve QoL and has a positive influence on fertility. We found a high satisfaction score on the outcome of the treatment. Therefore, we can conclude that radical laparoscopic surgery as performed in the UMCG is an effective treatment for DIE with a high rate of satisfied patients. Unfortunately, recurrence of symptoms still occurs in a proportion of patients. Therefore, further research is necessary to continue improving treatment.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Simons, Drs. A.H.M. |
| Supervisor name: | External supervisor: and Crane, Dr. L.M.A. and Location: and University Medical Center Groningen and Department: Obstetrics and Gynecology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2053 |
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