Derin İnfiltratif Endometriozis Cerrahisinde Komplikasyonları Nasıl Azaltabiliriz?
Özet
Derin infiltratif endometriozis (DIE), pelvik yapıların derinlerine nüfuz eden ve şiddetli ağrı, infertilite gibi semptomlarla seyreden ciddi bir hastalıktır. DIE cerrahisi, hastaların yaşam kalitesini artırmayı hedefler, ancak yüksek komplikasyon riski taşır. Komplikasyonları en aza indirmek için preoperatif, intraoperatif ve postoperatif süreçlerde dikkatli bir planlama yapılmalıdır. Preoperatif süreçte ayrıntılı hasta değerlendirmesi, pelvik muayene, ultrason ve MRG gibi görüntüleme yöntemleri önemlidir. İntraoperatif hazırlık aşamasında multidisipliner bir ekip yaklaşımı ve minimal invaziv cerrahi tekniklerin (laparoskopi ve robotik cerrahi) kullanımı komplikasyon riskini azaltır. Kanama kontrolü ve bağırsak ile üreterin korunması, cerrahi başarı açısından kritik öneme sahiptir. Postoperatif dönemde erken mobilizasyon, ağrı yönetimi ve komplikasyonların yakından takibi gereklidir. Tromboembolik komplikasyonların önlenmesi ve postoperatif ağrı yönetimi, hasta konforunu artırır. Cerrahiden sonra hormonal tedavi veya yardımcı üreme teknikleri, semptomların nüks etmesi durumunda değerlendirilebilir. DIE cerrahisinde başarılı bir sonuç için multidisipliner ekip çalışması ve uygun cerrahi tekniklerin kullanılması büyük önem taşır.
Deep infiltrative endometriosis (DIE) is a serious condition characterized by the penetration of pelvic structures, leading to severe symptoms such as pain and infertility. DIE surgery aims to improve the quality of life for patients, but it carries a high risk of complications. To minimize these risks, careful planning is necessary in the preoperative, intraoperative, and postoperative phases. In the preoperative phase, thorough patient evaluation, pelvic examination, and imaging techniques like ultrasound and MRI are essential. During the intraoperative phase, a multidisciplinary team approach and the use of minimally invasive surgical techniques (laparoscopy and robotic surgery) help reduce the risk of complications. Controlling bleeding and protecting the bowel and ureter are critical for surgical success. In the postoperative period, early mobilization, pain management, and close monitoring of complications are required. Preventing thromboembolic complications and managing postoperative pain enhance patient comfort. After surgery, hormonal therapy or assisted reproductive techniques may be considered if symptoms recur. For successful outcomes in DIE surgery, multidisciplinary teamwork and the use of appropriate surgical techniques are crucial.
Referanslar
D'Alterio MN, D'Ancona G, Raslan M, et al. Management Challenges of Deep Infiltrating Endometriosis. Int J Fertil Steril. 2021;15(2):88-94. doi:10.22074/IJFS.2020.134689
Lee SY, Koo YJ, Lee DH. Classification of endometriosis. Yeungnam Univ J Med. 2021;38(1):10-18. doi:10.12701/yujm.2020.00444
Working group of ESGE, ESHRE, and WES, Keckstein J, Becker CM, et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open. 2020;2020(1):hoaa002. Published 2020 Feb 12. doi:10.1093/hropen/hoaa002
Chen LH, Lo WC, Huang HY,et al. A Lifelong Impact on Endometriosis: Pathophysiology and Pharmacological Treatment. Int J Mol Sci. 2023;24(8):7503. Published 2023 Apr 19. doi:10.3390/ijms24087503
Nisenblat V, Bossuyt PM, Farquhar C,et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2(2):CD009591. Published 2016 Feb 26. doi:10.1002/14651858.CD009591.pub2
Nisenblat V, Prentice L, Bossuyt PM, et al. Combination of the non-invasive tests for the diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;7(7):CD012281. Published 2016 Jul 13. doi:10.1002/14651858.CD012281
Daniilidis A, Grigoriadis G, Dalakoura D, et al. Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis-An Overview: How, Why, and When. Diagnostics (Basel). 2022;12(12):2912. Published 2022 Nov 23. doi:10.3390/diagnostics12122912
Guerriero S, Ajossa S, Pagliuca M, et al. Advances in Imaging for Assessing Pelvic Endometriosis. Diagnostics (Basel). 2022;12(12):2960. Published 2022 Nov 26. doi:10.3390/diagnostics12122960
Yin S, Lin Q, Xu F,et al. Diagnosis of Deep Infiltrating Endometriosis Using Transvaginal Ultrasonography. Front Med (Lausanne). 2020;7:567929. Published 2020 Nov 23. doi:10.3389/fmed.2020.567929
Galazis N, Raza A. Diagnosis of deep infiltrating endometriosis with trans-vaginal ultrasonography. J Gynecol Obstet Hum Reprod. 2018;47(10):587. doi:10.1016/j.jogoh.2018.08.013
Grasso RF, Di Giacomo V, Sedati P, et al. Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography. Abdom Imaging. 2010;35(6):716-725. doi:10.1007/s00261-009-9587-7
Bazot M, Daraï E. Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertil Steril. 2017;108(6):886-894. doi:10.1016/j.fertnstert.2017.10.026
Karaman Y, Uslu H. Complications and their management in endometriosis surgery. Womens Health (Lond). 2015;11(5):685-692. doi:10.2217/whe.15.55
Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Res. 2019;8:F1000 Faculty Rev-529. Published 2019 Apr 23. doi:10.12688/f1000research.14817.1
Ávila I, Costa LMP, Soto M Jr, et al. Safe multidisciplinary approach in deeply infiltrating endometriosis (DIE): is it feasible?. JBRA Assist Reprod. 2014;18(4):139-143. Published 2014 Dec 27. doi:10.5935/1518-0557.20140020
Cao Q, Lu F, Feng WW, et al. Comparison of complete and incomplete excision of deep infiltrating endometriosis. Int J Clin Exp Med. 2015;8(11):21497-21506. Published 2015 Nov 15.
Piozzi GN, Burea V, Duhoky R, et al. Robotic surgery for bowel endometriosis: a multidisciplinary management of a complex entity. Tech Coloproctol. 2024;28(1):31. Published 2024 Feb 8. doi:10.1007/s10151-023-02904-0
Zhang S, Yu H, Dong Z, et al. Laparoendoscopic single-site surgery for deep infiltrating endometriosis based on retroperitoneal pelvic spaces anatomy: a retrospective study. Sci Rep. 2023;13(1):10785. Published 2023 Jul 4. doi:10.1038/s41598-023-38034-8
Behrens AM, Sikorski MJ, Kofinas P. Hemostatic strategies for traumatic and surgical bleeding. J Biomed Mater Res A. 2014;102(11):4182-4194. doi:10.1002/jbm.a.35052
Guo Y, Wang M, Liu Q, et al. Recent advances in the medical applications of hemostatic materials. Theranostics. 2023;13(1):161-196. Published 2023 Jan 1. doi:10.7150/thno.79639
Lescay HA, Jiang J, Leslie SW,et al. Anatomy, Abdomen and Pelvis Ureter. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 5, 2024.
Barns ME, Dinh Chau MV, Teloken PE,et al. The Use of Prophylactic Ureteric Stents in Major Abdomino-Pelvic Sarcoma Surgery: Risks, Benefits, and Potential Complications. Res Rep Urol. 2023;15:577-585. Published 2023 Dec 19. doi:10.2147/RRU.S435959
Koninckx PR, Ussia A, Adamyan L, et al. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012;98(3):564-571. doi:10.1016/j.fertnstert.2012.07.1061
Bridoux V, Roman H, Kianifard B, et al. Combined transanal and laparoscopic approach for the treatment of deep endometriosis infiltrating the rectum. Hum Reprod. 2012;27(2):418-426. doi:10.1093/humrep/der422
Chopin N, Vieira M, Borghese B, et al. Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol. 2005;12(2):106-112. doi:10.1016/j.jmig.2005.01.015
Dubernard G, Piketty M, Rouzier R, et al. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod. 2006;21(5):1243-1247. doi:10.1093/humrep/dei491
Dousset B, Leconte M, Borghese B, et al. Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg. 2010;251(5):887-895. doi:10.1097/SLA.0b013e3181d9722d
Fanfani F, Fagotti A, Gagliardi ML, et al. Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study. Fertil Steril. 2010;94(2):444-449. doi:10.1016/j.fertnstert.2009.03.066
Daniilidis A, Angioni S, Di Michele S, et al. Deep Endometriosis and Infertility: What Is the Impact of Surgery?. J Clin Med. 2022;11(22):6727. Published 2022 Nov 14. doi:10.3390/jcm11226727
Nezhat CH, Malik S, Osias J, et al. Laparoscopic management of 15 patients with infiltrating endometriosis of the bladder and a case of primary intravesical endometrioid adenosarcoma. Fertil Steril. 2002;78(4):872-875. doi:10.1016/s0015-0282(02)03332-0
Rozsnyai F, Roman H, Resch B, et al. Outcomes of surgical management of deep infiltrating endometriosis of the ureter and urinary bladder. JSLS. 2011;15(4):439-447. doi:10.4293/108680811X13176785203798
Leborne P, Huberlant S, Masia F, et al. Clinical outcomes following surgical management of deep infiltrating endometriosis. Sci Rep. 2022;12(1):21800. Published 2022 Dec 16. doi:10.1038/s41598-022-25751-9
