Surgical management of diaphragmatic and thoracic endometriosis’: a French multicentric descriptive study - 13/04/21

Doi : 10.1016/j.jogoh.2021.102147

Alexia Wetzel, (MD) ^a,^⁎ , Charles-André Philip, (MD) ^a , Francois Golfier, (MD, PhD) ^b , Pierre-Emmanuel Bonnot, (MD) ^c , Eddy Cotte, (MD, PhD) ^c , Pierre-Yves Brichon, (MD, PhD) ^d , Benjamin Darnis, (MD) ^e , Gautier Chene, (MD,PhD) ^f , Thierry Michy, (MD) ^g , Pascale Hoffmann, (MD, PhD) ^g , Francois Tronc, (MD, PhD) ^h , Gil Dubernard, (MD, PhD) ^a
^a Department of gynecology, Croix Rousse University Hospital, Hospices civils de Lyon (HCL), 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
^b Department of gynecology, Lyon-Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France
^c Department of digestive surgery, Lyon- Sud university hospital, HCL, 165 Chemin du Grand Revoyet, 69310 Pierre-Bénite, France
^d Department of thoracic surgery, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France
^e Department of digestive surgery, Croix Rousse University Hospital, HCL, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
^f Department of gynecology, Hopital Femme Mère Enfant, HCL, 59 Boulevard Pinel, 69500 Bron, France
^g Department of gynecology, Grenoble University hospital, Avenue Maquis du Grésivaudan, 38700 La Tronche, France
^h Department of thoracic surgery, Louis Pradel University Hospital HCL, 59 Boulevard Pinel, 69500 Bron, France,

^⁎CORRESPONDING AUTHOR Alexia Wetzel, Department of Gynecology, CHU Lyon, Hopital de la Croix Rousse, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, phone +33626462042Department of GynecologyCHU Lyon, Hopital de la Croix Rousse103 Grande Rue de la Croix-RousseLyon69004

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Abstract

Introduction

Surgical management of Diaphragmatic and thoracic endometriosis (DTE) is still controversial, a thoracic or an abdominal approach can be proposed.

Methods

We conducted a multicentric retrospective study in 8 thoracic, gynecology or digestive surgery units in 5 French university hospitals. The main objective was to review the current management of DTE.

Results

50 patients operated for DTE from 2010 to 2017 were included: 26 with a thoracic approach and 24 with an abdominal approach. Preoperative pelvic endometriosis (PE) concerned 25 patients. In 38 patients, DTE diagnosis was made on clinical symptoms (pneumothorax (n=19), chronic or catamenial chest pain (n=18) or hemopneumothorax (n=1)). Median time from onset of symptoms to diagnosis was 47 months (0-212). PE surgery concurrently occurred in 22 patients. We report diaphragmatic nodules, pleuropulmonary nodules and diaphragmatic perforations in 42, 5 and 22 women respectively. Lesions were right-sided in 45 patients. Nodules were destructed in 12 cases and resected in 38 cases. When a diaphragmatic reconstruction was needed (n= 31), a simple suture was performed in 26 patients, while 5 patients needed a mesh repair. Pleural symphysis was performed for all patients who received a thoracic approach. DTE resection was considered complete in 46 patients. Three patients had severe 30-days complications of DTE surgery. Median follow-up was 20 months (range 1-69). Recurrence occurred in 10 patients.

Conclusion

The results emphasize the importance of systematically looking for chest pain in patients suffering from PE and underline the lack of a standardized procedure and treatment in DTE.

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Keywords : Thoracic and/or diaphragmatic endometriosis, Pneumothorax, Scapular pain, Thoracic approach surgery, Abdominal approach surgery, Recurrence