Geoffrey D. Reid

Relevance of gastrointestinal symptoms in endometriosis

Background: Endometriosis commonly presents with a range of symptoms none of which are particularly specific for the condition, often resulting in misdiagnosis or delay in diagnosis.

Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: A review

Intestinal involvement in endometriosis is thought to occur in up to 12% of all endometriosis cases. While colorectal resection is being increasingly advocated as a feasible management option in patients with severe disease, there still remains significant resistance towards this surgery. This article aims to review the current literature to determine the pain and fertility outcomes following segmental bowel resection for colorectal endometriosis.

Bowel resection for severe endometriosis: An Australian series of 177 cases

Background: Colorectal resection for severe endometriosis has been increasingly described in the literature over the last 20 years.

Laparoscopic Excision of Endocervicosis of the Urinary Bladder

Endocervicosis is a benign lesion in which endocervical mucosa develops in anatomic locations distant from the endocervical canal. Two cases of infiltrating endocervicosis of the urinary bladder were managed by laparoscopic partial cystectomy. This avoided the morbidity of laparotomy and provided improved visualization of the extent of bladder resection required to remove the lesion completely.

Reliability of visual diagnosis of endometriosis.

OBJECTIVE To determine whether accuracy of visual diagnosis of endometriosis at laparoscopy is determined by stage of disease. DESIGN Prospective longitudinal cohort study (Canadian Task Force classification II-2). SETTING Tertiary referral centers in three Australian states. PATIENTS Of 1439 biopsy specimens, endometriosis was proved in at least one specimen in 431 patients. INTERVENTIONS Laparoscopy with visual diagnosis and staging of endometriosis followed by histopathologic analysis and confirmation. Operations were performed by five experienced laparoscopic gynecologists. MEASUREMENTS AND MAIN RESULTS Histopathologic confirmation of visual diagnosis of endometriosis adjusted for significant covariates. Endometriosis was accurately diagnosed in 49.7% of American Society for Reproductive Medicine (ASRM) stage I, which was significantly less accurate than for other stages of endometriosis. Deep endometriosis was more likely to be diagnosed accurately than superficial endometriosis (adjusted odds ratio, 2.51; 95% confidence interval, 1.50-4.18; p < .01). Lesion volume was also predictive, with larger lesions diagnosed more accurately than smaller lesions. In general, lesion site did not greatly influence accuracy except for superficial ovarian lesions, which were more likely to be incorrectly diagnosed visually as endometriosis (adjusted odds ratio, 0.16; 95% confidence interval, 0.06-0.41; p < .01). There was no statistically significant difference in accuracy between the gynecologic surgeons. CONCLUSION The accuracy of visual diagnosis of endometriosis was substantially influenced by American Society of Reproductive Medicine stage, the depth and volume of the lesion, and to a lesser extent the location of the lesion.

Hepatic endometriosis: A case report and review of the literature

A 46-year-old nulliparous woman presented in October 2001complaining of right upper quadrant pain. Pelvic endometriosishad been diagnosed at laparoscopy in 1987. An endome-triotic bladder nodule was removed in 1988 and a subtotalhysterectomy for endometriosis was carried out in 1990. Abilateral oopherectomy and resection of an endometrioticbowel lesion (requiring temporary colostomy) was under-taken in 1992, and oestradiol implants were used from 1992to 1996.In 1997, an upper abdominal ultrasound showed a 10-cmlesion within the right lobe of the liver, with echogenicmargins and internal debris. Computed tomography (CT)scanning showed a low-density lesion, a small subphrenic fluidcollection and a right pleural effusion. At laparotomy, thelesion was marsupialised. Pathological examination of thecyst wall confirmed an endometrioma.The patient was treated with Goserelin 3.6 mg monthlyfor a year following surgery. A further CT scan in August2000 showed reformation of a 6-cm cyst within the liverparenchyma. Repeat CT scanning carried out in August2001 revealed that this lesion had grown to 11 cm. It alsodemonstrated attachment to the inferior surface of the righthemi-diaphram (Fig. 1). She had experienced minimalmenopausal symptoms since cessation of Goserelin in 1998,although serum assays at her last presentation showed afollicle-stimulating hormone level of 48 IU/L, an oestradiollevel of 105 IU/L and a CA125 >1000 IU/L.A further laparotomy was undertaken in November 2001.The patient had a large multiloculated endometrioma occu-pying the right lobe of the liver that was attached to theinferior surface of the right hemi-diaphram. There was full-thickness invasion of endometriosis through the diaphram.A right hemi-hepatectomy, cholecystectomy and diaphrag-matic resection were undertaken. Fibrotic obliteration of thepleural cavity at the base of the right lung was noted, so noattempt was made to close the diaphragmatic defect.The specimen of hemi-liver contained an endometrioma(Fig. 2) showing moderately atypical complex hyperplasia(Fig. 3).Figure 1 Intrahepatic endometrioma demonstrated by computedtomography scanning.

Laparoscopic transabdominal cervico-isthmic cerclage: A minimally invasive approach

Background:  While the traditional approach to management of cervical insufficiency has been the insertion of a transvaginal cerclage during pregnancy, a transabdominal cervico‐isthmic suture is indicated in certain patients. This procedure is traditionally performed via laparotomy. Laparoscopic transabdominal cervico‐isthmic cerclage (LTCC) placement, however, confers the benefit of the low morbidity associated with laparoscopy.

Laparoscopic surgery for colorectal endometriosis and its impact upon fertility: an updated Australian series of 307 cases

Introduction Colorectal involvement occurs in up to 12% of cases of endometriosis. Various surgical options for its management have been described, including segmental resection and disc excision, with debate surrounding indications for surgery and the impact of such procedures. The current study aimed to describe the experiences of three Australian gynaecologists regarding laparoscopic bowel surgery for colorectal endometriosis. Methods The records of three gynaecological surgeons were analysed for patients who underwent surgical removal of colorectal endometriosis by way of appendicectomy, bowel disc excision and/or segmental resection, between 1999 and 2012. Results A total of 307 patients were identified. Sixteen (5.2%) underwent appendicectomy, 146 (47.6%) underwent disc excision, 126 (41.0%) underwent segmental resection and 19 (6.2%) underwent simultaneous procedures. The majority of procedures were performed laparoscopically (265 of 307; 86.3%). Nineteen procedures (6.2%) were planned laparotomies due to the known extent of disease. Twenty-three procedures were converted from laparoscopy to laparotomy (conversion rate of 7.5%). Complications occurred in 35 of the 307 cases (11.4%). Sixty-seven women amongst the 122 wishing to conceive post-operatively achieved at least one pregnancy (pregnancy rate of 54.9%). Of the 84 pregnancies achieved amongst the 67 women who conceived, 49 (58.3%) were achieved through assisted reproductive technologies, and 31 pregnancies (36.9%) were conceived spontaneously. This information was unavailable for 4 pregnancies (4.8%). Conclusions The current series demonstrates that laparoscopic surgery for severe disease is feasible in specialised centres. Furthermore, such surgery may have a positive impact upon post-operative fertility.

Dangerous injury associated with bipolar diathermy

A 34-year-old woman underwent laparoscopic surgery for endometriosis. During the procedure she sustained a partial thickness burn injury to her sigmoid colon. The operating suite staff became aware of unintended diathermy activation when an audible alarm on the generator sounded spontaneously. It was noted that the bipolar lead had been inadvertently placed into the monopolar sockets, and the paddles of the Lyons bipolar forceps became active when approximated within the abdominal cavity. The injury was immediately identified and repaired laparoscopically with 2/0 vicryl sutures. Endometriosis involving the pelvic sidewall, uterosacral ligaments and muscularis layer of the sigmoid colon was excised. The patient was discharged from hospital on day 2 with no postoperative sequelae.

A vascular complication of laparoscopic ovarian cyst aspiration

We report a case of a 26-year-old woman with large bilateral theca lutein cysts complicating her molar pregnancy. She presented with an acute abdomen 4 weeks after suction evacuation of the uterus. Laparoscopic aspiration of the cysts was performed but a conversion to laparotomy was required because of intraoperative hemorrhage. During laparoscopy a long aspiration needle was introduced through a 5-mm right iliac fossa cannula and inserted into the ovarian cyst. Suction was applied and thin straw-colored cystic fluid was aspirated, resulting in deflation of one cystic compartment. Following repositioning of the needle a moderate amount of fresh bleeding appeared. An estimated 300 ml of fresh blood was evacuated from the peritoneal cavity and continued bleeding appeared to leak from the cyst puncture site. Major vascular injury could not be excluded and a laparotomy was performed. The partially collapsed ovarian cyst was incised and a number of active bleeding sites were identified on