Deep Retraction Pockets, Endometriosis, and Quality of Life

Patrick P Yeung Jr; Ian Logan; Jeffrey A Gavard

doi:10.3389/fpubh.2016.00085

Endometriosis Surgical Treatment

Deep Retraction Pockets, Endometriosis, and Quality of Life

Yeung PP Jr, Logan I, Gavard JA

Published June 2016 Frontiers in Public Health, 4, 85

DOI 10.3389/fpubh.2016.00085 PMID 27242981 PMC PMC4861171

RRM Academy Synopsis

Deep retraction pockets can hold endometriosis even when clear

Endometriosis was found in about 5 out of 10 deep retraction pockets removed at surgery. The study followed 107 women with deep pain during sex who had excision surgery at one referral center. Pain and quality of life improved in the 53 women who answered a follow-up questionnaire.

Key Findings

Endometriosis was confirmed histologically in tissue removed from any location in 88 of 107 women (82.2%).
Twenty-five women (23.4%) had deep retraction pockets behind the uterus or along the uterosacral ligaments. Of 31 pockets excised, 15 (48.4%) contained endometriosis.
Ten of the 31 pockets (32.3%) had no visible lesion on the surface. Of those 10, 3 (30.0%) had endometriosis on histology.
The postoperative questionnaire came back from 53 of 107 women (49.5%) at a median of 13 months. Pain and quality of life improved significantly, whether or not pockets were present.
Improvements remained when women who took hormonal suppression after surgery were removed from the analysis.

Interpretation

This study tracked 107 women with deep pain during sex who had excision surgery at one hospital that treats endometriosis. Almost half of the pockets that looked clear on the outside held endometriosis once a lab checked the tissue under a microscope. Pain and quality of life got better after surgery, whether a woman had pockets or not. The gains held up even after the women on hormone-suppressing drugs were removed from the analysis. The authors say they did not use a tested scale for sexual function. Bigger studies of these pockets could build on these findings.

RRM Context

Restorative reproductive medicine looks for disease where it hides. These pockets looked clear from the outside. They held endometriosis only because the tissue was removed and checked under a microscope. A quick look at the pelvis can miss disease. Excision works as a way to find it and a way to treat it in women with deep pain during sex.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

The purpose of this study was to examine if deep retraction pockets (DRPs) in the posterior cul-de-sac and uterosacral ligaments could be a manifestation of endometriosis and if excision of these pockets improves pain symptoms and quality of life.

Study Design

Prospective cohort study Canadian Task Force Classification, II-3.

Materials and Methods

Preoperative data, operative data, and follow-up data were collected prospectively at the Center for Endometriosis at Saint Louis University, a referral center for the surgical management of endometriosis.

Results

The 107 consecutive patients who presented with preoperative deep dyspareunia were included in the study, and the median postoperative follow-up was 13 months. Endometriosis was confirmed histologically in any location excised in 88/107 (82.2%) of the women, and 31 DRPs were excised from 25 women with DRPs in the posterior cul-de-sac or uterosacral ligaments, of which 15/31 (48.4%) had endometriosis. Of the 10 DRPs without visible surface lesions, 3 (30.0%) had endometriosis on histology. Pain symptoms and quality of life significantly improved after excision surgery, whether or not DRPs were present. Women who had endometriosis in their DRP also had significant improvement in deep dyspareunia and chronic pelvic pain and quality of life. Results did not differ when patients who took postoperative hormonal suppression were removed from the analyses.

Conclusion

Patients had significantly improved pain symptoms and quality of life after excision surgery, whether or not DRPs were present. This study demonstrated that a DRP may be a manifestation of endometriosis (even with a clear surface of the pocket), so that DRPs should be excised to achieve optimal excision of endometriosis.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Topics

Endometriosis › Surgical Treatment › Excision Surgery · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Sexual Health › Sexual Pain › Dyspareunia

Patrick P Yeung Jr, Ian Logan, Jeffrey A Gavard

Pat Yeung, P Yeung, I Logan, Jeff Gavard, J Gavard

PMID 27242981 27242981 DOI 10.3389/fpubh.2016.00085 10.3389/fpubh.2016.00085 Yeung Jr et al. 2016, Yeung Jr 2016

Deep Retraction Pockets, Endometriosis, and Quality of Life

Deep retraction pockets can hold endometriosis even when clear

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

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