Nezhat, C., Seidman, D. S., Nezhat, F., & Nezhat, C. H. (1998). Laparoscopic surgical management of diaphragmatic endometriosis. Fertility and Sterility, 69(6), 1048-1055. https://doi.org/10.1016/s0015-0282(98)00056-9
Diaphragmatic endometriosis was symptom-free in 17 of 24 women
Diaphragm endometriosis came with no symptoms in about 7 out of 10 women studied. This case series from two referral centers reviewed 24 women. All 7 women with symptoms had fewer symptoms afterward, and none had postoperative complications from treatment.
About 7 in 10 women with diaphragm endometriosis had no symptoms from it. Source: Nezhat C et al., 1998, PMID 9627291.Study at a glance, case series of 24 women: Most diaphragm endometriosis caused no symptoms in 24 women. Source: Nezhat C et al., 1998, PMID 9627291.
Key Findings
Of 24 women, 7 had shoulder, chest, epigastric or right upper quadrant pain suggesting diaphragm disease. The other 17 reported no symptoms directly related to it.
Lesions sat only on the right hemidiaphragm in 14 women, only on the left in 2, and on both sides in 8. Deep muscle infiltration occurred in 7, 4 of them symptomatic.
Six lesions in 7 patients lay directly over the left ventricle, and three lay next to the phrenic nerve.
All 7 symptomatic women had fewer symptoms after treatment, with follow-up of at least 12 months. None had complete relief, and symptoms returned in 2 women with deep lesions.
CO2 laser treated lesions in 20 women, and CO2 laser plus ultrasonic surgery in 1. Three women without symptoms went untreated. One later had chest pain the authors linked to it.
Interpretation
This case series reviewed charts of 24 women treated at two centers from 1990 to 1996. All 24 women also had endometriosis in the pelvis. Most diaphragm lesions caused no symptoms and were found during surgery for pelvic disease. One woman had a brief abnormal heartbeat during ultrasonic treatment near the heart. The authors note that the natural course of silent lesions, and whether to treat them, is still unclear. The findings support larger studies of diaphragm endometriosis and its surgical care.
RRM Context
Restorative reproductive medicine treats endometriosis with excision surgery that removes the disease. In this series, the surgeons vaporized surface lesions with a laser and cut out deep lesions. Surface lesions came back in 1 of 20 women treated with laser alone. The authors advise checking the whole abdomen, including the diaphragm, at every surgery for endometriosis.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To review the clinical presentations of and management options for diaphragmatic endometriosis.
Design
Retrospective review.
Setting
Referral center.
Patients
Twenty-four women with endometriosis of the diaphragm.
Interventions
Surgical management.
Main Outcome Measures
Diagnostic accuracy and therapeutic feasibility of operative laparoscopy.
Results
Operative findings in 17 patients included 2-5 spots of endometriosis on the diaphragm measuring <1 cm. Seven women had numerous lesions scattered across the diaphragm. Lesions were bilateral in 8 patients, limited to the right hemidiaphragm in 14 patients, and limited to the left hemidiaphragm in 2 patients. In 7 patients, six endometriosis lesions were directly in the line of the left ventricle and three lesions were adjacent to the phrenic nerve. Endometriosis was infiltrating into the muscular layer of the diaphragm in 7 patients. The symptoms in all 7 symptomatic patients decreased significantly after treatment, with a minimum follow-up period of 12 months. No postoperative complications occurred.
Conclusions
The abdominal diaphragm can be involved with endometriosis and can be diagnosed and treated effectively with the use of videolaparoscopy.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
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