INFILTRATIVE ENDOMETRIOSIS IN REPRODUCTIVE-AGED PATIENTS: DIAGNOSIS AND SURGICAL TACTICS
Objective. To elaborate an algorithm for examination of patients with the infiltrative forms of endometriosis and their surgical tactics. Subjects and methods. Eighty-six patients aged 21 to 45 years with the infiltrative forms of genital and extragenital endometriosis were examined and operated on. General clinical and special studies involving a gynecological Results. The disease duration averaged 6.7+0.5 years. Sixty-seven (77.9%) women had been previously operated on for infiltrative endometriosis, of them 65 (75.6%) women underwent laparoscopic surgery. An endometrioid infiltrate was excised within the intact tissues from the wall of the affected bladder and large bowel in 42 (48.8%) patients; wedge resection was carried out in 9 (10.4%) cases. Laparoscopic bladder resection and appendectomy were performed in 5 (6.9%) and 9 (10.4%) patients, respectively. The foci were excised making a plastic repair of the defect with a mesh graft in sublay technique in 7(9.7%) cases of extragenital endometriosis of the anterior abdominal wall. Eighty-four (97.6%) patients showed a significant postoperative clinical effect: elimination of rectal bleeding, colonic evacuatory dysfunction, chronic pain syndrome, macrohematuria, recurrent dysuria, renal colics, and dyspareunia. Within the first year after surgery, pregnancy occurred in 4 (7%) patients, spontaneously in one of them and after IVF in 3. Conclusion. The diagnosis of the common inf iltrative forms of endometriosis should comprise the use of a set of current examinations, such as USG, MRI, colonoscopy, and cystoscopy, to specify the process extent, and biopsy of pathological foci to rule out the malignant nature of changes. The success of surgical treatment for endometriosis depends on the adequate volume of a primary operation, which is of particular importance for young patients. Laparoscopic access is preferential during surgery for infiltrative endometriosis, including operations on the bladder, ureters, and large bowel.