Can ovariopexy at the end of surgery for endometriosis be recommended? A case report.
BACKGROUND
Endometriosis affects 10-15% of the female population in the reproductive period and is detected in up to 40% of infertile women. Surgery is indicated to improve fertility and symptoms in these women, but some patients experience severe complications and develop postoperative adhesion. We discuss the potential impact on adhesion of systematic ovariopexy at the end of surgery for endometriosis.


METHODS
We report a case of a 31-year-old woman who underwent initial laparoscopic removal of endometriomas and rectovaginal endometriosis with bilateral transient ovariopexy five years ago. She was referred for recurrence of symptoms and infertility. Preoperative transvaginal sonography and MRI confirmed the recurrence of endometriosis with bilateral uterosacral ligament and rectal involvement. At laparoscopy severe and dense adhesions of the ovaries to the anterior abdominal wall using nonabsorbable suture were observed associated with distortion of tubal anatomy. In addition to the removal of these adhesions, a sigmoid adhesiolysis was performed with uterosacral ligament, rectosigmoid and vaginal resections, followed by a systematic protective colostomy.


CONCLUSIONS
This case illustrates the deleterious impact on adhesions to the abdominal wall of transient ovariopexy at the end of surgery for endometriosis.
Department of Gynecology-Obstetrics, Hôpital Tenon, Université Pierre et Marie Curie, Paris. emile.darai@tnn.aphp.fr
Emile
E
Daraï
Cyril
C
Touboul
Marcos
M
Ballester
Christophe
C
Poncelet
D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007247:Infertility, Female; D010053:Ovary / Q000000981:diagnostic imaging / Q000601:surgery*; D011184:Postoperative Period; D000267:Tissue Adhesions / Q000517:prevention & control*; D014463:Ultrasonography