title: Laparoscopic surgical treatment of diaphragmatic endometriosis: a 7-year single-institution retrospective review.
abstract: BACKGROUND
  Diaphragmatic endometriosis is a rare condition that may cause invalidating epigastric or thoracic pain and catamenial pneumothorax. During the past decades, laparoscopy has been proposed as an optimal tool for diagnosis and surgical eradication of the disease.
  
  
  METHODS
  We present a retrospective series of consecutive patients affected by diaphragmatic endometriosis, treated by laparoscopy at our institution, during a period of 7 years.
  
  
  RESULTS
  Among 3,008 patients with pelvic endometriosis, 46 cases with intraoperative diagnosis of diaphragmatic endometriosis were identified. Operative findings showed multiple diaphragmatic lesions in 32 (69.5 %) patients and single lesions in 14 (30.4 %). Diaphragmatic implants were distributed on the right side in 40 (86.9 %) patients; in 5 patients (10.8 %) they were bilateral and 1 patient had a single lesion on the left hemidiaphragm. Most of the symptomatic patients were treated by complete excision of the nodules, whereas only three patients referring right upper-quadrant abdominal pain and right shoulder catamenial pain had superficial diaphragmatic endometriosis and were treated by diathermocoagulation.
  
  
  CONCLUSIONS
  Diaphragmatic endometriosis should be included in the concept of complete eradication of endometriosis. This kind of surgery has been shown to be feasible and cost-effective; however, it should be managed in a referral center, by an expert laparoscopic gynecologist with knowledge of oncological surgical techniques, with the support of a general surgeon and a trained anesthesiologist.
authors.affiliation: Gynecologic Oncology Division, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, VR, Italy. issaschool@gmail.com
authors.forename: Marcello
authors.initials: M
authors.lastname: Ceccaroni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Roviglione
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Giampaolino
authors.forename: Roberto
authors.initials: R
authors.lastname: Clarizia
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruni
authors.forename: Giacomo
authors.initials: G
authors.lastname: Ruffo
authors.forename: Tito Silvio
authors.initials: TS
authors.lastname: Patrelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Placido
authors.forename: Luca
authors.initials: L
authors.lastname: Minelli
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D009135:Muscular Diseases / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult