title: Laparoscopic En Bloc Right Diaphragmatic Peritonectomy for Diaphragmatic Endometriosis According to the Sugarbaker Technique.
abstract: OBJECTIVE
  To evaluate the feasibility of a novel laparoscopic procedure for complete eradication of diaphragmatic endometriosis (DE).
  
  
  METHODS
  A retrospective multicenter study (Canadian Task Force Classification II-2).
  
  
  METHODS
  University tertiary referral centre.
  
  
  METHODS
  A consecutive series of 9 women with DE.
  
  
  METHODS
  Laparoscopic en bloc eradication using Sugarbaker's peritonectomy technique with or without diaphragmatic resection for DE. All surgical procedures were performed by the same surgeon in 2 tertiary referral centers (Charitè University, Berlin, Germany, and Catholic University of the Sacred Heart, Foundation John Paul II, Campobasso, Italy).
  
  
  RESULTS
  Rate of conversion to laparotomy, perioperative outcomes, intra- and postoperative complications, and recurrence rate. The procedures were successfully performed in all patients laparoscopically without conversion to laparotomy. All patients also presented with multiple endometriotic lesions in the Morison pouch, and in 3 cases a deep infiltration of the right diaphragm was observed that required partial diaphragmatic resection. In 2 women, pulmonary nodules were also detected, and lung laparoscopic resection was attempted to eradicate the disease. A chest drain was placed in 7 women and was removed after a median time of 6 days (range, 4-10 days). No intra- or postoperative complications were recorded. To complete the diaphragmatic peritonectomy, the median operative time required was 180 minutes (range, 90-240 minutes). The median estimated blood loss was 100 mL (range, 50-300 mL), and the median hospital stay was 10 days (range, 5-17 days). After a median follow-up of 6 months, we observed symptomatic relief for all study patients without major surgery-related morbidity. In 1 woman, laparoscopic adhesiolysis was performed after 18 months from surgery without signs of recurrent endometriosis.
  
  
  CONCLUSIONS
  Laparoscopic en bloc eradication of DE with Sugarbaker's peritonectomy is highly effective in the management of symptomatic DE, with no major intra-/postoperative complications and very favorable perioperative outcomes.
authors.affiliation: University of Molise, Campobasso, Italy; Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome and Campobasso, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome and Campobasso, Italy. Electronic address: margheritadessole@gmail.com.
authors.forename: Margherita
authors.initials: M
authors.lastname: Dessole
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome and Campobasso, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Petrillo
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome and Campobasso, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lucidi
authors.affiliation: Department of Gynecology, Campus Benjamin Franklin, Charitè University, Berlin, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Frangini
authors.affiliation: Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Legge
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome and Campobasso, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Department of Gynecology, Campus Benjamin Franklin, Charitè University, Berlin, Germany.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Mechsner
mesh_terms: D000328:Adult; D003964:Diaphragm / Q000473:pathology* / Q000601:surgery; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D009135:Muscular Diseases / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies
keywords: Diaphragmatic endometriosis; Laparoscopy; Peritonectomy; Sugarbaker's technique