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• W2294624105 abstract "The purpose of our study is to determine the pre-operative work-up and the surgical management of advanced stage endometriosis by Canadian Gynecologists. A survey was designed to determine the pre-operative investigations and surgical management of advanced stage endometriosis by Gynaecologists in Canada. It was electronically distributed by the Society of Obstetricians and Gynaecologists of Canada to 733 individuals. The response rate was 15.7% (115 respondents). Preoperatively, 62.2% of respondents perform a TVUS on all of their patients, while an MRI is reserved for patients with physical exam findings suspicious for advanced endometriosis (26.7%) or in whom the surgeons suspect deep infiltrating endometriosis (DIE), bowel, bladder, or uterosacral disease (54.4%). Most surgeons (81.4%) report encountering advanced disease that they did not suspect preoperatively <10% of the time. The majority of our respondents identify that suspected DIE (68.8%), bladder (70.3%), bowel (78.1%), or ureteric involvement (78.1%) are absolute indications for pre-operative referral to an endometriosis specialist; however, most do not refer on the basis of symptoms (bowel (25%), bladder (18.8%), dyspareunia (6.3%)), physical exam findings (uterosacral nodularity 15.6%), or the presence of endometriomas (3.1%). Although most respondents identified the presence of DIE and organ involvement as absolute indications for referral to an endometriosis specialist, only 40% admit they routinely refer their patients in whom they suspect DIE, endometriomas, bowel, bladder or uterosacral ligament involvement to an endometriosis specialist prior to any attempted surgery, and 54.4% state they would never refer without previously confirming the diagnosis at laparoscopy. Although about half of the respondents would never refer pre-operatively to an endometriosis specialist, only 15% of all respondents felt comfortable treating advanced endometriosis completely at time of laparoscopy, while 32.2% would treat surface disease and excise endometriomas if present, and 30% would do the same and refer to a specialist. Post-operatively, 67.8% of respondents would refer patients to an endometriosis specialist if their disease was not appropriately treated at the time of surgery, while 23.3% do not refer any of their patients. The most important barriers to providing total laparoscopic treatment of endometriosis that were cited by the respondents were: lack of adequate surgical training (42.5%), lack of equipment (40%), lack of OR time (30%) and difficulty in accessing an endometriosis specialist (23.8%). Our study identified significant variability in the management of advanced endometriosis in Canada, as well as existing and perceived barriers to complete laparoscopic treatment of severe endometriosis. Since such a small proportion of Gynaecologists in Canada feel comfortable completely managing advanced stage endometriosis surgically, this highlights the need to formulate a universal investigation and management plan for patients with endometriosis. This may improve the pre-operative identification of patients with advanced stage endometriosis who could benefit from treatment by an endometriosis specialist." @default.
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• W2294624105 date "2016-04-01" @default.
• W2294624105 modified "2023-09-23" @default.
• W2294624105 title "61: Understanding pre-operative staging and surgical practice in advanced endometriosis" @default.
• W2294624105 doi "https://doi.org/10.1016/j.ajog.2016.01.092" @default.
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