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The retrodisplacement of the uterus (retroflexion and/or retroversion) may be connected with pelvic pain symptoms and posterior deep infiltrating endometriosis (DIE).
Deeply infiltrating
endometriosis presents an endometriotic lesion penetrating the retroperitoneal
space or wall of pelvic organs to a depth of at least 5mm. Most of the patients
presented at follow-up had a retroverted and retroflexed uterus. The
laparoscopic hysteropexy to correct the uterine position significantly improved
the symptoms.
The retrodisplacement of
the uterus (retroflexion and/or retroversion) may be connected with pelvic pain
symptoms and posterior deep infiltrating endometriosis (DIE). The earliest
studies in symptomatic women with retrodisplacement of the uterus showed the
efficacy of hysteropexy for pain symptoms improvement. This study evaluated the
sonographic, clinical and surgical outcomes of a hysteropexy technique.
Laparoscopic round ligament
plication and tilting of the fundus portion of uterus in women with uterine
retrodisplacement and posterior deep infiltrating endometriosis was executed. A
total of 42 symptomatic women were enrolled. The sonographic data of every
participant (angle of uterine version and uterine flexion, uterine mobility)
was examined before and after surgery with transvaginal and transperineal
approaches. Women were also observed at 1, 6 and 12 months after surgery for
pain symptoms using a numerical rating scale (dyspareunia, dysmenorrhoea, and
chronic pelvic pain), intraoperative data and surgical
complications.
Additional mean operative
time of hysteropexy method was 8 ± 3 min. At an early follow-up, both the
uterine angles were significantly reduced. At 12-month follow-up, seven patients
(16.7%) showed a retroverted uterus, while 12 (28.6%) showed a retroflexed
uterus; the sliding sign continued negative in four patients (9.5%). A
significant improvement of symptoms was observed during the follow-up.
Laparoscopic hysteropexy appears as a useful additional surgical procedure, which can temporarily correct the uterine position to reduce the risk of postoperative adhesions.
Aust N Z J Obstet Gynaecol
Transvaginal and transperineal ultrasound follow-up after laparoscopic correction of uterine retrodisplacement in women with posterior deep infiltrating endometriosis
Seracchioli R et al.
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