Abdominal Wall Endometriosis: Management Strategies and Surgical Techniques

Study Objective

To review medical and interventional management strategies of abdominal wall endometriosis (AWE) and highlight a case of deep infiltrating pelvic endometriosis with concurrent AWE requiring wide local excision.

Design

Surgical video case presentation

Setting

Tertiary care academic center

Patients or Participants

This is a video case presentation of a 39 yo G0 patient who presented with a longstanding history of pelvic pain and endometriosis. MRI showed deep pelvic endometriosis with multifocal anterior rectal wall infiltration and soft tissue implants along the uterovesical space and rectouterine fascia as well as soft tissue thickening in the left anterior abdominal wall measuring up to 4.5 cm most compatible with AWE. The patient desired surgical management due to the severity of her symptoms, however also desired fertility preservation. The decision was made to proceed with robotic-assisted endometriosis excision and AWE resection.

Interventions

Robotic-assisted excision of deep infiltrating endometriosis with bowel resection and open excision of AWE with fascial repair.

Measurements and Primary Results

Uncomplicated surgical management of deep infiltrating endometriosis and AWE was performed in a fertility preserving manner. The patient was discharged on postoperative day #3 on norethindrone for further endometriosis suppression. This video reviews techniques for treatment of AWE and highlights opportunities for expanding treatment options of this rare manifestation of endometriosis.

Conclusion

While surgical excision has been historically regarded as standard of care for AWE, many adjuvant and non-surgical techniques are emerging to ensure safe and complete excision.