Perioperative Considerations for Abdominal Wall Endometriosis

Study Objective

To review the pre, intra, and postoperative considerations for the management of abdominal wall endometriosis.

Design

Case report.

Setting

Tertiary medical center.

Patients or Participants

40-year-old G4P0040 with an abdominal wall mass, suspicious for abdominal wall endometriosis, who desired surgical management.

Interventions

The patient underwent an abdominal wall endometriosis excision with omental endometriosis excision. Perioperative considerations include:

Preoperatively:

 • Obtaining an MRI for surgical planning.

 • Determining the surgical approach, either laparoscopic or abdominal.

 • Consulting General Surgery for disease with larger fascial involvement.

 • Utilizing the rectus to defect ratio.

Intraoperatively:

 • Understanding key anatomy of the abdominal wall.

 • Employing traction/countertraction and circumferential dissection.

 • Undermining the fascia for a tension-free primary closure.

Postoperatively:

 • Instructing the patient to follow activity restrictions for 6 weeks.

 • Deferring medical management for isolated abdominal wall endometriosis given the lack of evidence for disease suppression.

Measurements and Primary Results

The patient was discharged home on postoperative day 1 and was healing well by her postoperative visit.

Conclusion

Abdominal wall endometriosis causes significant symptoms for patients, and complex gynecologists must be well versed in its management. Optimization for its excision by the abdominal approach includes obtaining an MRI for planning excision and closure, understanding the anatomy of the abdominal wall, and undermining the fascia for a tension-free primary closure.