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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

Surgical Importance
of Recognition of Endometriosis

Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991

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Deep endometriosis and surgery for deep endometriosis is associated with increased complications. (Brudenell, 1996; Moore, Binstock, & Growdon, 1988; Nezhat, Nezhat, Nezhat, Nasserbakht, Rosati, & Seidman, 1996) Koninckx has demonstrated that fewer complications and less difficulty is associated with the use of preoperative medical suppression. (Koninckx, 1996) In this series, there was one ureteral perforation and seven delayed bowel perforations. Only one of the six complications happened in patients who had been pretreated. Preoperative recognition of the possibility of deep endometriosis is needed to prepare for this possibility. Menstrual examination, preoperative bowel prep and preoperative medical suppression appear to be associated with improved surgical outcome. (Koninckx, 1996; Koninckx, Meuleman, Oosterlynck, & Cornillie, 1996) 

Pockets are extra folds of peritoneum (internal skin) possibly created by scar pulling on the skin.  Pockets can create their own concern. This is particularly true when pockets are in the broad ligament and associated with medial ureteral displacement. (Batt, Smith, Buck, Naples, & Severino, 1989)  In this situation, close observation is needed to avoid damage to ureters which may look like uterosacral ligaments. The uterosacral ligament should descend toward the sacrum.  A "uterosacral ligament" that ascends over the pelvic brim is usually the ureter.

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Bibliography

bulletBatt, R. E., Smith, R. A., Buck, G. M., Naples, J. D., & Severino, M. F. (1989). A case series - peritoneal pockets and endometriosis: rudimentary duplications of the Mullerian system. Adolesc Pediatr Gynecol, 2, 47-56.
bulletBrudenell, M. (1996). Medico-legal aspects of ureteric damage during abdominal hysterectomy. Br J Obstet Gynaecol, 133, 1180-1183.
bulletKoninckx, P. R. (1996). Complications of C02 laser endoscopic excision of deep endometriosis. Hum Reprod, 11, 2263-2268.
bulletKoninckx, P. R., Meuleman, C., Oosterlynck, D., & Cornillie, F. J. (1996). Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentrations. Fertil Steril, 65, 280-287.
bulletMoore, J. G., Binstock, M. A., & Growdon, W. A. (1988). The clinical implications of retroperitoneal endometriosis. Am J Obstet Gynecol, 158, 1291-1298.
bulletNezhat, C., Nezhat, F., Nezhat, C., Nasserbakht, F., Rosati, M., & Seidman, D. S. (1996). Urinary tract endometriosis treated by laparoscopy. Fertil Steril, 66, 920-924.

Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991

The color illustrations that accompanied this paper are in the Color Atlas.

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