Index A surgical technique in hysterectomy, Antibiotics, 85 176-186 intraoperative, in cul-de-sac endome­ Abortion, spontaneous, in endometriosis periadnexal, with aspiration of endo­ triosis surgery, 107 -108 patients, 52, 63, 246 metriomas, 100 See also specific medications Absorbable surgical membranes, for postoperative, in laparoscopic sur­ Antibodies, antiendometrial, 53 minimizing postoperative adhe­ gery, 93 assay for, 64 sion formation, 194 postsurgical, and infertility or recur­ and embryo implantation, 246- Abuse, sexual or physical, and chronic rence of pain, 164 247 pain, 270-271 preventing, in surgery, 78, 193-199 See also Immune system Acosta's classification, pelvic endometri­ between the small bowel and abdomi­ Antidepressants osis, 29, 29t nal wall, 215 for chronic pain, 271-272 Acupuncture, 232 Adnexa heterocyclic, for pain, 271-272 Adenocarcinoma malignant lesions of, differentiating Antigens. See CA-125 antigen; Immune bowel, colonoscopy to rule out, 73, from endometriomas, 99 system 262-263 preservation of, in hysterectomy, Antihistamines for minimizing postoper­ endometrioid, 102 175 ative adhesion formation, 196 Adenomyoma, 9,16-17,77 Adnexectomy, 175 Appendix, endometriosis of, 128, 139- localization of, lOf Affective distress, and chronic pain, 140 Adenomyomata versus leiomyomata, 258 270-271 Artery, inferior epigastric, management Adenomyosis, 257-264 Age of bleeding from, 212 changes in B-cell and T-cell activity in, and cumulative pregnancy rates, for Aspiration, of endometriomas, versus re­ 53 hMG/IUI treated patients, 251 moval of the cyst wall, 100 postsurgical, and infertility or recur­ and evolution of endometriotic le­ Autoimmune phenomena rence of pain, 164 sions, 14, 33-34 associated with endometriosis, 247 subserosal, 257 American Association of Gynecologic autoantibodies associated with adeno­ Adhesiolysis, 87-92 Laparoscopists (AAGL), 207-220 myosis, 262 anterior ovarian, 89-90 American College of Obstetricians and laparoscopic, 195-197 Gynecologists (ACOG), 108 B and treatment of endometriosis, American Fertility Society (AFS), 108 93 classification scheme, 30-33 Beecham's classification, 28, 28t Adhesions revised, 32, 64 Bias, detection, 5 formation of, 242 Amitriptyline (Elavil), 272 Biofeedback, for chronic pain, 272 in endometriosis, 40 Analgesic therapy, time-contingent, 232 Biopsy, 70 pelvic Anatomy, of pain, 37-38 myometrial, for diagnosing adeno­ danazol therapy to reduce the risk Anesthesia, complications of, in laparos­ myosis, 260, 263 of,242-243 copy,212 Bladder and infertility, 62 Anovulation, associated with endometri­ endometriosis of, 155-156 and pregnancy rate, 29 osis, 50 surgical management of, 73 289 290 Index Bladder (Continued) Central models of pain, 268 electrosurgical excision of endometrio­ injury to, in laparoscopic surgery, Cerebral endometriosis, 132 sis, 111 213-214 Chromotubations, 64 endometriosis of, 105-114, 143 postoperative complications involv- Classification schemes, 27-35 obliteration of, 112-113 ing, 219 Clinical findings, in adenomyosis, 257- injuries during surgery for, 217 Bladder flap, developing, 175, 176 258 Culdotomy Bladder pillars, transection of, 179, 183f Clinical presentation, of endometriosis, with cuff closure, 179, 183f Bleeding 61-63 posterior, 184f emergency laparotomy to control, 213 Clinical studies Curtis-Fitz-Hugh syndrome, 63 as an indication of bowel trauma, 216 case-control, 4 Cutaneous endometriosis, 132 postoperative, 218 uncontrolled, 4 Cutting current, electrosurgical settings, 111 Bowel Clomiphene citrate (CC), for treating en­ Cyclooxygenase pathway involvement in endometriosis, 72-73 dometriosis-associated infertility, eicosanoid products of, 41 lysis of adhesions, 138-139 250 role of, in ovulation, 48 resection of, 143-149, 186 Coagulation Cyst in cul-de-sac endometriosis, 113 with a CO2 laser, 88 endometrial, 17 after hysterectomy, 176 for superficial endometriosis, 78 endometrial ovarian, 9 possibility of, in tertiary surgery, 71 Coelomic metaplasia pathogenesis of, 14-17 for postoperatively observed injury, resulting in endometriosis in men, Cystectomy 217 132-133 bladder, 155-156 to repair intraoperative injury, 216 theory of, 127 ovarian, 90, 100-102 sites of endometriosis in, 128 Cohen's classification, 30 Cystoscopy, for urinary tract endometri­ Bowel preparation, 138 Colon osis evaluation, 129 in adhesion lysis, 197 anterior wall of, resection of severe en­ Cytolytic lymphocytes (CL), 54 in cul-de-sac endometriosis, 107-108 dometriosis, 145, 147 in extrapelvic endometriosis, 81, 129 pseudomass in, differentiating from D prior to laparoscopy, 210 ovarian endometriosis, 95 Breakthrough bleeding, with progesto­ Colony-forming unit-granulocyte­ Danazoltherapy, 70, 164,232-234 gen medication, 236 macrophage (CFU-GM) cells, 48- for adenomyosis, 262 Bromocriptine, effect on development of 50 and androgenic side effects, 232 adenomyosis, animal experi­ Colostomy, diverting, in repair of large for bladder endometriosis, 151 ments, 261-262 bowel injury, 218 and cytoxicity of peritoneal fluid in en­ Buttram's classification, expanded, 30, Complement system, 53 dometriosis patients, 54 30t Complications FDA approval of, 77 of laparoscopy and fecundity of donor insemination c in bowel endometriosis, 148-149 patients, 46 in bowel repair in cul-de-sac sur­ and pregnancy rate, in endometriosis CA-125 antigen gery, 113 patients, 50, 204, 248 in endometriosis, 64 in hysterectomy, 186-187 preoperative, and risk of hemorrhage, levels of preventing and managing, 207- 99-100 to differentiate endometriotic cysts 220 in recurrence, 190 from, 98 postoperative, 218-220 and resolution of obstruction, 46 to identify adenomyosis, 260-261 of presacral neurectomy, 119, 120 and risk of recurrence after laparos- to identify ovarian neoplasia, 231 Computed tomography (CT), for evalu­ copic surgery, 162-164 Cancer, endometrial, and adenomyosis, ating adnexal masses, 99 study of, 242-243 262-263 Connective tissue, in subovarian adhe­ Deep endometriosis, 15-16 Carcinoma, differentiation from atypi­ sions, 19 and pain, 34, 40 cal endometriosis, 128 Contraindications, to operative laparos­ in the peritoneum and soft tissue, 71 Cardiac disease, contraindication to la­ copy, 209-212. See also Compli­ Deep tissue techniques, 71 paroscopy in, 209 cations Denervation, combination with conser­ Cardinal ligaments, dissection of, in hys­ Corpus luteum vative surgery, 164 terectomy, 179, 182f chocolate cysts, 96-97 Depression Cefoxitin, prophylactic, before bowel hemorrhagic, differentiating from and chronic pain, 270-271 surgery, 138 ovarian endometriosis, 95 with GnRH-a therapy, 235 Cell-mediated immunity, 233, 276-277 Corticosteroid-binding globulin (CBG), Dermoid cyst, differentiating from ovar­ mechanism of, 53-54 displacement of progesterone and ian endometriosis, 95 Cellular changes, B-cell and T-cell activ­ cortisol by danazol, 233 Dextran 70 (Hyskon), for minimizing ity in endometriosis, 53 Costs, laparoscopy versus laparotomy, postoperative adhesion forma­ Center for Special Pelvic Surgery 204 tion, 194 (CSPS), analysis of laparoscopic Credentialing, 224-225 Diagnosis, 63-64 complications at, 207 Cul-de-sac of ovarian endometriosis, 98-100 Index 291 surgical, 78 clinical and pathologic evaluation, 96 Fiberoptics, for endoscopy, 82 See also Differential diagnosis differentiation from malignancy, 86 Fibrinolytic activity, suppression of, and Diaphragmatic endometriosis, 130 randomized prospective study of pro- adhesion formation, 193 pulmonary endometriosis originating cedures, 164 Fibromyosis, 16-17 from, 131 surgery for, 71-72 Fibrosis Diathermy treatment, and progression staged,73-74 around deep infiltrating implants, 87 of Stage I endometriosis, 69 treating, 89-92 at extragenital endometriosis sites, 128 Diathesis-stress model of chronic pain, Endometriosis pain associated with, 40 268 defined, 229-230, 275-278, 288 Fimbrioplasty, 197 clinical implication of, 269 microscopic, 34 Foley catheter, to reduce risk of injury Differential diagnosis peritoneal, 10-11 to the bladder, 210 of adenomyosis, by MRI, 260 See also Deep endometriosis; particu­ Follicle of intestinal endometriosis, 129 lar systems, e.g. Urinary tract en­ abnormal dynamics, 51 of ovarian endometriosis, 95-102 dometriosis function of, and prostaglandins, 48 of pulmonary endometriosis, 131 Endometriosis Association Follicle-stimulating hormone (FSH), to See also Diagnosis on association of endometriosis with identify ovarian remnants, 190 Dioxin, and immune responses, 279 other health problems, 278 Forceps Distraction, and pain tolerance, 268 research registry of, 276 atraumatic Doxepin (Sinequan), 272 Endorphins, and pain management, 232 for laparoscopic adhesiolysis, 88 Dwell time, in electrosurgery, 109-110 Endoscopy, 77-78 atraumatic grasping, for ovarian endo­ Dyschezia, and endometriosis, 62 for radical surgery, 81 metrioma excision, 90 Dysmenorrhea for rectal endometriosis, 81 bipolar, 88 in adenomyosis, 258 Enterotomy, 81 Frankenhauser's ganglia, 38 without endometriosis, LUNA for, during enterolysis, 197 118 Epidemiology, 3-6 G endometriotic lesions associated with, Equipment, laparoscopic, 110-114 17,39,276-277 Estrogen/progestin therapy, 70 Galactorrhea, association with endome­ and pain, 38-39, 62, 232 Estrogen-progestogen therapy, 77 triosis, 50, 63 and prostaglandins, 48 Estrogen replacement therapy, and re- Gas embolism, managing, 211 Dyspareunia, 62 currence of endometriosis, 169, Genitourinary tract in adenomyosis, 258 189. See also Hormone therapy endometriosis