The Imbalance of Pelvic Forces and the Pain Caused By Endometriosis: En Bloc Peritonectomy, a Solution for This

Study Objective Demonstrate how fibrosis in the uterine parametrium by endometriosis leads to an imbalance of forces between the two sides of the pelvis causing retractions in pre-sacral fascia and somatic nerves. Also, how en bloc peritonectomy can rebalance the forces in the pelvis healing pain.DesignEdited video with regular case of laparoscopic surgery for endometriosis excision.SettingThree-port laparoscopic surgery.Patients or Participants23-year-old patient presenting chronic pelvic pain with radiating to left leg and dyspareunia.InterventionsPosterior compartment en bloc peritonectomy made to relax the pre-sacral fascia above the somatic nerves on both sides of the pelvis simultaneously, recovering the forces balance around the uterus. The patient was previously submitted to physical examination with left parameter retraction and MRI showing left parametrium fibrosis and uterine deviation to the left side.Measurements and Main ResultsThe video shows the releasing of entrapment and rebalancing of the forces recovering elasticity on both sides of pelvis by peritonectomy. A dissociation between the high intensity of the symptoms, the physical examination findings, the MRI and the aspects of the peritoneum lesions during laparoscopy was observed. The real infiltration of endometriosis in the collagen could be observed. The patient had complete improvement of pelvic pain symptoms in the immediate postoperative period and in the follow-up 6, 12 and 18 months.ConclusionEndometriosis could be considered much more than a peritoneal surface disease. The dissociation between the intensity of the symptoms, the physical examination, MRI and the peritoneal aspects during laparoscopy suggests that endometriosis is a infiltration of endometrium into collagen instead of dark spots on the peritoneum surface. The en bloc fibrosis and lesions removal demonstrates to be an effective and reproducible way for solving painful symptoms for releasing the pre-sacral fascia from the entrapment and rebalancing the forces in the pelvis.

Igor Chiminacio, Carolina Obrzut. Journal of Minimally Invasive Gynecology Volume 30, Issue 11, Supplement, November 2023, Page S41. Sub-category: Non-oncological use for pelvic pertinectomy; En-bloc excision for endometriosis. https://doi. org/10.1016/j.jmig.2023.08.127