LAPAROSCOPIC SURGICAL-MANAGEMENT OF DIAPHRAGMATIC ENDOMETRIOSIS

Objective: To review the clinical presentations of and management opti ons for diaphragmatic endometriosis. Design: Retrospective review. Set ting: Referral center. Patient(s): Twenty-four women with endometriosi s of the diaphragm. Intervention(s): Surgical management. Main Outcome Measure(s): Diagnostic accuracy and therapeutic feasibility of operat ive laparoscopy. Result(s): Operative findings in 17 patients included 2-5 spots of endometriosis on the diaphragm measuring <1 cm. Seven wo men had numerous lesions scattered across the diaphragm. Lesions were bilateral in 8 patients, limited to the right hemidiaphragm in 14 pati ents, and limited to the left hemidiaphragm in 2 patients. In 7 patien ts, six endometriosis lesions were directly in the line of the left ve ntricle and three lesions were adjacent to the phrenic nerve. Endometr iosis was infiltrating into the muscular layer of the diaphragm in 7 p atients. The symptoms in all 7 symptomatic patients decreased signific antly after treatment, with a minimum follow-up period of 12 months. N o postoperative complications occurred. Conclusion(s): The abdominal d iaphragm can be involved with endometriosis and can be diagnosed and t reated effectively with the use of videolaparoscopy. (C) 1998 by Ameri can Society for Reproductive Medicine.