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  1. Article ; Online: Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery.

    Tummers, Fokkedien H M P / Peltenburg, Sophie I / Metzemaekers, Jeroen / Jansen, Frank Willem / Blikkendaal, Mathijs D

    Archives of gynecology and obstetrics

    2023  Volume 308, Issue 5, Page(s) 1531–1541

    Abstract: Purpose: Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent ... ...

    Abstract Purpose: Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery.
    Methods: A retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures.
    Results: 595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001).
    Conclusion: Previous therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post-operative complications was observed.
    MeSH term(s) Female ; Humans ; Endometriosis/surgery ; Retrospective Studies ; Dissection ; Intraoperative Complications ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Treatment Outcome
    Language English
    Publishing date 2023-08-28
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 896455-5
    ISSN 1432-0711 ; 0932-0067
    ISSN (online) 1432-0711
    ISSN 0932-0067
    DOI 10.1007/s00404-023-07193-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Clavien-Dindo, comprehensive complication index and classification of intraoperative adverse events: a uniform and holistic approach in adverse event registration for (deep) endometriosis surgery.

    Metzemaekers, Jeroen / Bouwman, Lotte / de Vos, Marit / van Nieuwenhuizen, Kim / Twijnstra, Andries R H / Smeets, Maddy / Jansen, Frank Willem / Blikkendaal, Mathijs

    Human reproduction open

    2023  Volume 2023, Issue 2, Page(s) hoad019

    Abstract: Study question: What is the additional value of the comprehensive complication index (CCI) and ClassIntra system (classification for intraoperative adverse events (ioAEs)) in adverse event (AE) reporting in (deep) endometriosis (DE) surgery compared to ... ...

    Abstract Study question: What is the additional value of the comprehensive complication index (CCI) and ClassIntra system (classification for intraoperative adverse events (ioAEs)) in adverse event (AE) reporting in (deep) endometriosis (DE) surgery compared to only using the Clavien-Dindo (CD) system?
    Summary answer: The CCI and ClassIntra are useful additional tools alongside the CD system for a complete and uniform overview of the total AE burden in patients with extensive surgery (such as DE), and with this uniform data registration, it is possible to provide greater insight into the quality of care.
    What is known already: Uniform comparison of AEs reported in the literature is hampered by scattered registration. In endometriosis surgery, the usage of the CD complication system and the CCI is internationally recommended; however, the CCI is not routinely adapted in endometriosis care and research. Furthermore, a recommendation for ioAEs registration in endometriosis surgery is lacking, although this is vital information in surgical quality assessments.
    Study design size duration: A prospective mono-center study was conducted with 870 surgical DE cases from a non-university DE expertise center between February 2019 and December 2021.
    Participants/materials setting methods: Endometriosis cases were collected with the EQUSUM system, a publicly available web-based application for registration of surgical procedures for endometriosis. Postoperative adverse events (poAEs) were classified with the CD complication system and CCI. Differences in reporting and classifying AEs between the CCI and the CD were assessed. ioAEs were assessed with the ClassIntra. The primary outcome measure was to assess the additional value toward the CD classification with the introduction of the CCI and ClassIntra. In addition, we report a benchmark for the CCI in DE surgery.
    Main results and the role of chance: A total of 870 DE procedures were registered, of which 145 procedures with one or more poAEs, resulting in a poAE rate of 16.7% (145/870), of which in 36 cases (4.1%), the poAE was classified as severe (≥Grade 3b). The median CCI (interquartile range) of patients with poAEs was 20.9 (20.9-31.7) and 33.7 (33.7-39.7) in the group of patients with severe poAEs. In 20 patients (13.8%), the CCI was higher than the CD because of multiple poAEs. There were 11 ioAEs reported (11/870, 1.3%) in all procedures, mostly minor and directly repaired serosa injuries.
    Limitations reasons for caution: This study was conducted at a single center; thus, trends in AE rates and type of AEs could differ from other centers. Furthermore, no conclusion could be drawn on ioAEs in relation to the postoperative course because the power of this database is not robust enough for that purpose.
    Wider implications of the findings: From our data, we would advise to use the Clavien-Dindo classification system together with the CCI and ClassIntra for a complete overview of AE registration. The CCI appeared to provide a more complete overview of the total burden of poAEs compared to only reporting the most severe poAEs (as with CD). If the use of the CD, CCI, and ClassIntra is widely adapted, uniform data comparison will be possible at (inter)national level, providing better insight into the quality of care. Our data could be used as a first benchmark for other DE centers to optimize information provision in the shared decision-making process.
    Study funding/competing interests: No funding was received for this study. The authors have no conflicts of interest to declare.
    Trial registration number: N/A.
    Language English
    Publishing date 2023-05-11
    Publishing country England
    Document type Journal Article
    ISSN 2399-3529
    ISSN (online) 2399-3529
    DOI 10.1093/hropen/hoad019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Dynamic

    Del Valle, Julieta S / Mancini, Vanessa / Laverde Garay, Maitane / Asseler, Joyce D / Fan, Xueying / Metzemaekers, Jeroen / Louwe, Leoni A / Pilgram, Gonneke S K / van der Westerlaken, Lucette A J / van Mello, Norah M / Chuva de Sousa Lopes, Susana M

    Frontiers in endocrinology

    2022  Volume 13, Page(s) 936765

    Abstract: Current strategies for fertility preservation include the cryopreservation of embryos, mature oocytes or ovarian cortical tissue for autologous transplantation. However, not all patients that could benefit from fertility preservation can use the ... ...

    Abstract Current strategies for fertility preservation include the cryopreservation of embryos, mature oocytes or ovarian cortical tissue for autologous transplantation. However, not all patients that could benefit from fertility preservation can use the currently available technology. In this regard, obtaining functional mature oocytes from ovarian cortical tissue
    MeSH term(s) Cryopreservation/methods ; Female ; Fertility Preservation/methods ; Humans ; Microfluidics ; Oocytes ; Ovarian Follicle
    Language English
    Publishing date 2022-07-29
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2592084-4
    ISSN 1664-2392
    ISSN 1664-2392
    DOI 10.3389/fendo.2022.936765
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Treatment preferences for medication or surgery in patients with deep endometriosis and bowel involvement - a discrete choice experiment.

    Metzemaekers, Jeroen / van den Akker-van Marle, M Elske / Sampat, Jonathan / Smeets, Mathilde J G H / English, James / Thijs, Elke / Maas, Jacques W M / Willem Jansen, Frank / Essers, Brigitte

    BJOG : an international journal of obstetrics and gynaecology

    2021  Volume 129, Issue 8, Page(s) 1376–1385

    Abstract: Objective: To study the preferences of women with deep endometriosis (DE) with bowel involvement when they have to choose between conservative (medication) or surgical treatment.: Design: Labelled discrete choice experiment (DCE).: Setting: Dutch ... ...

    Abstract Objective: To study the preferences of women with deep endometriosis (DE) with bowel involvement when they have to choose between conservative (medication) or surgical treatment.
    Design: Labelled discrete choice experiment (DCE).
    Setting: Dutch academic and non-academic hospitals and online recruitment.
    Population or sample: A total of 169 women diagnosed with DE of the bowel.
    Methods: Baseline characteristics and the fear of surgery were collected. Women were asked to rank attributes and choose between hypothetical conservative or surgical treatment in different choice sets (scenarios). Each choice set offered different levels of all treatment attributes. Data were analysed by using multinomial logistic regression.
    Main outcome measures: The following attributes - effect on/risk of pain, fatigue, pregnancy, endometriosis lesions, mood swings, osteoporosis, temporary stoma and permanent intestinal symptoms - were used in this DCE.
    Results: In the ranking, osteoporosis was ranked with low importance, whereas in the DCE, a lower chance of osteoporosis was one of the most important drivers when choosing a conservative treatment. Women with previous surgery showed less fear of surgery compared with women without surgery. Low anterior resection syndrome was almost equally important for patients as the chance of pain reduction. Pain reduction had higher importance than improving fertility chances, even in women with desire for a future child.
    Conclusions: The risk of developing low anterior resection syndrome as a result of treatment is almost equally important as the reduction of pain symptoms. Women with previous surgery experience less fear of surgery compared with women without a surgical history.
    Tweetable abstract: First discrete choice experiment in patients with deep endometriosis.
    MeSH term(s) Endometriosis/pathology ; Endometriosis/surgery ; Female ; Humans ; Osteoporosis ; Pain ; Postoperative Complications ; Pregnancy ; Rectal Diseases/surgery ; Rectal Neoplasms ; Syndrome
    Language English
    Publishing date 2021-12-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 2000931-8
    ISSN 1471-0528 ; 0306-5456 ; 1470-0328
    ISSN (online) 1471-0528
    ISSN 0306-5456 ; 1470-0328
    DOI 10.1111/1471-0528.17053
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Crossroad decisions in deep endometriosis treatment options: a qualitative study among patients.

    Metzemaekers, Jeroen / Slotboom, Suzanne / Sampat, Jonathan / Vermolen, Polo / Smeets, Mathilde J G H / Elske van den Akker-van Marle, M / Maas, Jacques / Bakker, Esther C / Nijkamp, Marjan / Both, Stephanie / Jansen, Frank Willem

    Fertility and sterility

    2020  Volume 115, Issue 3, Page(s) 702–714

    Abstract: Objective: To study the experiences, considerations, and motivations of patients with endometriosis in the decision-making process for deep endometriosis (DE) treatment options.: Design: Qualitative study using semi-structured in-depth focus group ... ...

    Abstract Objective: To study the experiences, considerations, and motivations of patients with endometriosis in the decision-making process for deep endometriosis (DE) treatment options.
    Design: Qualitative study using semi-structured in-depth focus group methodology.
    Setting: University medical center.
    Patient(s): A total of 19 Dutch women diagnosed with DE between 27 and 47 years of age.
    Intervention(s): Not applicable.
    Main outcome measure(s): Focus group topics were disease impact and motives for treatment, expectations of the treatment process, and important factors in the decision process.
    Result(s): Women reported that pain, fertility, and strong fear of complications are important decisive factors in the treatment process. The goal of conceiving a child is considered important, however, sometimes doctors emphasize this topic too much. It emerged that complication counseling is frequently about surgical complications, whereas side effects of hormonal treatments are neglected. Shared decision making and information about treatment options, complications, and side effects are not always optimal, making it difficult to make a well-considered choice. Despite negative experiences encountered after surgery, the positive effect of surgery ensures that most women do not regret their choice.
    Conclusion(s): In the treatment decision process for patients with DE, pain is almost always the most important decisive factor. The wish to conceive and strong fear of complications can change this choice. Doctors should understand the importance of fertility for the majority of women, but, also, if this is not considered paramount, respect that view. To improve shared decision making, exploration of treatment goals, training of healthcare providers, and better patient information provision are desirable.
    MeSH term(s) Adult ; Decision Making/physiology ; Endometriosis/epidemiology ; Endometriosis/psychology ; Endometriosis/therapy ; Female ; Fertility Preservation/methods ; Fertility Preservation/psychology ; Focus Groups ; Humans ; Infertility, Female/epidemiology ; Infertility, Female/psychology ; Infertility, Female/therapy ; Middle Aged ; Motivation/physiology ; Pain/epidemiology ; Pain/psychology ; Pain Management/methods ; Pain Management/psychology ; Physician-Patient Relations ; Qualitative Research
    Language English
    Publishing date 2020-10-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80133-1
    ISSN 1556-5653 ; 0015-0282
    ISSN (online) 1556-5653
    ISSN 0015-0282
    DOI 10.1016/j.fertnstert.2020.06.041
    Database MEDical Literature Analysis and Retrieval System OnLINE

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