Definitive Bowel Surgery for Endometriosis. Ladies and gentlemen, thank you very much to Professor Martin for this nice presentation of my activity. I am very grateful to Tamer to invite me to this prestigious meeting and to let me speak about my favorite topic, which is the surgery of deep endometriosis of colorectal endometriosis.
And I choose for this topic the title Primum Non Nocere, meaning, first, don't harm. So, as usual, I would like to declare my conflict of interest, because as I am involved in master classes and workshops, I receive fees from these four societies.
Now, what does mean a reasonable surgical approach in deep endometriosis? And to introduce this topic, I will present you three cases, three young women with comparable age and comparable disease. The first one, I recently met her. And three days ago, I perform a biopsy. She's year-old nullipara. And she has one symptom, 10 days a month. She has a cyclic pain involving the anterior face of the right thigh, with troubles of walking and climbing stairs.
Despite my analysis, I did not find any deep dyspareunia, dysgeusia, dysuria, bowel movements trouble, left sciatic pain, nothing. And when I performed an examination, I found a huge infiltration of the posterior and left vagina, while the symptoms are on the right side. And here you have the MRI. She has a huge nodule of the right iliopsoas muscle, involving the cecum and the abdominal wall.
Now, complete excision of this mass, is it possible? Yes, we can. Can we remove it? However, should we do it? I think, no, because the risk of sequelae is huge in this woman who continues to climb stairs and to walk. So, I choose to perform cryotherapy in a hospital in Paris. And I administrate her continuous hormonal treatment, particularly, because she has no chance to get pregnant naturally or with IVF.
