3 Year Audit of a Multidisciplinary Approach to the Investigation and Management of Severe Endometriosis (#C9)
Preoperative diagnosis of the extent of severe endometriosis, particularly degree of bowel involvement, remains problematic with variable accuracy when based off symptoms, clinical examination, ultrasound and MRI in isolation. Resulting uncertainty can result in inefficient allocation of theatre resources- particularly operating time, primary operating gynaecologist and need for colorectal assistance.
In an attempt to better triage patients with severe endometriosis undergoing surgical management, the Endosurgery Department at Mercy Hospital for Women has adopted a Multidisciplinary pre operative approach. On referral to the unit, patients have an endometriosis focused transvaginal ultrasound after a FLEET enema by a gynaecologist sonologist. If the ultrasound suggests stage IV endometriosis, patients proceed to a MRI.
A multidisciplinary meeting (MDM) is then conducted with gynaecologist, colorectal surgeon, radiologist and ultrasonologist present to come to a consensus on degree of bowel involvement and planned surgery (expected or possible need for bowel resection). Feedback at the meeting is also provided on patients who have since had operations completed to compare surgical findings to pre operative imaging.
A prospective audit of patients who have been reviewed at the multidisciplinary meeting and had their operations completed from Mar 2012 to Nov 2014.
38 patients were operated on during the study period. Bowel endometriosis of varying severity was diagnosed in 29 MRI and 30 US patients. At MDM, 19 of patients were deemed to have endometriosis involving rectal muscularis or deeper. 17 patients were expected to require some form of bowel resection and colorectal colleagues were expected to attend 22 operations.
15 bowel resections actually occured. 13 of the resections were predicted with colorectal already in attendance.
Multidisciplinary pre operative assessment of severe endometriosis can aid in the triage of patients to appropriately staffed operating lists. MDM also has the benefit of providing surgical feedback to our imaging colleagues.