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Cited by 31Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

True Prevalence of Diaphragmatic Endometriosis and Its Association with Severe Endometriosis: A Call for Awareness and Investigation

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Pagano, Flavia, Schwander, Adriana, Vaineau, Cloé, Knabben, Laura, Nirgianakis, Konstantinos, Imboden, Sara, Mueller, Michael D.·2023·Journal of Minimally Invasive Gynecology
DOI 10.1016/j.jmig.2023.01.006
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Abstract

STUDY OBJECTIVE: To identify characteristics indicating preoperatively the presence of diaphragmatic endometriosis (DE). DESIGN: Comparison of characteristics of patients with diaphragmatic endometriosis (DE) with characteristics of patients with abdominal endometriosis without diaphragmatic involvement, in a prospective cohort study. SETTING: Tertiary referral center; endometriosis center. PATIENTS: A total of 1372 patients with histologically proven endometriosis. INTERVENTIONS: Surgery performed laparoscopically under general anesthesia. All patients with suspected endometriosis underwent a complete bilateral inspection of the diaphragm. MEASUREMENTS AND MAIN RESULTS: Demographic and clinical pathologic characteristics were evaluated using basic descriptive statistics (comparison of the groups using the χ2 test and the Mann-Whitney t test). A logistic regression analysis was performed to evaluate the relationship (hazard ratio) between symptoms and the presence of DE. DE was diagnosed in 4.7% of the patients (65 of 1372). There was no significant difference between the 2 groups (patients with abdominal endometriosis with or without DE) with regard to typical endometriosis pain (dysmenorrhea, dyschezia, dysuria, and/or dyspareunia). However, in the DE group, diaphragmatic pain was present significantly more often preoperatively (27.7% vs 1.8%, p <.001). Four DE patients (6.1 %) were asymptomatic (with infertility the indication for surgery). In the DE group, 78.4 % had advanced stages of endometriosis (revised American Fertility Society III° or IV°); the left lower pelvis was affected in more patients (73.8%). In cases of ovarian endometriosis, patients with DE showed a significantly higher prevalence of left ovaries involvement (left 63% vs right 35.7%, p <.001). Patients with DE had a significantly higher rate of infertility (49.2% vs 28.7%, p <.05). CONCLUSION: Patients with shoulder pain, infertility, and/or endometriosis in the left pelvis have a significant higher risk of DE and therefore need specific preoperative counseling and if indicated surgical treatment.

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  • Lesions on the diaphragm tend to be associated with more severe pelvic endometriosis.

    “Lesions on the diaphragm tend to be associated with more severe pelvic endometriosis [ 21 , 45 , 68 , 70 ].”

    From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [70]

  • Pagano et al. recently reported a rate of 4.7% diaphragmatic endometriosis in their patients after complete laparoscopic inspection of the diaphragm was performed in patients undergoing laparoscopy for endometriosis at their tertiary care referral center.

    “Of note, Pagano et al. recently reported a rate of 4.7% diaphragmatic endometriosis in their patients, after complete laparoscopic inspection of the diaphragm was performed in patients’ undergoing laparoscopy for endometriosis at their tertiary care referral center [ 70 ].”

    From Thoracic Endometriosis Syndrome: A Comprehensive Review and Multidisciplinary Approach to Management (2024) · cites this paper as [70]

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  1. preoperative assessment and therapy. Acta Obstet Gynecol Scand. 2011;90:136-139.a

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Authors
Pagano, F., Schwander, A., Vaineau, C., Knabben, L., Nirgianakis, K., Imboden, S., & Mueller, M. D.
Affiliations
University of Bern (CH)
Corresponding author
Mueller, Michael D.
ORCID
Venue
Journal of Minimally Invasive Gynecology
Publisher
Elsevier BV
Published
2023-04
Volume
30
Issue
4
Pages
329-334
ISSN
1553-4650 (ISSN-L)
DOI
10.1016/j.jmig.2023.01.006
OpenAlex
W4316804286
Cited by
31
References
40
Citations by year
2026: 8 · 2025: 14 · 2024: 7 · 2023: 2
FWCI
7.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Minimally Invasive Gynecology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • BORIS (University Library Bern) (submittedVersion, other-oa)
  • Open Access CRIS of the University of Bern
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
diaphragmatic endometriosis, endometriosis prevalence, severe endometriosis, infertility, endometrioma, preoperative risk factors, shoulder pain
MeSH terms
Diaphragm, Dysmenorrhea, Endometriosis, Female, Humans, Laparoscopy, Prospective Studies, Prevalence, Pelvic Pain

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