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Endometriosis, a benign, chronic gynecological disorder characterized by the presence of endometrial-like tissue outside the uterine cavity, affects 15% of women of reproductive age. Galectins, a family of beta-galactoside-binding proteins, regulate inflammation and autoimmunity and are widely expressed in reproductive tissues. This study aimed to assess Galectin-3 (Gal-3) levels in the serum of patients with endometriosis compared to asymptomatic controls and investigate serum Gal-3 level changes over a one-year follow-up period of patients with endometriosis. To determine the levels of soluble Gal-3 in the serum of women with endometriosis or gynecological tumors as well as healthy controls, a human Gal-3-specific ELISA was used. Our findings revealed significantly elevated serum Gal-3 levels in patients with endometriosis compared with healthy controls. Furthermore, Gal-3 concentrations were markedly higher in patients with malignant gynecological transformation of the endometrium than in patients with or without endometriosis. During the one-year follow-up, patients with endometriosis exhibited a progressive increase in serum Gal-3 levels. These findings highlight the potential of Gal-3 as a biomarker for endometriosis and related gynecological conditions. However, further prospective studies with larger, more representative patient cohorts are needed to validate its clinical value. [ABSTRACT FROM AUTHOR]

Introduction: Surgical resection of sacral plexus endometriosis (SPE) is contemplated in severely symptomatic patients not responding to medical or hormonal therapy. However, there is only limited data on the effects of surgery on pain and neurological symptoms. This study aims to report on the surgical outcomes in terms of pain and neurological symptom reduction in women undergoing surgical resection of SPE. Material and Methods: Thirty premenopausal patients with histologically confirmed SPE who underwent surgical resection of the disease between 2018 and 2024 were included in this multicenter prospective analysis. The primary outcome was the change in neurological symptoms reflected by sacral radiculopathy including dysaesthesia, paraesthesia, hyperaesthesia, and pain. The secondary outcome was post‐surgical morbidity reflected by rates of major intra‐ and postoperative complications. Results: All patients exhibited DE affecting the sacral roots S1‐S4, whereas no case of isolated supracardinal sciatic nerve involvement was observed. Out of 30 patients, one was lost to follow‐up leaving 29 patients for final analysis. Six (20%) of the 30 patients underwent partial resection of the sacral root because of endometriotic infiltration of the nerval tissue. In all other patients, dissection and shaving with cold scissors were sufficient to remove DE affecting the sacral root. Dysaesthesia was observed in 13/30 (43.3%), paraesthesia in 16/30 (53.3%), hyperaesthesia in 5/30 (16.7%), and secondary motor dysfunction in 4/30 (13.3%), preoperatively. The mean follow‐up interval was 25.5 ± 20.2 months showing an overall improvement in sacral radiculopathy in 93.1% (27/29) of the patients. A significant decrease in numeric rating scale (NRS) scores of dysaesthesia (p = 0.003), paraesthesia (p ≤ 0.001) and hyperaesthesia (p = 0.068) were observed post‐surgically. Equally, reduced pain symptoms including dysmenorrhea, dyspareunia and dyschezia (all p ≤ 0.001) with a relevant increase in post‐surgical quality of life scores (p ≤ 0.001) were recorded. De novo hyperaesthesia and paraesthesia occurred in 6.8% (2/29) and 3.4% (1/29) of the patients, respectively. Major Clavien‐Dindo grade III complications occurred in 13.3% (4/30) of the cases. Conclusions: Radical resection of symptomatic deep endometriosis affecting the sacral plexus reduces neurological and pain symptoms and leads to an increase in quality of life but is associated with high surgical morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion‐to‐anal‐verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. Nevertheless, it is not yet known to what extent the size and LAVD of bowel DE influence the severity of gastrointestinal symptoms. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms. Material and Methods: In this prospective study, premenopausal patients with histologically confirmed DE undergoing modified limited nerve‐vessel sparing rectal segmental bowel resection or full‐thickness discoid resection were evaluated. Extent of endometriosis was defined according to the #Enzian classification during surgery. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome was differences in presurgical numeric rating scale pain scores of dyschezia, dyspareunia, and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity. Results: Of 162 consecutive patients, 151 were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS‐like symptoms (p = 0.314 and p = 0.185, respectively) or pain symptoms (dyschezia, p = 0.440; dyspareunia, p = 0.136; and dysmenorrhea p = 0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 vs. C3; p = 0.611). In addition, LAVD did not affect the degree of dyschezia (p = 0.892), dyspareunia (p = 0.395), or dysmenorrhea (p = 0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p = 0.493) or dysmenorrhea (p = 0.128) but showed a trend toward affecting gastrointestinal function (p = 0.078) and was significantly associated with dyspareunia (p = 0.035). Conclusions: In present study, we could not find a correlation between colorectal DE lesion size and location (LAVD) and gastrointestinal function impairment or intensity of dyschezia and dysmenorrhea. Additional involvement of vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) exerts a significant impact on the degree of dyspareunia in women with colorectal DE. [ABSTRACT FROM AUTHOR]

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction. The last decade of the usage of intrauterine contraception has been marked by the application of levonorgestrel-releasing hormonal devices. A hormonal intrauterine device (IUD) releases a certain amount of progestogen, whose effect on endometrium is such that, apart from preventing unwanted pregnancy, also regulates the menstrual bleeding by reducing the quantity and the duration of haemorrhage. This effect of hormonal IUDs has led to their additional indications and use, so that nowadays these IUDs are used not only as contraceptives but for therapeutic purposes as well. Case Outline. After examination and treatment in an out-patient department, a 38-year-old woman was referred to our hospital due to suspected spontaneous uterine perforation caused by hormonal IUD (Mirena®) one month after its application. Clinical and sonographic examinations were unable to determine the uterine perforation or the exact IUD location. Radiographic examination confirmed the presence of the IUD in the abdomen, so it was decided to operate on the patient. Perforation in the isthmus of the uterus and to the right was identified intraoperatively. By exploration of the genital organs and the abdominal cavity, the IUD was finally located in the omentum. Conclusion. Even in cases of adequate indications for hormonal IUD application, the doctor’s experience and complying with all the principles of appropriate insertion, we should always consider the possibility of the occurrence of serious complications, which sometimes may even require surgery. The extragenital position of IUD, as in this case, may create serious difficulties in the detection of location. A possible development of asymptomatic complications additionally emphasizes the necessity of regular check-ups of all IUD users.

Introduction. Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis. Case Outline. We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel. Conclusion. Transvaginal sonography has an important role in detecting deep endometriosis of the pelvis. Fertility sparing surgery is the treatment of choice in symptomatic women wishing to retain fertility, since drugs used for endometriosis interfere with ovulation. The success of the surgery depends on the accuracy of the preoperative diagnosis. A multidisciplinary approach in managing deep endometriosis is mandatory in order to offer patients the best possible treatment using the combined skills of the colorectal and gynaecologic surgical teams. The presented case exhibits the feasibility of laparoscopic approach to severe pelvic endometriosis with bowel involvement.