Pellerin Madeleine, Faller Emilie, Minella Chris, Garbin Olivier, Host Aline, Lecointre Lise, Akladios Chérif
Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France.
Gynaecology Unit, Hautepierre Hospital, University Hospitals of Strasbourg, 1 avenue Molière, 67000 Strasbourg France.
J Gynecol Obstet Hum Reprod. 2021 Nov;50(9):102158. doi: 10.1016/j.jogoh.2021.102158. Epub 2021 May 1.
Endometriosis is a common disease in women, which requires a medical and surgical approach. Surgical societies recommend a multidisciplinary management in tertiary referral centers. The objective of our study is to assess the surgical management of endometriosis in France by studying the surgeons' attitude for bowel and urinary endometriosis.
We sent a survey to french endometriosis surgeons. We did a descriptive analysis and a comparative analysis between surgeons who believe endometriosis surgeons should be considered as "pelvic surgeons", able to treat bowel and urinary involvement.
We included 90 answers, from gynaecologic surgeons from all over France. Gynaecologic surgeons perform minor bowel and urinary tract surgery, and more complex procedures are performed with digestive or urological surgeon (bowel resection 85% of cases, ureteric resection-anastomosis 84% of cases, ureteric reimplantation 91% of cases). Surgeons considering that gynaecologists should be able to deal with urinary and bowel endometriosis carry out more bowel and urinary procedures. They have an additional training in surgery and perform more endometriosis surgery every year. However, bowel and urinary endometriosis management by gynaecologic surgeons is contested amongst gynaecologists.
To this day, there is no dedicated training in France to coach gynaecologist to perform such procedures. Multidisciplinary approach is essential for quality care, in expert centers. The basic education of gynaecologic surgeons does not allow them to perform complex pelvic surgeries, but qualifications can be gained for these interventions with a special training, and perform a greater number of surgeries.
子宫内膜异位症是女性的常见疾病，需要药物和手术治疗。外科协会建议在三级转诊中心采用多学科管理方法。我们研究的目的是通过研究外科医生对肠道和泌尿系统子宫内膜异位症的态度，评估法国对子宫内膜异位症的手术治疗情况。
我们向法国的子宫内膜异位症外科医生发送了一份调查问卷。我们对认为子宫内膜异位症外科医生应被视为“盆腔外科医生”、能够治疗肠道和泌尿系统受累情况的外科医生与其他外科医生进行了描述性分析和比较分析。
我们纳入了来自法国各地妇科外科医生的90份回复。妇科外科医生进行小肠和泌尿道的小型手术，更复杂的手术则由消化科或泌尿科医生进行（肠道切除术占85%的病例，输尿管切除吻合术占84%的病例，输尿管再植术占91%的病例）。认为妇科医生应能够处理泌尿系统和肠道子宫内膜异位症的外科医生进行的肠道和泌尿系统手术更多。他们接受了额外的手术培训，并且每年进行更多的子宫内膜异位症手术。然而，妇科外科医生对肠道和泌尿系统子宫内膜异位症的处理在妇科医生中存在争议。
时至今日，法国没有专门培训指导妇科医生进行此类手术。在专家中心，多学科方法对于优质护理至关重要。妇科外科医生的基础教育不允许他们进行复杂的盆腔手术，但通过特殊培训可以获得进行这些干预的资质，并进行更多手术。
