Laparoscopic surgical management of diaphragmatic endometriosis

Objective: To review the clinical presentations of and management options for diaphragmatic endometriosis. Design: Retrospective review. Setting: Referral center. Patient(s): Twenty-four women with endometriosis of the diaphragm. Intervention(s): Surgical management. Main Outcome Measure(s): Diagnostic accuracy and therapeutic feasibility of operative laparoscopy. Result(s): Operative findings in 17 patients included 2-5 spots of endometriosis on the diaphragm measuring <1 cm. Seven women had numerous lesions scattered across the diaphragm. Lesions were bilateral in 8 patients, limited to the right hemidiaphragm in 14 patients, and limited to the left hemidiaphragm in 2 patients. In 7 patients, six endometriosis lesions were directly in the line of the left ventricle and three lesions were adjacent to the phrenic nerve. Endometriosis was infiltrating into the muscular layer of the diaphragm in 7 patients. The symptoms in all 7 symptomatic patients decreased significantly after treatment, with a minimum follow-up period of 12 months. No postoperative complications occurred. Conclusion(s): The abdominal diaphragm can be involved with endometriosis and can be diagnosed and treated effectively with the use of videolaparoscopy.