Dr. Roberto Luigi Cazzato, Interventie radioloog, University Hospital of Strasbourg

Presentatie

Foci of abdominal wall endometriosis (AWE) are located within the anterior abdominal wall, in the subcutaneous tissue (superficial AWE), or within the muscular layers of the rectus abdominis (deep AWE). AWE affects up to 0.5% of young (mean age 35 years) women with history of previous caesarean section or pelvic surgery, and it clinically presents with cyclical pain rhyming with menses and mass effect.

Traditional treatments of AWE include hormonal therapies and surgical resection. However, both these therapeutic options may be undesirable for many patients, or even deemed
unfeasible for many others. Moreover, surgery of AWE may be challenging due to the fibrotic changes occurring following previous surgeries. Accordingly, surgery may be somehow demolitive, thus resulting in prosthesis implantation and large scars.

For this reason, there was a real need for minimally invasive treatments, and interventional radiologists filled this gap by proposing percutaneous US/CT- (or MRI-)guided cryoablation. The intervention is often proposed under local anesthesia (80% cases) and in an out-patient basis. Less than 3 cryoprobes are generally used along  with protective measures of surrounding organs (i.e. hydrodissection for the skin and the muscular layers whenever possible and carbo-dissection for the content of the abdominal cavity). Pain relief is rapid and long-lasting with more than 80% of treated patients experiencing an effective pain relief at 12-month follow-up.

Complication rates are very low (< 3%). The few data available comparing cryoablation to surgical resection showed similar clinical results, along with fewer complications and shorter hospitalization periods for cryoablation.