Cryoablation of abdominal wall endometriosis nodules

Abdominal wall endometriosis is a rare disease, but is the most common form of extrapelvic endometriosis. It generally manifests within two years of a surgical intervention in the abdominal or pelvic region, and has a major impact on quality of life.

Abdominal wall endometriosis nodules develop near scar tissue. These scars may have been caused by a cesarean section, the use of trocarts in laparoscopic surgery, an episiotomy or the removal of the Bartholin glands.

Symptoms of abdominal wall endometriosis appear during menstruation and may include:

• Pain at the site of a cesarean section scar
• Bleeding from the navel, at the site of a laparoscopic surgery scar
• Nodules or cysts in the abdominal wall
• Abdominal pain when endometriosis cells travel beyond scar tissue

Until now, treatments were drug-based (hormones to relieve pain) or surgical (removal of the cysts or nodules). The efficacy of hormonal treatments is debatable, while surgical treatments are a potential source of complications. Some patients refuse to undergo surgery and prefer to endure the symptoms.

Minimally invasive alternatives have been developed over the past several years. One such alternative is cryoablation, an innovative interventional radiology technique.

Cryoablation is a minimally invasive technique that has been used for several years to treat malignant lung and kidney tumors as well as soft tissue lesions (metastases, desmoid tumors).

It has recently been adapted to treat abdominal wall endometriosis nodules. The procedure consists in inserting one or more needles into the lesion(s) to form an ice ball. The extreme cold (-40° C/-40° F) destroys the endometriosis lesions.

Cryoablation offers several advantages:

• Leaves no visible scar and spares the abdominal wall
• Can be used to treat several nodules at the same time
• Can be performed on an outpatient basis under local anesthesia
• Is performed under X-ray guidance (the doctor can view the ice ball throughout the procedure)
• Is simple and quick to implement
• Is much less invasive than its surgical alternative and is associated with a lower risk of recurrence

To best prepare for your procedure at the American Hospital of Paris, please follow the guidelines below:

• Bring your ultrasound and MRI results
• Bring your blood workup results
• Come for a preoperative anesthesia consultation in the month prior to the procedure
• Inform us of any medications you are currently taking
• Do not eat or drink after midnight the night before the procedure.

Endometriosis nodule cryoablation is a safe and effective treatment that shows promising results:

• Rapidly effective against pain (pain is diminished from the first menstrual cycle following the procedure)
• Decrease in nodule volume
• Clear improvement in patient’s quality of life

Because endometriosis nodule cryoablation is a minimally invasive procedure, it carries a very low risk of complications compared to surgical techniques, and its benefits far outweigh those of surgery.

Cryoablation may cause:

• Bruising at the needle puncture site
• Skin burns
• Abdominal pain
• Risk of bleeding
• Infection in the area treated