Surgery for deep endometriosis without involvement of digestive or urinary tracts: do not worry the patients!

Surgery for deep endometriosis without involvement of the digestive or urinary tract provides a low rate of postoperative complications and good improvement of pelvic pain and fertility outcomes.

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Volume 109, Issue 6, Pages 1079–1085.e1

Authors:

Aurélie Vallée, M.D., Stéphane Ploteau, M.D., Carole Abo, M.D., Emanuela Stochino-Loi, M.D., Salwa Moatassim-Drissa, M.D., Noémie Marty, M.D., Benjamin Merlot, M.D., Horace Roman, M.D., Ph.D.

Abstract:

Objective

To report postoperative outcomes after surgery for deep endometriosis without involvement of the digestive or urinary tracts.

Design

Retrospective study using data prospectively recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis (CIRENDO) database.

Setting

University tertiary referral center.

Patient(s)

One hundred thirty consecutive patients whose follow-up ranged from 1 to 6 years.

Intervention(s)

Laparoscopic excision of deep endometriosis nodules.

Main Outcome Measure(s)

Postoperative complications were recorded in the CIRENDO database and medical charts. Postoperative digestive function was assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott Symptom Questionnaire.

Result(s)

Deep endometriosis nodules involved uterosacral ligaments, rectovaginal space, and vagina and spared the bowel, the bladder, and the ureters. Nodule size was <1 cm, 1–3 cm, and >3 cm in diameter in 20.8%, 64.6%, and 14.6% of cases, respectively. Clavien-Dindo 1, 2, and 3b complications occurred in 0.8%, 4.6%, and 5.4% of cases, respectively. Among Clavien-Dindo 3b complications, most involved pelvic hematoma. Gastrointestinal scores revealed significant improvement in digestive function or defecation pain at 1 and 3 years after surgery. The pregnancy rate was, respectively, 43.3% and 56.7% at 1 and 3 years postoperatively, among which 66.7% and 64.7% were spontaneous conceptions.

Conclusion(s)

Our data suggest that surgery for deep endometriosis without involvement of the digestive or urinary tracts provides a low rate of postoperative complications and satisfactory fertility outcomes.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.