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

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.