The impact of deep disease on surgical treatment of endometriosis

Abstract

Objective: To compare the difficulty of surgery in patients with and without deeply infiltrating endometriosis.

Study design: Prospective cohort study performed in one hospital specialized in the surgical treatment of endometriosis. 193 consecutive patients undergoing excision of all visible endometriosis by laparoscopy (176 patients, 91.2%) or by laparotomy (17 patients, 8.2%). The duration of surgery, the number of operations, the number of day-surgery operations, the need to operate with a surgeon, the ability to perform complete excision during one operation, and the ability to perform operation by laparoscopy were compared in patients with and without deep lesions.

Results: The mean duration of surgery was 192 (SD 96), and 76 (SD 41)min in patients with and without deep lesions (p<0.001). Ureterolysis (66% vs. 20%, p<0.001), division of adhesions (92% vs. 69%, p<0.001), and hysterectomy (32% vs., 8%, p<0.001), were more often performed on patients with deep lesions. 41 patients (42%) with deep lesions, and 1 patient (1%) without deep lesions were operated with a surgeon (p<0.001). Day-surgery was less often performed on patients with deep lesions (11% vs. 45%, p<0.001). Complete excision during one operation was performed on 95% and on 97% of the patients with and without deep lesions (p=1.0). Complete excision was less often performed by laparoscopy in patients with deep lesions (79% vs. 95%, p<0.001).

Conclusions: Surgical treatment of deep lesions is more demanding and time-consuming than surgical treatment of other types of endometriosis, and collaboration with a surgeon is often necessary. Complete excision during one operation is a realistic goal for endometriosis surgery, but it is significantly less often achievable by laparoscopy in patients with deep lesions than in patients without deep lesions.