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  • Title: Surgery for deep endometriosis without involvement of digestive or urinary tracts: do not worry the patients!
    Author: Vallée A, Ploteau S, Abo C, Stochino-Loi E, Moatassim-Drissa S, Marty N, Merlot B, Roman H.
    Journal: Fertil Steril; 2018 Jun; 109(6):1079-1085.e1. PubMed ID: 29935644.
    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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