Major complications can follow surgery for deeply infiltrating pelvic endometriosis, according to a new study.
Researchers at CHU Estaing (Clermont-Ferrand, France) evaluated complications in 568 women who underwent surgery for deeply infiltrating endometriosis; 8 of the women underwent primary laparotomy, and 560 had laparoscopic surgery. The procedures included uterosacral ligament resection (41.2%), excision of rectovaginal nodule (18%), excision of vesicovaginal nodule (1.2%), rectal shaving (32.2%), excision of a rectal lesion and suture (3%), and segmental bowel resection (4.4%). The mean operative time was 155 minutes, and 2.3% of laparoscopic cases required conversion to laparotomy, mainly due to the complexity of the bowel surgery.
The researchers found that postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3%, compared with only 1.5% for the other women; shaving presented less major postoperative complications compared with segmental resection. The study was published early online on November 18, 2010, in the British Journal of Obstetrics and Gynaecology (BJOG).
"The treatment of deep endometriosis is necessary for many patients, but the complication rate is important,” said lead author William Kondo, MD. "Endometriosis surgery is not a simple surgery, and only experienced surgeons and teams should perform these kinds of procedures.”
Endometriosis is a gynecological medical condition in which endometrial-like cells appear and flourish in areas outside the uterine cavity, most commonly on the ovaries. These endometrial-like cells in areas outside the uterus are influenced by hormonal changes and respond in a way that is similar to the cells found inside the uterus. Symptoms often worsen with the menstrual cycle.