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Tummers FHMP, Peltenburg SI, Metzemaekers J, Jansen FW, Blikkendaal MD. Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery. Arch Gynecol Obstet 2023; 308:1531-1541. [PMID: 37639036 PMCID: PMC10520192 DOI: 10.1007/s00404-023-07193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery. METHODS A retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures. RESULTS 595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001). CONCLUSION Previous therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post-operative complications was observed.
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Affiliation(s)
| | - Sophie I Peltenburg
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen Metzemaekers
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Mathijs D Blikkendaal
- Endometriosis Center, Haaglanden Medical Center, The Hague, The Netherlands
- Nederlandse Endometriose Kliniek, Reinier de Graaf Hospital, Delft, The Netherlands
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Leborne P, Huberlant S, Masia F, de Tayrac R, Letouzey V, Allegre L. Clinical outcomes following surgical management of deep infiltrating endometriosis. Sci Rep 2022; 12:21800. [PMID: 36526707 PMCID: PMC9758215 DOI: 10.1038/s41598-022-25751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
The main aim of the study was to evaluate severe post-operative complications following deep endometriosis surgery in a tertiary referral centre. This is a retrospective cohort study that included women who had surgery for deep infiltrating endometriosis between 1st January 2013 and 31st December 2019. Endometriosis was diagnosed based on clinical, imaging and histological parameters. We evaluated the rates of post-operative complications, potential risk factors for such complications and postoperative pregnancy rates. A total of 165 patients were included in the final analysis. The median follow-up was 63 (25-106) months. Thirty-seven patients (22.42%) had hysterectomy, 60 (36.81%) had ureterolysis and 44 (26.67%) had colorectal surgery. The overall and severe rates of post-operative complications were 16.20% (n = 23) and 2.42% (n = 4) respectively. Of the variables assessed, operative time and age were the only statistically significant risk factor for complications on multivariate analysis. Among women operated on for infertility, 34.5% (n = 20/58) got pregnant following surgery with 30% of these spontaneously. This study demonstrates acceptable overall and severe post-operative complications and pregnancy rates after deep endometriosis surgery. This information should help clinicians when counselling women to enable them making an informed choice about their management.
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Affiliation(s)
- Perrine Leborne
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France.
| | - Stephanie Huberlant
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Florent Masia
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Renaud de Tayrac
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Vincent Letouzey
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Lucie Allegre
- Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
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Popoutchi P, Marques Junior OW, Averbach P, Cardoso Filho CAM, Averbach M. SURGICAL TECHNIQUES FOR THE TREATMENT OF RECTAL ENDOMETRIOSIS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS AND OBSERVATIONAL STUDIES. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:548-559. [PMID: 34909864 DOI: 10.1590/s0004-2803.202100000-97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriosis is a common disease in reproductive-age women and it is estimated to occur in up to 50% of those with infertility. Intestinal involvement is reported in up to a third of the cases. This condition is related to chronic pain and loss of quality of life, resulting in emotional, social and economic costs. Treatment consists of hormonal block and surgical resection, with variable side effects and efficacy. The best choice for surgical treatment for rectal endometriosis is a matter of discussion regarding the indication and the best technique to be employed. OBJECTIVE To summarize data on indications, results and complications of surgical techniques for the treatment of rectal endometriosis. METHODS This comprehensive systematic review is a compilation of the available literature and discussion, carried out by a team with experience in the surgical treatment of intestinal endometriosis. Data regarding indications, results and complications of conservative and radical techniques for the surgical treatment of rectal endometriosis was carefully reviewed. Searches of PubMed, EMBASE, and CENTRAL up to May 2021 were performed to identify randomized controlled trials (RCTs) and observational studies that compared at least two of the three surgical techniques of interest (i.e., shaving, discoid resection, segmental resection). RESULTS One RCT and nine case series studies with a total of 3,327 patients met the eligibility criteria. Participants ages ranged from a mean of 30.0 to 37.9 years old. Mean follow-up ranged from 1.2 to 42.76 months. With regards the methodological quality, overall the included studies presented a low risk of bias in the majority of the domains. Surgical treatment of rectal endometriosis is indicated for patients with obstructive symptoms and those with pain scores above 7/10. Patients with disease involving beyond muscularis propria of the rectum, documented in magnetic resonance imaging or transvaginal pelvic ultrasound with intestinal preparation, are candidates for discoid or segmental resection. The presence of multifocal disease, extension greater than 3 cm and infiltration greater than 50% of the loop circumference favor the radical technique. The distance from the lesion to the anal verge, age, symptoms and reproductive desire are other factors that influence the choice of the technique to be employed. The risk of complications and unfavorable functional results seems to be directly related to the complexity of the procedure. CONCLUSION The choice of surgical technique performed for the treatment of rectal endometriosis is a matter of discussion and depends not only on the preoperative staging, but also on the patient's expectations, risks and potential complications, recurrence rates and the expertise of the multidisciplinary team.
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Affiliation(s)
- Pedro Popoutchi
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil
| | - Oswaldo Wiliam Marques Junior
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil.,Fundação Antônio Prudente - A.C.Camargo Hospital, São Paulo, SP, Brasil
| | - Pedro Averbach
- Disciplina de Coloproctologia, Departamento de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Celso Augusto Milani Cardoso Filho
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil.,Fundação Antônio Prudente - A.C.Camargo Hospital, São Paulo, SP, Brasil
| | - Marcelo Averbach
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, São Paulo, SP, Brasil
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Adhesion prevention after endometriosis surgery - results of a randomized, controlled clinical trial with second-look laparoscopy. Langenbecks Arch Surg 2021; 406:2133-2143. [PMID: 34036409 PMCID: PMC8481146 DOI: 10.1007/s00423-021-02193-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/10/2021] [Indexed: 12/02/2022]
Abstract
Purpose Adhesion formation after endometriosis surgery is a severe problem affecting up to 90% of patients. Possible complications include chronic pain, ileus, and secondary infertility. Therefore, effective adhesion prophylaxis is desirable, for which the adhesion barrier 4DryField® PH is evaluated in the present clinical study. It is a starch-based powder that forms a gel after irrigation with saline solution and thus separates surgical sites as physical barrier for adhesion prevention. Methods Fifty patients with extensive and deep infiltrating endometriosis were included in this prospective, randomized, controlled clinical trial with two-staged laparoscopic approach. The patients were randomized into two groups, one receiving 4DryField® PH and the other irrigation with saline solution for adhesion prevention. Adhesion formation was directly scored during second-look interventions considering incidence, extent, and severity. Adhesion prevention treatment in the second surgery was performed corresponding to the first intervention to evaluate the long-term outcome in the later course. Results Both groups were comparable with respect to relevant patient parameters. Severity and extent of adhesions were significantly reduced by 85% in the 4DryField® PH group compared to the control group (mean total adhesion score 2.2 vs. 14.2; p = 0.004). Incidence of adhesion formation based on the number of affected sites was significantly reduced by 53% in the intervention vs. control group (mean 1.1 vs. 2.3 sites; p = 0.004). Follow-up of secondary endpoints is not yet completed; results will become available at a later stage. Conclusion Adhesion formation could be reduced significantly by 85% by application of the adhesion barrier 4DryField® PH. Trial registration Trial registration main ID: DRKS00014720, secondary ID: U1111-1213-4142; date of registration 09th May 2018.
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Thomassin-Naggara I, Lamrabet S, Crestani A, Bekhouche A, Wahab CA, Kermarrec E, Touboul C, Daraï E. Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management. Hum Reprod 2021; 35:1589-1600. [PMID: 32619220 DOI: 10.1093/humrep/deaa103] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Is an MRI classification of deep pelvic endometriosis (DE) able to correctly predict the risk of DE surgery. SUMMARY ANSWER A new radiological classification, that we have called the deep pelvic endometriosis index (dPEI) classification, is accurate and reproducible to assess the extension of the disease in central and lateral compartments and well correlated with operating time, hospital stay duration and the risk of voiding dysfunction. WHAT IS KNOWN ALREADY Few imaging classifications are currently available to predict the extent of DE to help preoperative assessment of surgical outcomes and provide the patient with objective information about the risk of surgical complications. STUDY DESIGN, SIZE, DURATION Retrospective monocentric observational study was conducted between 01 January 2017 and 31 December 2018 and included 150 women (mean age = 34.5 years, 20-52 years) with DE on MRI and who subsequently underwent surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Two radiologists independently graded the disease according to MRI-based Enzian classification (A (rectovaginal septum and vagina locations), B (uterosacral locations) and C (rectosigmoid locations)) and a new radiological classification, that we have called the dPEI, that grades the severity of DE as: mild, moderate or severe DE. MRI findings and classification were correlated with surgical and pathological results. MAIN RESULTS AND THE ROLE OF CHANCE MRI-based and surgical Enzian classifications were concordant for A lesions in 78.7% (118/150), for B lesions in 34.7% (52/150) and for C lesions in 82.7% (124/150). Operating time and hospital stays were longer in Group A2 (rectovaginal septum and vagina, 1-3 cm) compared to A0, B2 (uterosacral, 1-3 cm) compared to B0, C3 (rectosigmoid >3 cm) compared to C2 (rectosigmoid 1-3 cm) or C0 (P < 0.001), in severe compared to moderate DE patients, and in moderate compared to mild extensive patients (P < 0.01). Patients with vaginal or rectosigmoid involvement were respectively six and three times more likely to experience high-grade complications according to Clavien-Dindo classification than patients without vaginal or rectosigmoid disease (P < 0.001). Postoperative voiding dysfunction was correlated with A lesions (odds ratio (OR) = 6.82, 95% CI 2.34-20.5), moderate or severe DE (OR = 4.15, 95% CI 1.26-17.9), the presence of at least unilateral lateral pelvic involvement (OR = 3.6, 95% CI 1.14-11.2, P = 0.03) and C lesions (OR = 2.6, 95% CI 1.03-6.8, P < 0.01). LIMITATIONS, REASONS FOR CAUTION The study was conducted in an expert center and needs to be validated in a multicenter study. There is a limited number of patients with lateral pelvic endometriosis beyond the parietal fascia, probably due to the low prevalence of this disease presentation. WIDER IMPLICATIONS OF THE FINDINGS MRI imaging can be used to accurately predict postoperative complications for women with DE. This may help the clinician to preoperatively inform a patient about the risks of surgery. Larger clinical studies are required to validate these results. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. I.T.N.: Remunerated lecture GE, Hologic, Guerbet, Canon; Advisory board: Siemens - These relationships are on the topic of breast imaging, not related to the topic of this paper. Other coauthors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Samia Lamrabet
- Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Adrien Crestani
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, GRC-6 (Clinical Research Group on Endometriosis) Sorbonne University, UMRS-938, 75020 Paris, France
| | - Asma Bekhouche
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Cendos Abdel Wahab
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Edith Kermarrec
- Department of Radiology, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - Cyril Touboul
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, GRC-6 (Clinical Research Group on Endometriosis) Sorbonne University, UMRS-938, 75020 Paris, France
| | - Emile Daraï
- Sorbonne Université, IUC, 75005 Paris, France.,Department of Gynaecology and Obstetrics, AP-HP, Hôpital Tenon, GRC-6 (Clinical Research Group on Endometriosis) Sorbonne University, UMRS-938, 75020 Paris, France
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Crispi CP, Crispi CP, de Oliveira BRS, de Nadai Filho N, Peixoto-Filho FM, Fonseca MDF. Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia? PLoS One 2021; 16:e0250046. [PMID: 33891600 PMCID: PMC8064592 DOI: 10.1371/journal.pone.0250046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022] Open
Abstract
STUDY OBJECTIVE To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. METHODS This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. RESULTS Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P < .001) by 3 points or more in 75.8% (95%CI: 64.7-86.2) and disappeared totally in 59.7% of cases (95%CI:47.8-71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0-10.7) and the probability of a woman with no DDyspareunia developing "de novo" moderate or severe DDyspareunia was 7.7% (95%CI: 1.8-15.8) and 5.8% (95%CI: 0.0-13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. CONCLUSION Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.
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Affiliation(s)
| | | | | | - Nilton de Nadai Filho
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando Maia Peixoto-Filho
- Department of Women’s Health—Fernandes Figueira National Institute for Women, Children and Youth Health—Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Marlon de Freitas Fonseca
- Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Women’s Health—Fernandes Figueira National Institute for Women, Children and Youth Health—Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Ma Y, Kang J, Zhang Y, Ma C, Wang Y, Zhu L. Changes in voiding function after transvaginal mesh repair for advanced anterior vaginal prolapse. Eur J Obstet Gynecol Reprod Biol 2020; 255:29-33. [PMID: 33070087 DOI: 10.1016/j.ejogrb.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study evaluated changes in voiding function at 3 months and 1 year after transvaginal mesh (TVM) repair in women with advanced anterior vaginal prolapse (AVP) and identified predictive risk factors of postoperative voiding dysfunction (PVD). STUDY DESIGN Women with stage≥3 AVP who underwent TVM repair surgery were included in this retrospective cohort study. Voiding dysfunction was defined as an average flow rate (Qave)<10 ml/s, a maximum flow rate (Qmax)<15 ml/s, or a postvoid residual volume (PVR)>50 ml. Pre- and postoperative voiding function was assessed by uroflowmetry, PVR examination, and the Urinary Distress Inventory-6 (UDI-6) and the Urinary Impact Questionnaire-7 (UIQ-7). Statistical analyses were performed using paired-sample t tests, χ2 tests, and multivariate logistic regression. RESULTS Sixty-two women were included in this study, uroflowmetry data were available for 35 of them at 1-year follow-up. Forty-three percent of women showed evidence of voiding dysfunction preoperatively. The PVR decreased significantly from baseline to 1 year postoperatively (17.97 ± 38.48 vs. 0.00 ± 0.00, p < 0.001). Voiding difficulties decreased significantly postoperatively (55 % vs. 5%, p<0.001); frequency, urgency and urinary incontinence symptoms did not exhibit significant improvement (p>0.05). The UDI-6 and UIQ-7 indicated significant improvement postoperatively (both p<0.001). Multivariate analysis identified low Qave as an independent predictor of PVD (odds ratio, 0.40; 95 % CI, 0.16-0.98). CONCLUSION Nearly half of the patients had advanced AVP accompanied by preoperative voiding dysfunction. Improvement in voiding function was observed at 3 months and could last for one year postoperatively.
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Affiliation(s)
- Yidi Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Kang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ye Zhang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Congcong Ma
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
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Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb). Arch Gynecol Obstet 2020; 302:983-993. [PMID: 32676859 DOI: 10.1007/s00404-020-05694-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/09/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. METHODS All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. RESULTS Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. CONCLUSIONS Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
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Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol 2019; 239:21-29. [PMID: 31163353 DOI: 10.1016/j.ejogrb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/20/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
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Affiliation(s)
- Johannes Lermann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
| | - Nalan Topal
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany; Department of Obstetrics and Gynecology, Klinikverbund Südwest, Klinikum Sindelfingen-Böblingen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefanie Burghaus
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Felix Heindl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
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