Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery

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.

[Radiological abnormalities and long-term IUD use: think of actinomycosis]

BACKGROUND

A rare cause of nonspecific, chronic abdominal pain is actinomycosis. Extensive disease can cause chronic peritonitis mimicking malignancy.

CASE DESCRIPTION

A 59-year-old women presented with aspecific chronic abdominal pain, after 23 years of IUD use. Imaging showed two solid masses in the abdomen suggestive of malignant disease. Additional diagnostic procedures did not prove malignancy and biopsies showed chronic inflammation. In the absence of proof of malignancy and with regard to the long-term IUD use, actinomycosis was considered. A Pap smear showed Actinomyces 5 years earlier. Antibiotic treatment was instituted and remission of the intra-abdominal masses was seen after six months of treatment.

CONCLUSION

Consider actinomycosis in a patient presenting with abdominal pain and (long-term) IUD use. Diagnosis is challenging and frequently impossible to confirm before treatment. This diagnosis should be considered after thorough workup for other diseases, especially malignancy. After such analysis, starting antibiotic therapy could prevent secondary complications and invasive procedures.