Safe multidisciplinary approach in deeply infiltrating endometriosis (DIE): is it feasible?

Ivete de Ávila, Luciana M P Costa, Luciana Maria Pyramo Costa, M. Soto, Mario Soto, Ivone Dirk Sousa Filogônio, Ivone D S Filogônio, Márcia M Carneiro, Márcia Mendonça Carneiro
JBRA assisted reproduction · 2014 · vol. 18(4) , pp. 139–143 · doi:10.5935/1518-0557.20140020 · PMID:35761742 · PMC9239420 · W2333254222
article OA: gold CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This observational study of 154 patients with severe deep infiltrating endometriosis found that a multidisciplinary surgical approach resulted in a 9.59% postoperative complication rate, including 5.48% major complications, with no deaths observed.

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Abstract

OBJECTIVE: Evaluate the type and incidence of postoperative complications after surgery for deep infiltrative endometriosis at Biocor Hospital. METHODS: Our observational study involved a multidisciplinary surgical team that performed laparoscopy on 154 patients suffering from pelvic pain. Surgical complications occurring up to the 30th postoperative day were recorded. RESULTS: Mean age patient age was 34.1 years. Infertility was present in 69 (45%) although 31% had not attempted to get pregnant. Dysmenorrhea was the most frequent symptom (79.3%) followed by chronic pelvic pain (59.7%) and deep dyspareunia (48,7%). Most cases required extensive surgery as the majority (n=117; 76.9%) were classified as severe endometriosis (ASRM grade IV). The most frequent surgical procedures were: 136 adhesiolysis, 100 intestinal surgeries (85 retosigmoidectomies), 92 peritonal lesion excision, 39 vaginal resections, 19 myomectomies, 21 hysterectomies and 5 partial bladder resections. Postoperative complications were recorded in 14 (9.59%) patients: 8 (5.48%) major complications and 6 (4.11%) minor. Major complications included blood transfusion (n=2) retosigmoid anastomosis dehiscence (1), rectovaginal fistula (n=1), urinary fistula (n=1), deep vein thrombosis (n=1), lower limb compartment syndrome with motor deficit (n=1) and one intestinal obstruction (n=1). Minor complications were abdominal wall infection (n=3), peripheral neuropathy (n=3), bladder atony (n=1) and bladder perforation (n=1). No deaths were observed. All major complication cases underwent retosigmoidectomy associated with vaginal resection (n=6), uterosacral ligament excision (n=5) or hysterectomy (n=3). CONCLUSION: The surgical treatment of DIE is complex and subject to complications. The surgical expertise of a multidisciplinary team plays a vital role in this setting.

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Condition tags

endometriosisdie_deep_infiltratingchronic_pelvic_paindysmenorrheadyspareuniainfertility

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