Possible Role of the Posterior Compartment Peritonectomy, as a Part of the Complex Surgery, Regarding Recurrence Rate, Improvement of Symptoms and Fertility Rate in Patients with Endometriosis, Long-Term Follow-Up

Abesadze E, Elene Abesadze, Jalid Sehouli, Sehouli J, Sylvia Mechsner, Vito Chiantera, Vito Chiàntera
Journal of minimally invasive gynecology · 2019 · vol. 27(5) , pp. 1103–1111 · doi:10.1016/j.jmig.2019.08.019 · PMID:31449906 · W2969710640
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This study investigated the impact of posterior compartment peritonectomy, as part of complex surgery, on recurrence rates, symptom improvement, and fertility in endometriosis patients over a long-term follow-up.

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Abstract

Study objectiveBeside the pain, there are 2 further problems in the management of endometriosis: the high recurrence rate (10% per year) and the high rate of impaired fertility. The objective of this study was to investigate the pathogenesis of these 2 factors.DesignThis is a retrospective cohort study, and the aim is to evaluate the complete excision of endometriotic lesions, including the posterior compartment of the peritoneum, with regard to postoperative outcome, focusing on relieving pain, increasing fertility rate, and decreasing recurrence rate.SettingCharité-University Clinic, Department of Gynaecology, Endometriosis research Centre.PatientsFifty-four patients were enrolled in this study, with severe deep infiltrating endometriosis (scored by ENZIAN) and superficial endometriosis, as well as endometriomas (revised American Society for Reproductive Medicine [rASRM] I = 3; II = 15; III = 10; and IV = 26).InterventionsPosterior compartment peritonectomy (visible endometriotic lesions and inflamed altered peritoneum) was performed in all patients as part of a complex surgery: complete excision of endometriosis.Measurements and main resultsPostoperative outcomes were evaluated, based on the postoperative follow-up (up to 5 years) of 54 investigated patients. In 36 women (66%) preoperative complaints were eliminated. Furthermore, of 28 women seeking improved fertility, pregnancy was reported in 13 cases (46%). In 7 (54%) cases pregnancy occurred spontaneously, and in the remainder with assisted fertilization. In addition, long-term follow-up demonstrated a recurrence rate in 1.8% of patients.ConclusionOverall, the number of complaints was significantly reduced. Only in the case of reproductive-aged women with ongoing postoperative complaints was it important to preserve the uterus. Although this pilot study on systematic posterior peritonectomy showed improvement in recurrence and fertility rate, the main question remains: will this surgical technique achieve better results and outcomes in the future? This has to be addressed in a prospective randomized study.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Fertility Laparoscopy Peritoneal Diseases Peritoneum Adult Birth Rate Endometriosis Endometriosis Endometriosis Endoscopy, Gastrointestinal Endoscopy, Gastrointestinal Endoscopy, Gastrointestinal Female Fertility Follow-Up Studies Humans Laparoscopy Laparoscopy Laparoscopy

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