Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients

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This prospective study of 244 patients undergoing laparoscopic excision of deeply infiltrating endometriosis found low rates of major (1.2%) and minor (11.1%) perioperative complications.

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This prospective observational case series evaluated perioperative complications in 244 women undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE) at a tertiary referral center in Iran between 2013 and 2016, with data collected on demographics, intraoperative details, and postoperative outcomes up to 1 month. Radical laparoscopic excision of all visible DIE was performed, often requiring segmental or disc bowel resections/shaving and multidisciplinary colorectal and/or urological involvement in 29.6% of cases. Major postoperative complications occurred in 3 patients (1.2%) and minor complications in 27 patients (11.1%), with 1.6% conversion to laparotomy; most patients had stage IV disease. The study’s key limitation is that it lacks a control/comparator group and reports outcomes only to 1 month post-surgery. This paper is centrally about endometriosis — specifically perioperative safety/complication rates after laparoscopic excision of deeply infiltrating endometriosis.

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Abstract

PurposeTo examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE).MethodsThis was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1 month following surgery.ResultsWe analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8 min (± 80.7 standard deviation, range 60-440 min) and mean hospital stay was 2.9 days (± 1.5 standard deviation, range 1-11). The conversion to laparotomy rate was 1.6%.ConclusionsA combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates.
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Abstract

Purpose To examine peri-operative complications in patients undergoing laparoscopic excision of deeply infiltrating endometriosis (DIE).

Methods

This was a prospective study of a case series of women having laparoscopic excision of deeply infiltrating endometriosis from September 2013 through August 2016 in a tertiary referral center for endometriosis and minimally invasive gynaecological surgery in Iran. Data collected included demographics, baseline characteristics, intraoperative and postoperative data up to 1 month following surgery.

Results

We analysed data from 244 consecutive patients, who underwent radical laparoscopic excision of all visible DIE. Major postoperative complications occurred in 3 (1.2%) and minor complications in 27 (11.1%) of patients. 80.3% of our patient group had Stage IV endometriosis. Segmental bowel resection was performed in 34 (13.9%), disc resection in 7 (2.9%), rectal shave in 53 (21.7%). Joint operating between a gynaecologist and colorectal and/or urological colleague was required in 29.6% of cases. The mean operating time was 223.8 min (± 80.7 standard deviation, range 60–440 min) and mean hospital stay was 2.9 days (± 1.5 standard deviation, range 1–11). The conversion to laparotomy rate was 1.6%.

Conclusions

A combination of different laparoscopic surgical techniques to completely excise all visible DIE, within the context of a tertiary referral center offering multi-disciplinary approach, produces safe outcomes with low complication rates. Similar content being viewed by others

References

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Fertil Steril 109:172–178 Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg Endosc 21:1572–1577 Meuleman C, Tomassetti C, D’Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D’Hooghe T (2011) Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 17:311–326 Funding No external funding was used for this study. Author information Authors and Affiliations Contributions SK: Project development, Lead surgeon, Manuscript writing and editing, Data analysis. AG: Surgeon, Manuscript writing, Data collection, management and analysis. AM: Database design, project coordination, Data analysis. RK: Surgeon, Data collection. RP: Surgeon, Data collection. KS: Surgeon, Data collection. VM: Data analysis, Manuscript writing and editing Corresponding author Ethics declarations Conflict of interest The authors have no conflicts of interest to declare. Ethical approval All procedures performed were in accordance with the ethical standards of the Ethics Committee of the Avicenna Research Institute, affiliated to the Academic Center for Education, Culture and Research (ACECR) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (Ethical Committee approval number IR.ACECR.Avicenna.REC.1395.1). Informed consent Informed consent was obtained from all patients included in the study. No minors were included in this study. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Khazali, S., Gorgin, A., Mohazzab, A. et al. Laparoscopic excision of deeply infiltrating endometriosis: a prospective observational study assessing perioperative complications in 244 patients. Arch Gynecol Obstet 299, 1619–1626 (2019). https://doi.org/10.1007/s00404-019-05144-6 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-019-05144-6

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Laparoscopy Postoperative Complications Adolescent Adult Endometriosis Female Humans Laparoscopy Middle Aged Postoperative Complications Prospective Studies Rectal Diseases Rectal Diseases Treatment Outcome Young Adult

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