Tratamento cirúrgico da endometriose profunda: série de 16 casos

Overview and aims: Deep endometriosis is defined as the presence of infiltrating lesions more than 5mm deep to the peritoneum and it corresponds to 5-10% of all endometriotic lesions. Laparoscopy is considered the gold standard for the diagnosis and treatment of endometriosis and it is successful in controlling pain, decreasing recurrence rates and improving fertility. This study aims to evaluate the work of a Laparoscopic unit specialized in the treatment of endometriosis. Study design, Population and Methods: Retrospective study of all laparoscopies performed for deep endometriosis between January 2013 and December 2014. Clinical presentation, pre-operatory exams, intra and post-operatory surgical data and follow-up were accessed. Results: Sixteen surgeries were done (15 patients). The patient's mean age was 35 years (28- 43); ten women were nulliparous of which nine were infertile. Dysmenorrhea was the most frequent symptom (n=12), followed by dyspareunia (n=8). In six women a node in the rectovaginal septum was present in the physical exam. In six cases a colpectomy was done in order to accomplish total excision of the rectovaginal node. One discoid excision of the rectum was done. No conversions to laparotomy were needed. The mean operative time was 142±55min, with estimated blood loss < 250ml in 15 surgeries. There was a case of an intra-abdominal abscess. Mean follow-up duration was eight months, with 81% of the patients referring clinical improvement. Conclusions: Laparoscopic surgery in the treatment of deep endometriosis requires a high degree of surgical expertise and the approach by a multidisciplinary team. Only then, a low rate of complications, symptoms regression and a potential fertility improvement can be achieved.