Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis.

Cordula Schippert, Yvonne Witte, Janina Bartels, Guillermo-José Garcia-Rocha, Matthias Jentschke, Peter Hillemanns, Sudip Kundu
In: Research Square · 2020 · doi:10.21203/rs.3.rs-24237/v1 · W3193173697
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Abstract

Abstract Background Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis the recurrence rates amount to 50%. The objective of this retrospective study was to evaluate the recurrence and pregnancy rates following surgical resection of endometriosis stage III/IV. Methods 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Data and responses of 206 patients (45.2%) were analyzed. The statistical analysis was performed with the statistical software ´R`. Statistical significance was given if the p-value was less than 0.05. The study was approved by the local Ethics Committee of Hannover Medical School. Results 66.5% (N=137) of patients were established with stage III, 33.5% (N=69) with stage IV. Average age was 37 years (17-59). 63.1% (N=130) of surgeries were performed by laparoscopy with an average duration of 81 minutes, 21.8% (N=45; 189 minutes) by laparotomy and 15% (N=31; 202 minutes) by conversion. Complete resection of endometriosis was achieved in 90.8% (N=187). After surgery, 48.5% (N=100) of the women did not receive hormonal treatment, main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% (N=192). Rate of recurrence was 21.8% (N=45). The association between incomplete resection and recurrence was on the threshold of significance (p=0.1). After surgery, 65.8% (79/120) of patients who wished to have children got pregnant. There is a statistically significant association between postoperative pregnancy rate and age <35 (p<0.002) and laparoscopic surgical access (p<0.01). Conclusion We assess the high percentage of complete or partial reduction of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered as ´gold standard` of endometriosis surgery, laparotomy still may be indicated in cases of extended endometriosis especially to preserve reproductive function.

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endometriosis

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