Comparison of Laparoscopic Hysterectomy in Patients with Endometriosis with and without an Obliterated Cul-de-sac

Melnyk A, Alexandra Melnyk, Alexandra I. Melnyk, Noah B Rindos, Noah Rindos, Rindos NB, Samar R. El Khoudary, Ted Teh Min Lee, Lee TTM
Journal of Minimally Invasive Gynecology · 2019 · vol. 27(4) , pp. 892–900 · doi:10.1016/j.jmig.2019.07.001 · PMID:31279776 · W2895969111
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This study compared laparoscopic hysterectomy outcomes in patients with endometriosis who had an obliterated cul-de-sac versus those who did not.

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Abstract

Study objectiveTo determine if intraoperative outcomes for patients undergoing laparoscopic hysterectomy with endometriosis and an obliterated cul-de-sac are different than patients with endometriosis and no obliteration of the cul-de-sac.DesignA retrospective cohort study.SettingAn academic tertiary care hospital.PatientsPatients undergoing total laparoscopic hysterectomy with endometriosis between 2012 and 2016.InterventionsTotal laparoscopic hysterectomy, laparoscopic modified radical hysterectomy, and other procedures as indicated.Measurements and main resultsA total of 333 patients undergoing hysterectomy were found to have endometriosis at the time of surgery. Ninety-six (29%) patients were found to have stage IV endometriosis as defined by the American Society for Reproductive Medicine staging criteria. Of those, 55 (57%) had an obliterated cul-de-sac, and 41 (43%) did not. The remaining 237 (71%) patients had stage I, II, or III endometriosis. Fifty-one (93%) patients with an obliterated cul-de-sac required laparoscopic modified radical hysterectomy compared with 12 (29%) patients with stage IV endometriosis without obliteration and 60 (25%) patients with stages I through III endometriosis (p < .0001). The median total surgical time in minutes differed among the 3 groups as follows: obliterated cul-de-sac = 159 minutes, stage IV endometriosis without obliteration = 108 minutes, and stages I through III endometriosis = 116 minutes (p <.0001). Additional procedures at the time of hysterectomy were more frequently performed for patients with an obliterated cul-de-sac and included salpingectomy (p = .02), ureterolysis (p <.0001), enterolysis (p <.0001), cystoscopy (p = .0006), ureteral stenting (p <.0001), proctoscopy (p <.0001), oversewing of the bowel (p <.0001), and anterior resection and anastomosis (p = .006).ConclusionPatients with stage IV endometriosis and an obliterated cul-de-sac required laparoscopic modified radical hysterectomy and various other intraoperative procedures more than patients with stage IV endometriosis without obliteration and stages I through III. Patients with obliterated cul-de-sacs who are identified intraoperatively should be referred to minimally invasive gynecologic specialists because of the difficult nature of these procedures and extra training required to perform them safely with limited morbidity.

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Condition tags

endometriosis

MeSH descriptors

Douglas' Pouch Endometriosis Hysterectomy Hysterectomy Hysterectomy Hysterectomy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Peritoneal Diseases Adult Cohort Studies Douglas' Pouch Douglas' Pouch Endometriosis Endometriosis Endometriosis Endometriosis Female

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