OC13.04: The association between pre‐operative TVS findings and pouch of Douglas obliteration at laparoscopy in women with suspected endometriosis

To determine the association between pre-operative transvaginal ultrasound (TVS) findings and the presence of POD obliteration at laparoscopy, in women with suspected endometriosis. Multi-centre prospective observational study undertaken from January 2009 to November 2011. All women with symptoms suggestive of endometriosis, who were scheduled for laparoscopy, underwent a detailed pre-operative TVS. Presence of the following features at TVS was recorded: ovarian mobility, ovarian cyst, ovarian endometrioma, endometriotic nodule, anterior rectum/rectosigmoid nodule, and USL nodule. The association between pre-operative TVS findings and the finding of POD obliteration at laparoscopy was then analyzed for significance using Fisher's exact test. 100 consecutive women with pre-operative TVS and laparoscopic outcomes were included in the final analysis. Mean age was 32.8 years and mean age for diagnosis of endometriosis was 27.4 years. At laparoscopy, 30/100 (30%) had an obliterated POD. The association between TVS findings and POD obliteration at laparoscopy was significant for the following features: right and left ovarian fixation (P-values = 7.87E-08 and 1.16E-07, respectively), left ovarian cyst (P-value = 0.0015), right and left ovarian endometrioma (P-values = 0.0119 and 9.63E-05, respectively), endometriotic nodule (P-value = 2.55E-14), anterior rectum and rectosigmoid nodules (P-values = 3.86E-07 and 7.26E-05, respectively). Traditional TVS findings known to be associated with endometriosis also appear to be significantly associated with POD obliteration at laparoscopy. The pre-operative identification of specific TVS markers may alert the clinician to the possibility of difficult endometriosis surgery, and therefore further aid in the surgical planning.