Major Postoperative Complications After Endometriosis Surgery: Incidence and Outcomes From a Multicenter French Cohort

OBJECTIVE: Surgery is a therapeutic option for patients with deep endometriosis presenting with infertility and/or pain refractory to medical treatment. Major postoperative complications may impair quality of life and delay the initiation of assisted reproductive techniques. However, data on their incidence and outcomes remain limited. The aim of this study is to estimate the incidence and outcomes of major postoperative complications (Clavien-Dindo grade ≥III) following surgery for deep endometriosis in referral centers. DESIGN: Retrospective multicenter cohort analysis. SETTING: Seven French referral centers participating in the ENDOVALIRM cohort. PARTICIPANTS: A total of 605 women undergoing surgery for deep endometriosis between 2019 and 2020 were included. INTERVENTIONS: Surgical management of deep endometriosis, including gynecologic, digestive, and urinary tract procedures. RESULTS: The incidence of Clavien-Dindo grade ≥III postoperative complications across all surgical procedures was 4.5% (27/605). Digestive and urinary fistulas were the most common complications (9/27, 33.3%), followed by anastomotic leakages (5/27, 18.5%) and pelvic abscesses (4/27, 14.8%). Multivariate analysis identified no individual surgical procedure significantly and independently associated with the occurrence of major complications. However, findings should be interpreted cautiously, given the limited number of events. Overall, 6.8% of patients (41/605) experienced a hospital stay longer than 7 days. Surgical procedures independently associated with prolonged hospitalization were: parametrectomy (OR = 2.0; 95% CI, 1.1-3.7; p = .02), disc resection (OR = 8.3; 95% CI, 2.6-25.9; p < .001), colorectal resection (OR = 5.9; 95% CI, 2.2-16.3; p < .001), and ileocecal or small bowel resection (OR = 4.6; 95% CI, 1.3-16.4; p = .02). CONCLUSION: In this multicenter cohort from referral centers, the incidence of major postoperative complications (Clavien-Dindo ≥ III) was 4.5%. These findings provide descriptive data to inform preoperative counseling regarding major surgical morbidity. Functional postoperative outcomes were not systematically evaluated and should be considered when interpreting these results.