Surgical treatment of deep endometriosis and risk of recurrence

Michele Vignali, M. Vignali, Stefano Bianchi, Massimo Candiani, Giovanna Spadaccini, Spadaccini G, Oggioni G, Giulia Oggioni, Mauro Busacca, Busacca M
Journal of Minimally Invasive Gynecology · 2005 · vol. 12(6) , pp. 508–513 · doi:10.1016/j.jmig.2005.06.016 · PMID:16337578 · W2127908683
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This study investigated the impact of surgical interventions on the recurrence rates of deep endometriosis.

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Abstract

Study objectiveTo evaluate the risk of recurrence of deep endometriosis after conservative surgery.DesignRetrospective analysis (Canadian Task Force classification II-3).SettingTertiary care university hospital.PatientsOne hundred fifteen symptomatic patients operated on in our department from 1996 through 2002 with postoperative follow-up of at least 12 months.InterventionAll patients underwent conservative surgery for deep infiltrating endometriosis.Measurement and main resultsRisk factors for recurrence of symptoms and clinical findings and for repeated surgery were evaluated by univariate and multivariate analysis. During follow-up, we observed 28 patients with pain recurrence and 15 patients with recurrent clinical findings, and 12 patients required reoperation for deep endometriosis. Recurrence rates of pain and clinical findings during 36 months were 20.5% and 9%, respectively. Multivariate analysis showed that only age was a significant predictor of pain recurrence (OR 0.9, 95% CI 0.81-0.99, p<.05), enhancing the risk in younger patients. Recurrence of clinical signs of deep endometriosis was predicted by obliteration of the pouch of Douglas (OR 1.46, 95% CI 1.16-16.2, p<.05). Reoperation for deep endometriosis was predicted only by the incompleteness of first operation (OR 21.9, 95% CI 3.2-146.5, p<.001).ConclusionOur study indicates that age, obliteration of the pouch of Douglas, and surgical completeness may have a significant influence on the recurrence of the disease.

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Condition tags

endometriosischronic_pelvic_pain

MeSH descriptors

Endometriosis Gynecologic Surgical Procedures Actuarial Analysis Adult Douglas' Pouch Douglas' Pouch Endometriosis Endometriosis Female Follow-Up Studies Gynecologic Surgical Procedures Humans Infertility, Female Infertility, Female Pelvic Pain Pelvic Pain Recurrence Reoperation Retrospective Studies Risk

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