Improvement in quality of life and pain scores after laparoscopic management of deep endometriosis: a retrospective cohort study

Purpose This is a retrospective cohort study that evaluates the postoperative pain findings of a consecutive series of laparoscopic surgeries for deep endometriosis (DE).

This multi-center retrospective cohort study was carried out in university hospitals (Istanbul, Turkey). Sixty-five patients diagnosed through bimanual gynecologic examination, gynecologic ultrasound or magnetic resonance imaging-confirmed endometrioma and DE together; who underwent a laparoscopic surgery between 2013 and 2019 by a team of gynecologists, colorectal surgeons, and a urologist were retrospectively evaluated. The data were collected in a specific database and analyzed for postoperative pain outcomes through a comparison with preoperative symptoms scored using a visual analogue score (VAS), and the British Society of Gynecologic Endoscopy (BSGE) pelvic pain questionnaire.

Sixty-five patients who met the criteria were included. The mean age of all patients was 35.0 ± 6.3 (range 22–50) years. The mean operative time was 121.3 ± 50.2 (range, 60–270) minutes. Preoperative and postoperative comparison of VAS scores for dysmenorrhea (8.57 vs. 2.91), dyspareunia (6.62 vs. 1.66), dyschezia (7.46 vs. 2.43), dysuria (5.67 vs. 1.34), chronic pelvic pain (4.11 vs. 1.22), and BSGE score (40.98 vs. 11.00) showed significantly reduced pain scores, respectively (p < 0.01).

Laparoscopic management of DE is a valid treatment option in terms of reduced postoperative pain and increased quality of life according to pain score outcomes. To have more robust conclusions, a prospective cohort study with a larger sample size which evaluates patients who had segmental bowel resection and those who did not have segmental bowel resection is necessary. Similar content being viewed by others

Koninckx PR, Meuleman C, Demeyere S et al (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55(4):759–765 Koninckx PR, Martin DC (1992) Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 58(5):924–928 Koninckx PR, Ussia A, Adamyan L et al (2012) Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril 98(3):564–571 Fedele L, Bianchi S, Zanconato G et al (2004) Is rectovaginal endometriosis a progressive disease? Am J Obstet Gynecol 191(5):1539–1542 Gordts S, Koninckx P (2017) Brosens I. Pathogenesis of deep endometriosis. Fertil Steril 108(6):872–885e1 Somigliana E, Infantino M, Candiani M et al (2004) Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications. Hum Reprod 19(1):168–171 Szubert M, Zietara M, Suzin J (2018) Conservative treatment of deep infiltrating endometriosis: review of existing options. Gynecol Endocrinol Off J Int Soc Gyneco Endocrinol 34(1):10–14 Roman H, Bubenheim M, Huet E et al (2018) Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Human Reprod. 33(1):47–57 Donnez J, Squifflet J (2010) Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 25(8):1949–1958 Fanfani F, Fagotti A, Gagliardi ML et al (2010) Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study. Fertil Steril 94(2):444–449 Nezhat C, Nezhat F, Ambroze W et al (1993) Laparoscopic repair of small bowel and colon. A report of 26 cases. Surg Endosc. 7(2):88–89 Woods RJ, Heriot AG, Chen FC (2003) Anterior rectal wall excision for endometriosis using the circular stapler. ANZ J Surg 73(8):647–648 Jatan AK, Solomon MJ, Young J et al (2006) Laparoscopic management of rectal endometriosis. Dis Colon Rectum 49(2):169–174 Bachmann R, Bachmann C, Lange J et al (2014) Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting. Arch Gynecol Obstet 290(5):919–924 Garry R (2004) The effectiveness of laparoscopic excision of endometriosis. Curr Opin Obstet Gynecol 16(4):299–303 Club EETI (2019) When more is not better: 10 'don'ts' in endometriosis management. An ETIC (*) position statement. Hum Reprod Open. 2019(3):hoz009 Vercellini P, Buggio L, Somigliana E (2017) Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril 108(6):913–930 Riiskjaer M, Forman A, Kesmodel US et al (2018) Pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective. Obs Study Dis Colon Rectum 61(2):221–229 Bassi MA, Podgaec S, Dias JA Jr et al (2011) Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement. J Minim Invasive Gynecol 18(6):730–733 Berlanda N, Somigliana E, Frattaruolo MP et al (2017) Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol 209:67–71 Uccella S, Gisone B, Serati M et al (2018) Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet 298(3):639–647 Fedele L, Bianchi S, Zanconato G et al (2004) Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 190(4):1020–1024 Campagnacci R, Perretta S, Guerrieri M et al (2005) Laparoscopic colorectal resection for endometriosis. Surg Endosc 19(5):662–664 Radosa MP, Meyberg-Solomayer G, Radosa J et al (2014) Standardised registration of surgical complications in laparoscopic-gynaecological therapeutic procedures using the clavien-dindo classification. Geburtshilfe Frauenheilkd 74(8):752–758 Acien P, Nunez C, Quereda F et al (2013) Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement? Int J Womens Health 5:449–455 Ianieri MM, Mautone D, Ceccaroni M (2018) Recurrence in deep infiltrating endometriosis: a systematic review of the literature. J Minim Invasive Gynecol 25(5):786–793 De Cicco C, Corona R, Schonman R et al (2011) Bowel resection for deep endometriosis: a systematic review. BJOG Int J Obstet Gynaecol 118(3):285–291 Vercellini P, Vigano P, Buggio L et al (2018) "We can work it out:" The hundred years' war between experts of surgical and medical treatment for symptomatic deep endometriosis. J Minim Invasive Gynecol 25(3):356–359

We would like to thank David F. Chapman, BSc for language editing of the manuscript. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author information Authors and Affiliations Contributions EB, CY, FB and HG contributed to the study conception, design and project supervision. Data collection was performed by DY, MS and AD. HGC and YK carried out the data analysis and edited the first draft. The first draft of the manuscript was written by EB, MS and AD and all authors commented on previous versions of the manuscript. ST and SO worked in data collection and editing of the manuscript. Final editing was made by EB and HGC. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest Drs. Bastu, Goksever Celik, Ozaltin, Yasa, Kocyigit, Tas, Yozgatli, Soylu, Durbas, Gorgen and Buyru declare that they have no conflicts of interest. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Bastu, E., Celik, H.G., Kocyigit, Y. et al. Improvement in quality of life and pain scores after laparoscopic management of deep endometriosis: a retrospective cohort study. Arch Gynecol Obstet 302, 165–172 (2020). https://doi.org/10.1007/s00404-020-05583-6 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-020-05583-6