Is the presence of deep infiltrative endometriosis underestimated in the surgical management of endometriosis?

Sabahattin Anıl Arı, Ali Akdemir, Gürdenız Serın, Murat Ulukuş, Fatih Şendağ
Ginekologia polska · 2023 · vol. 94(1) , pp. 41–45 · doi:10.5603/gp.a2022.0150 · PMID:36597750 · W4313489129
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study retrospectively analyzed 191 women with suspected endometriosis and found a high (84%) positive predictive value for laparoscopic diagnosis of deep infiltrative endometriosis when no preoperative signs were present.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective study analyzed operation notes and histopathology from 191 women undergoing surgery for suspected endometriosis without preoperative clinical signs of deep infiltrative endometriosis (DIE) at Ege University Hospital (2008–2018), comparing laparoscopic visualization of DIE with postoperative histopathology. Surgeons removed 213 lesions suspected to be DIE; most specimens were confirmed as endometriosis (179/213), with additional findings including endometriosis in 44/49 right uterosacral ligament specimens, 35/45 left uterosacral ligament specimens, and 22/25 recto-vaginal nodules. The positive predictive value for laparoscopic visualization was 84%, while a major limitation was the absence of preoperative histopathology and the reliance on symptom-based suspicion rather than imaging or preoperative confirmation. This paper is centrally about endometriosis — it specifically quantifies how often DIE is present despite no preoperative signs and how this affects surgical resection.

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Abstract

OBJECTIVES: The aim of the study was to determine the presence of deep infiltrative endometriosis (DIE) in the surgical management of endometriosis. MATERIAL AND METHODS: Operation notes and histopathological reports of women with endometriosis were retrospectively analyzed in the Ege University Hospital between 2008 and 2018. A total of 191 women with suspicious of endometriosis but without clinical signs of DIE were enrolled in the study. Laparoscopic diagnosis of DIE was compared with histopathological reports. There was no histopathology before surgery. Endometriosis was suspected only based on symptoms. RESULTS: A total of 213 lesions that were thought to be DIE were removed from 191 women with endometriosis. Among these 213 lesions, 179 specimens were reported as endometriosis and 34 lesions as fibro-adipose tissue. Forty-nine right uterosacral ligaments were excised, and endometriosis was detected in 44 out of 49 specimens. Histopathological examination of 45 left uterosacral ligaments revealed endometriosis in 35 specimens. Finally, 25 endometriotic nodules were removed from the recto-vaginal space, and 22 of these were verified as endometriosis by a pathologist. The positive predictive value of laparoscopic visualization for DIE in the group suspected of endometriosis but without any clinical findings of DIE was 84%. CONCLUSIONS: Women with the suspicious of endometriosis, qualified to surgery, because of infertility or pain, should be prudently investigated to confirm or to exclude coexistence of DIE even if no preoperative sign of DIE was observed to provide complete resection. Otherwise, DIE continues to grow, causes pain postoperatively, and complicates subsequent surgery.

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Condition tags

mesh:D004715endometriosisdie_deep_infiltratinginfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Laparoscopy Adnexa Uteri Adnexa Uteri Adnexa Uteri Adnexa Uteri Adnexa Uteri Adnexa Uteri Adnexa Uteri

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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