Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade

Purpose We aimed to assess post-operative complications based on the Clavien–Dindo classification system following routine laparoscopic treatment of all stages of endometriosis.

A retrospective cohort study was carried out to identify women who underwent laparoscopic complete resection of newly diagnosed endometriosis between 2013 and 2016. 401 patients were identified using hospital database search software, and electronic files were reviewed. The stages of endometriosis had been classified according to the revised score of the American Society of Reproductive Medicine (rASRM) and the Enzian classification in cases of deep infiltrating endometriosis. Post-operative complications were recorded based on the Clavien–Dindo classification. Multivariate regression analysis was used to investigate the impact of the stages of endometriosis and surgical steps on complications.

Grade III complications requiring surgical, endoscopic, or radiological intervention occurred in only 1.7% of patients and were significantly associated with rASRM stage IV (OR 1.8). Grade II complications (blood transfusion, total parenteral nutrition) occurred in 18.7% of patients. rASRM stage IV (OR 2.0), hysterectomy (OR 3.2), conversion to laparotomy (OR 11.1), and bowel resection (OR 27.6) were significantly associated with increased risk of grade II complications. rASRM stages I–III did not show an effect on post-operative complications or hospital stay.

Clavien–Dindo complication grading was readily applicable to laparoscopic removal of endometriosis of all stages. Higher Clavien–Dindo grades correctly reflected clinically relevant complications and were associated with deep infiltrating endometriosis, stage IV endometriosis, bowel surgery, or hysterectomy. Clavien–Dindo classification can be recommended for evaluation of laparoscopic endometriosis surgery outcome. Similar content being viewed by others

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The authors would like to thank Dr. Klaus Bühler, Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, Saarbrücken, for assistance in project development. Funding No external funding was obtained for this study. Author information Authors and Affiliations Contributions KN: protocol/project development, data collection and data management, and manuscript writing/editing. SZ: data collection. DB: data collection. JJ-C: statistics and data management. TL: statistics. MR: project development. HD: project development. IBR: manuscript writing/editing. Corresponding author Ethics declarations Conflict of interest There are no competing interests to declare. Ethical approval This research project was covered by the study approval for data use and clinical studies of the General Ethics Commission, Faculty of Medicine, Jena University Hospital, Germany (no. 2018-1072). An additional ethical approval from the Ethics Commission of the Faculty of Medicine, Jena University Hospital, Germany, was not required because the analysed data were anonymised. Informed consent A declaration of consent of the patients is available. 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 Nicolaus, K., Zschauer, S., Bräuer, D. et al. Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 301, 699–706 (2020). https://doi.org/10.1007/s00404-019-05425-0 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-019-05425-0