AAGL 2021 Endometriosis Classification: An Anatomy-based Surgical Complexity Score

Mauricio S Abrao, Maurício Simões Abrão, Andres MP, Marina Paula Andres, Charles E Miller, Miller CE, Julian A Gingold, Rius M, Mariona Rius, João Siufi Neto, Joao Siufi Neto, Neto JS, Francisco Carmona
Journal of minimally invasive gynecology · 2021 · vol. 28(11) , pp. 1941–1950.e1 · doi:10.1016/j.jmig.2021.09.709 · PMID:34583009 · W3204342273
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This paper presents an anatomy-based surgical complexity score for endometriosis, the AAGL 2021 Endometriosis Classification.

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Abstract

Study objectiveTo develop a new endometriosis classification system for scoring intraoperative surgical complexity and to examine its correlation with patient-reported pain and infertility.DesignMulticenter study of patients treated at 3 recognized endometriosis centers.SettingThree specialized endometriosis surgical centers in São Paulo, Brazil and Barcelona, Spain.PatientsPatients aged 15 to 45 years with histologically proven endometriosis and no history of pelvic malignancy underwent laparoscopic treatment of endometriosis.InterventionsDemographic data and clinical history, including dysmenorrhea, noncyclic pelvic pain, dyspareunia, dysuria and dyschezia, were prospectively recorded. All patients were staged surgically according to the new 2021 American Association of Gynecologic Laparoscopists (AAGL) and revised American Society of Reproductive Medicine (ASRM) classification systems. The staging for each system was compared against a 4-level surgical complexity scale defined by the most complex procedure performed.Measurements and main resultsA total of 1224 patients undergoing surgery met inclusion criteria. The AAGL score discriminated between 4 stages of surgical complexity with high reproducibility (κ = 0.621), whereas the ASRM score discriminated between the complexity stages with poor reproducibility (κ = 0.317). The AAGL staging system correlated with dysmenorrhea, dyspareunia, dyschezia, total pain score, and infertility comparably with the ASRM staging system.ConclusionThe AAGL 2021 Endometriosis Classification allows for identifying objective intraoperative findings that reliably discriminate surgical complexity levels better than the ASRM staging system. The AAGL severity stage correlates comparably with pain and infertility symptoms with the ASRM stage.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Dyspareunia Dyspareunia Endometriosis Endometriosis Endometriosis Endometriosis Laparoscopy Brazil Dysmenorrhea Dysmenorrhea Female Humans Pelvic Pain Pelvic Pain Reproducibility of Results United States

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