Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis

Purpose To assess the quality of care following the establishment of a multidisciplinary care pathway for patient operated on for deep pelvic endometriosis with digestive impairment.

We conducted a retrospective monocentric study of patients suffering from deep infiltrating endometriosis, treated in Gynaecological Department at Toulouse University Hospital from January 2018 to December 2020. We compared our results to those of our previous study, Gornes et al. which showed a postoperative complication occurred in 37.8% of the cases and a postoperative severe complication according to the Clavien–Dindo classification (grades 3b) rate of 18.3%.

98 patients were included. Our study shows a clear decrease in postoperative complications with an overall complication rate of 19.4% and severe complications (grades 3b) of 4.1%. The rate of complication appeared to be significantly less frequent in the case of shaving in relation to other digestive procedures (p = 0.008) and in the case of a lesion of < 20 mm by MRI (p = 0.01). The use of multidisciplinary surgical care was more frequent in the case of multiple locations (66.7% vs. 41.8%, p = 0.07) and was more frequent in the case of transmural damage with echo endoscopy (and to a lesser degree in the case of damage of the muscularis or mucous membrane) (p = 0.05).

Multidisciplinary care of endometriosis with digestive damage appears to be indispensable. The intraoperative intervention of a skilled digestive surgeon of bowel endometriosis helps create the best balance between effectiveness–complications–functional prognosis, with a reduction of severe postoperative complications. Similar content being viewed by others Data availability Not applicable.

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Author information Authors and Affiliations Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EC, AW and VS. The first draft of the manuscript was written by EC, AW and VS, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors have no relevant financial or non-financial interests to disclose. Ethical approval This is an observational study. The RnIPH2022-107 Research Ethics Committee has confirmed that no ethical approval is required. Informed consent Not applicable. IRB ethical approval Not applicable. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Weyl, A., Sevy, V., Lepage, B. et al. Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis. Arch Gynecol Obstet 307, 1459–1468 (2023). https://doi.org/10.1007/s00404-022-06899-1 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-022-06899-1