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

Nicolaus, K; Zschauer, Stefan; Bräuer, Dominik; Jimenez-Cruz, Jorge; Rengsberger, Matthias; Diebolder, Herbert; Runnebaum, I. B.

doi:10.1007/s00404-019-05425-0

Cited by 24 publications

(15 citation statements)

References 20 publications

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“…In our study, clinically relevant complications (CD type III) were only recorded in 2.54% of cases. These complications were also related to bowel surgeries, similar to previously published data [13,[23][24][25].…”

Section: Discussionsupporting

confidence: 88%

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Gràcia

Guirior

Valdés-Bango

et al. 2021

Preprint

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Background Deep endometriosis (DE) occurs in 15–30% of patients with endometriosis and is associated with concomitant adenomyosis in around 49% of cases. There are no data about the effect of the presence of adenomyosis in terms of surgical outcomes and complications. Thus, the aim of the present study was to evaluate the impact of adenomyosis on surgical complications in women with deep endometriosis undergoing laparoscopic surgery. Methods A retrospective cohort study including women referred to the endometriosis unit of a referral teaching hospital. Two expert sonographers preoperatively diagnosed DE and adenomyosis. DE was defined according to the criteria of the International Deep Endometriosis Analysis group. Adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien-Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. Results 157 DE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.5% (noA group) (p < 0.001). Multivariate analysis showed a 4.56-fold increased risk of presenting complications in women with adenomyosis (CI: 1.9–11.3; p = 0.001) independently of undergoing hysterectomy. There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p < 0.001). Conclusions Adenomyosis increases the risk of presenting complications in DE surgery after controlling for demographic, clinical and surgical factors and should be considered an independent preoperative risk factor of surgical complications.

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Section: Discussionsupporting

confidence: 88%

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Gràcia

Guirior

Valdés-Bango

et al. 2021

Preprint

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“…With 6.8%, the peri-and postoperative rate of rather minor complications was low despite the partly very extensive disease and is in line with or even lower than the data published in the literature [20,30,38,39]. In half of these patients, the complications were associated with the immediate operative distance of the endometriosis lesions at the respective anatomical structures.…”

Section: Stage-related Surgical Procedures and Postoperative Rate Of supporting

confidence: 77%

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis.

Schippert

Witte

Bartels

et al. 2020

Preprint

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Background Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis the recurrence rates amount to 50%. The objective of this retrospective study was to evaluate the recurrence and pregnancy rates following surgical resection of endometriosis stage III/IV. Methods 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Data and responses of 206 patients (45.2%) were analyzed. The statistical analysis was performed with the statistical software ´R`. Statistical significance was given if the p-value was less than 0.05. The study was approved by the local Ethics Committee of Hannover Medical School. Results 66.5% (N=137) of patients were established with stage III, 33.5% (N=69) with stage IV. Average age was 37 years (17-59). 63.1% (N=130) of surgeries were performed by laparoscopy with an average duration of 81 minutes, 21.8% (N=45; 189 minutes) by laparotomy and 15% (N=31; 202 minutes) by conversion. Complete resection of endometriosis was achieved in 90.8% (N=187). After surgery, 48.5% (N=100) of the women did not receive hormonal treatment, main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% (N=192). Rate of recurrence was 21.8% (N=45). The association between incomplete resection and recurrence was on the threshold of significance (p=0.1). After surgery, 65.8% (79/120) of patients who wished to have children got pregnant. There is a statistically significant association between postoperative pregnancy rate and age <35 (p<0.002) and laparoscopic surgical access (p<0.01). Conclusion We assess the high percentage of complete or partial reduction of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered as ´gold standard` of endometriosis surgery, laparotomy still may be indicated in cases of extended endometriosis especially to preserve reproductive function.

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“…In our analysis, nearly 45% of women undergoing hysterectomy for benign indications reported pain before the operation, a prevalence higher than the one previously reported of 10–32% [ 10 , 36 , 37 ]. Uccella et al found that the presence of endometriosis is associated with longer surgical time and increased morbidity related to total laparoscopic hysterectomy [ 38 ]; other studies support this statement [ 39 ]. In this study, no difference was found in the surgical time, blood loss, and the Clavien–Dindo complications between the groups.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis

Kanellos

Nirgianakis

Siegenthaler

et al. 2021

JCM

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(1) Background: The aim of this study was to evaluate the impact of endometriosis on postoperative pain following laparoscopic hysterectomy; (2) Methods: A total of 214 women who underwent a laparoscopic hysterectomy between January 2013 and October 2017 were divided into four subgroups as follows: (1) endometriosis with chronic pain before the surgery (n = 57); (2) pain-free endometriosis (n = 50); (3) pain before the surgery without endometriosis (n = 40); (4) absence of both preoperative pain and endometriosis (n = 67). Postoperative pain was compared by using Visual Analog Scale (VAS) scores and by tracking the use of painkillers during the day of surgery and the first two postoperative days; (3) Results: Women with chronic pain before the surgery reported higher VAS scores during the first postoperative days, while the use of analgesics was similar across the groups. There was no difference in the postoperative pain when comparing endometriosis patients to non-endometriosis patients; (4) Conclusions: Women with chronic pelvic pain demonstrated increased postoperative pain after laparoscopic hysterectomy, which was independent of the presence or severity of endometriosis. The increased VAS scores did not, however, translate into equally greater use of painkillers, possibly due to the standardised protocols of analgesia in the immediate postoperative period. These findings support the need for careful postsurgical pain management in patients with pain identified as an indication for hysterectomy, independent of the extent of the surgery or underlying diagnosis.

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

Cited by 24 publications

References 20 publications

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis.

Postoperative Pain Is Driven by Preoperative Pain, Not by Endometriosis

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