Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement

Poupon, Clothilde; Owen, Cathy; Arfi, Alexandra; Cohen, Jonathan; Bendifallah, Sofiane; Daraı̈, Émile

doi:10.1016/j.eurox.2019.100028

Cited by 27 publications

(18 citation statements)

References 28 publications

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“…Similarly, in a study including 112 women with endometriosis undergoing hysterectomy, Ucella et al ( 2016 ) found that surgical complications were more common in rASRM stage III-IV than stage I-II endometriosis. Poupon and colleagues reported no significant differences in major surgical complications between rASRM stages I-II and rASRM stages III-V ( Poupon et al, 2019 ). However, both Clavien-Dindo complications grade I-II, grade III and voiding problems were more common in women with endometriosis rASRM stage III-IV than rASRM stage I-II (17% vs. 11%, 7% vs. 4%, and 7% vs. 3%).…”

Section: The Rasrm Scorementioning

confidence: 99%

“…Haas et al ( 2013 ) demonstrated that intra-operative Enzian classification correlated with the duration of the surgical procedure. To create a prediction model for the risk of surgical complications, Poupon et al ( 2019 ) developed a nomogram based on three simple criteria; the age of the patient, previous surgery for DE, and the extent of disease described by the surgical Enzian classification. Patients were classified as being at low, intermediate or high risk of surgical complications based on the Enzian classification (low risk defined as A0, A1, B1 and C0, intermediate risk as A2 and/or B2, high risk as A3, B3 or C1).…”

Section: The Enzian and (#) Enzian Classificationsmentioning

confidence: 99%

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What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Hudelist¹,

Valentin²,

Sarıdoğan³

et al. 2021

Facts Views Vis ObGyn

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Background: Endometriosis is a common benign gynaecological disease that affects pelvic structures and causes adhesions. Endometriosis outside the pelvis exists but is rarer. Deep endometriosis may affect organs such as the urinary bladder, ureters, bowel and sacral roots. Adenomyosis (growth of endometrium in the myometrium, sometimes explained by disruption of the uterine junctional zone) frequently co-exists with deep endometriosis. Over the past decades, multiple attempts have been made to describe the anatomical extent of endometriosis. Out of approximately 20 classification systems suggested and published so far, three have gained widespread acceptance. These are the rASRM (American Society of Reproductive Medicine) classification, the Endometriosis Fertility Index (EFI) and the Enzian classification. Ideally, a classification system should be useful both for describing disease extent based on surgical findings and results of imaging methods (ultrasound, magnetic resonance imaging). Objectives: To highlight the advantages and disadvantages of the three classification systems. Methods: This is a narrative review based on selected publications and experience of the authors. We discuss the current literature on the use of the rASRM, EFI and Enzian classification systems for describing disease extent with imaging methods and for prediction of fertility, surgical complexity, and risk of surgical complications. We underline the need for one universally acceptable terminology to describe the extent of endometriosis. Conclusions: A useful classification system for endometriosis should describe the sites and extent of the disease, be related to surgical complexity and to disease-associated symptoms, including subfertility and should satisfy needs of both, imaging specialists for pre-operative classification and surgeons. The need for such a system is obvious and is provided by the #Enzian classification. Future research is necessary to test its validity.

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Section: The Rasrm Scorementioning

confidence: 99%

Section: The Enzian and (#) Enzian Classificationsmentioning

confidence: 99%

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Hudelist¹,

Valentin²,

Sarıdoğan³

et al. 2021

Facts Views Vis ObGyn

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“…These data are in agreement with those of the Enzian classification underlining an increased risk of complications associated with the extent of the disease. 28 However, the absence of a clear definition of parametrial endometriosis in the Enzian classification precludes any relation between parametrial involvement and surgical risk. 29…”

Section: Discussionmentioning

confidence: 99%

Value of sonography in assessing parametrial endometriotic involvement: Preliminary results

Bazot

Daraı̈

Bendifallah

2021

Journal of Endometriosis and Pelvic Pain Disorders

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Objectives: The aims of the study were to evaluate ultrasound (US) in the diagnosis of parametrial endometriosis compared with surgical-pathological findings, and to define an optimal cut-off of lesion size for correlation between torus/uterosacral ligaments (USL) or rectosigmoid and parametrial involvement by deep endometriosis. Methods: Longitudinal study of 60 patients referred for surgical management of pelvic endometriosis, who underwent sonography performed by an experienced sonographer. The presence of parametrial endometriosis shown by US was compared with surgical and histologic findings. The presence of endometrial cysts, deep endometriotic locations, and their potential association with parametrial endometriosis was assessed by US. The sensitivity, specificity, predictive values (PV), accuracy, and positive and negative likelihood ratios (LR) of US for predicting parametrial endometriosis and other pelvic endometriotic locations were assessed. Descriptive analysis, optimal cut-off analysis, categorical (Fisher’s exact test) and non-categorical variables (Mann—Whitney) were calculated. Results: Parametrial, ovarian, and deep endometriosis were found by surgery in respectively 30 (50%), 21 (35%), and 59 (98.63%) of the 60 patients. The sensitivity, specificity, PPV, NPV, accuracy, PLR, and NLR of US for the sonographic diagnosis of parametrial endometriosis were 40%, 96.7%, 92.3%, 61.7%, 68.3%, 12, and 0.62 respectively. In patients with parametrial involvement, a relation with rectosigmoid ( p = 0.005) and USL ( p = 0.0074) endometriosis was noted. For isolated torus/USL and rectosigmoid endometriosis, optimal cut-offs suggesting parametrial involvement by DE were 11 mm and 30 mm, respectively. Conclusions: US has low sensitivity but high specificity to diagnose parametrial endometriosis and could be used to rule in diagnosis before surgery.

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“…Also this study focussed on Clavien-Dindo grade III complications, while several Clavien-Dindo grade I/II complications, such as voiding dysfunction, also result in increased medical costs and social impairment. 43 In addition, complication rates in smaller centres with less experience in treating DE are likely to be higher than the rates reported by expert centres for DE in the literature, which were used as input for the model. There is considerable variation in the literature on the reporting of complications after bowel or urinary tract surgery, which greatly influences the outcomes of the model, as is shown by the sensitivity analyses.…”

Section: Discussionmentioning

confidence: 99%

Potential Value of Haptic Feedback in Minimally Invasive Surgery for Deep Endometriosis

Vlek¹,

Burm²,

Govers³

et al. 2020

Surg Innov

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Introduction. Laparoscopic treatment of deep endometriosis (DE) is associated with intra- and post-operative morbidity. New technological developments, such as haptic feedback in laparoscopic instruments, could reduce the rate of complications. The aim of this study was to assess the room for improvement and potential cost-effectiveness of haptic feedback instruments in laparoscopic surgery. Methods. To assess the potential value of haptic feedback, a decision analytical model was constructed. Complications that could be related to the absence of haptic feedback were included in the model. Costs of complications were based on the additional length of hospital stay, operating time, outpatient visits, reinterventions, and/or conversions to laparotomy. The target population consists of women who are treated for DE in the Netherlands. A headroom analysis was performed to estimate the maximum value of haptic feedback in case it would be able to prevent all selected intra- and post-operative complications. Results. A total of 9.7 intraoperative and 47.0 post-operative complications are expected in the cohort of 636 patients annually treated for DE in the Netherlands. Together, these complications cause an additional length of hospital stay of 432.1 days, 10.2 additional outpatient visits, 73.9 reinterventions, and 4.2 conversions. Most consequences are related to post-operative complications. The total additional annual costs due to complications were €436 623, amounting to €687 additional costs per patient. Discussion. This study demonstrated that the potential value for improvement in DE laparoscopic surgery by using haptic feedback instruments is considerable, mostly caused by the potential prevention of major post-operative complications.

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Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement

Cited by 27 publications

References 28 publications

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Value of sonography in assessing parametrial endometriotic involvement: Preliminary results

Potential Value of Haptic Feedback in Minimally Invasive Surgery for Deep Endometriosis

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