Complications after surgery for deeply infiltrating pelvic endometriosis

Abstract

Sample All women given surgical treatment for deep endometriosis.Methods Women who underwent surgery for deep endometriosis were reviewed for intra-and postoperative complications.Main outcome measures Primary outcomes were rates of intraand postoperative complications. Complications were compared according to the procedure performed.Results A total of 568 women were included in the study, with a mean age of 32.4 years. The mean estimated diameter of the nodule felt by vaginal examination was 1.8 cm (ranging from 0.5 to 7 cm). Laparoscopic surgery was performed in 560 women (98.6%), and conversion was required in 2.3%. The mean operative time was 155 minutes. Intraoperative complications occurred in 12 women (2.1%), including six minor (1.05%) and six major (1.05%) complications. Postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3% (21 out of 226), compared with only 1.5% for the other women (five out of 342) (P < 0.01). Shaving presented less major postoperative complications compared with segmental resection (24 versus 6.7%; P = 0.004).Conclusions Surgery for deep endometriosis is feasible, but it is associated with major complications, especially when any type of rectal surgery must be performed.

Associação entre endometrioma ovariano e endometriose profunda infiltrativa

“…Dada a complexidade do tratamento cirúrgico da EPI 12-14 e a taxa considerável de potenciais complicações pós-operatórias 2,15 , é sensato e necessário que se identifiquem na investigação pré-operatória marcadores de severidade da doença para o aconselhamento adequado da paciente e para o planejamento cirúrgico apropriado 10 . Na ausência de equipe especializada para o tratamento das formas avançadas de endometriose, a identificação de tais marcadores pode alertar o cirurgião para a possibilidade de presença de EPI, levando-o a referenciar a paciente a um centro especializado no tratamento da doença.…”

Complications after surgery for deeply infiltrating pelvic endometriosis

“…2 We presume that Kondo et al 1 meant skinning of the lesions when they used the terminology 'shaving', but once again it is not clear whether they were carrying this out at the mucosal or serosal surface of the bowel.…”

Prostaglandin E2 vaginal gel or tablets for the induction of labour at term: a randomised controlled trial

“…j Sir, Having recently performed a comparison between prostaglandin E2 (PGE 2 ) gel and tablets for induction of labour, 1 we were interested in the recent paper by Taher et al 2 We compared labour outcomes in women induced with PGE 2 tablet (n = 154) with those induced with PGE 2 gel (n = 157). Prior to 2007 our hospital used PGE 2 gel.…”

“…3 The resection must include only the palpable/visible nodule, and no more than that. j Sir, It was a delight to read Taher et al 1 paper which addressed a common obstetric debate. However, there are two aspects of the statistics which require clarification.…”

“…1 The rectal shaving technique entails the resection of the rectal nodule from the anterior rectal wall without entering the lumen of the bowel. The dissection is carried out up to the muscular layer of the rectum, avoiding the complete opening of the bowel wall.…”