Impact of nerve‐sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function

Abstract

Objective: To evaluate the functional outcomes of nerve-sparing surgery for deep infiltrating endometriosis (DIE) with or without posterolateral parametrectomy. Methods:A multicenter, observational, retrospective, cohort study was performed including all symptomatic women who underwent nerve-sparing laparoscopic excision of DIE and preoperative and postoperative assessment of functional outcomes through validated questionnaires between April 2019 and March 2020. Women with posterolateral parametrial DIE (P-group) and women with no parametrial involvement (NP-group) were compared in terms of preoperative and postoperative functional outcomes related to pelvic organs assessed through validated questionnaires (KESS and GIQLI for bowel function, BFLUTS for urinary function, and FSFI for sexual function); pain symptoms at 3-month follow up assessed through an 11-point visual analogue scale (VAS) for dyschezia, dysmenorrhea, dyspareunia and chronic pelvic pain; surgical outcomes; and rate of urinary voiding dysfunction at 3-month follow up.Results: One-hundred patients were included: 69 in the P-group and 31 in the NPgroup. Preoperative and postoperative values of questionnaires, pain symptoms, and postoperative complication rates were comparable between the two groups, except for postoperative dyspareunia and sexual dysfunction, which were statistically higher in the P-group. Only patients in the P-group experienced urinary voiding dysfunction, but no statistical significance was reached (P = 0.173). Conclusion:Posterolateral parametrectomy for DIE appears to be associated with a higher risk of postoperative dyspareunia and sexual dysfunction.

Surgeons' workload assessment during indocyanine-assisted deep endometriosis surgery using the surgery task load index: The impact of the learning curve

“…Furthermore, this technique helps with one of the most critical steps of pelvic surgery: to locate the ureter ( 31 ), which can lead to a rapid ureter visualization. This can avoid the surgical dissection of the anatomical spaces trying to prevent any iatrogenic damage ( 32 ). It is not surprising that the introduction of this technique ( 21 ) helps surgeons during surgery and reduces their workload.…”

Colorectal infiltrating deep endometriosis: Laparoscopic treatment. A case report

“…Concerning pararectal involvement, only the posterior part of the Sacro-recto-genital septum was strongly associated with a significant number of colorectal resections. A multicenter retrospective study clarified that the posterolateral parametrium was a possible site of involvement together with bowel localization and had a possible functional impact with association with a higher risk of postoperative dyspareunia and sexual dysfunction ( 9 ). On the contrary, the removal of deep rectal nodules by shaving or disc excision preserves the mesorectum, rectal vasculature and nerves, as the procedure only affects the anterior rectal wall and does not change the overall length of the rectum.…”

Effect of Psychological Intervention on Pelvic Floor Function and Psychological Outcomes After Hysterectomy

“…Hysterectomy is a common gynecological procedure for various benign indications, such as hysteromyoma, endometrioma, deep infiltrating endometriosis, dysmenorrhea and dysfunctional uterine bleeding ( 1 – 5 ). Although hysterectomy rates have declined globally due to the application of conservative treatment, it still remains the second most common therapeutic modality ( 6 , 7 ).…”