Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Abstract

Background: Surgical management of deep endometriosis infiltrating pelvic nerves may allow an overall improvement in pain and neurologic disorders. Objective: To assess 1-year postoperative outcomes of surgery for deep endometriosis involving sacral roots and the sciatic nerve. Study Design: Retrospective study including 52 women undergoing surgery for deep endometriosis involving sacral roots and the sciatic nerve. We assessed 1-year postoperative outcomes. Results: Deep endometriosis involved sacral roots in 49 women (94.2%) and the sciatic nerve in 3 cases (5.8%). Sciatic pain was recorded in 43 women (82.7%), pudendal neuralgia in 11 women (21.2%) and leg motor weakness in 14 cases (27%). Surgical procedures carried out on pelvic nerves included complete releasing and decompression (92.3%), excision of epineurium (5.8%) and intraneural excision (1.9%). Additional procedures involved the digestive tract in 82.7% of cases and the urinary tract in 46.2%. Rectovaginal fistula occurred in 13.5% of cases. Self-catheterisation was required in 14 cases (27%) at 3 weeks after surgery, and in only 3 women (5.8%) 12 months later. One-year follow up showed significant improvement in quality of life using SF36 and standardised gastrointestinal scores. De novo hypoesthesia, hyperaesthesia or allodynia were recorded in 9 women (17.2%). The cumulative pregnancy rate was 77.2% following natural conception in 47%. Conclusions: Laparoscopic management of deep endometriosis involving sacral roots and the sciatic nerve improves patient symptoms and overall quality of life. Although pain reduction may be rapid following surgery, other sensory or motor complaints including bladder dysfunction may be recorded over months or years.