Laparoscopic management of deep pelvic endometriosis with minimal complications: three-year experience

Abstract

Study Objective: To describe our surgical experience with laparoscopic management of deep infiltrating endometriosis (DIE) while keeping complications to a minimum. Design: Retrospective observational cohort study. Setting: University hospital and academic affiliated private hospital. Patients: All patients had stage IV endometriosis according to the American Fertility Society (AFS) classification and were operated on between 2012-2015. Intervention: All women underwent multidisciplinary preoperative evaluation by an experienced team of gynecologists, general surgeons and an urologist before the surgery. Laparoscopic endometrioma excision, cul-de-sac dissection and nodule excision from uterosacral ligament, ureter or bladder wall resection, bowel surgery including shaving and/or segmental resection-anastomosis were performed. Patient history, complaints, physical findings, details of the performed procedures, and complications were recorded for each patient. Measurements and Main Results: fifty-eight patients underwent laparoscopic surgery. Of these, two were converted to laparotomy due to need for ureteroneocystostomy. Cul-de-sac dissection was done in all of the cases. Nodule was excised from the uterosacral ligaments in 45 cases. Thirty-nine patients had bowel endometriosis; 21 patients underwent rectosigmoid bowel shaving while segmental bowel resection and anastomosis was performed in 18 patients. Six cases suffered from urinary system endometriosis and had ureter and/or bladder nodule excisions. No major complication was seen. Four patients had subileus, one patient who underwent laparotomy for ureteroneocystostomy had temporary voiding problems due to kinking of the intramural part of the contralateral ureter. There were no perforations, fistulas, or infections. Blood transfusion was not required in any of the cases. Conclusion: an experienced team of surgeons with different backgrounds can collaborate to minimize the complications for this challenging surgery.