60 A retroperitoneal approach to endometriosis excision: Surgical outcomes & 7-year follow-up

Abstract

The objective of this mixed method retrospective study was to investigate the outcomes for women up to 7 years after undergoing laparoscopic surgery using a retroperitoneal approach to isolate and lateralize the ureters and excise endometriosis. The 2-part design included a case series of 350 patients who underwent laparoscopic surgical excision at a GYN-only ambulatory surgery center between October 2013 and September 2020; and a voluntary survey of the same patient population administered via email in September 2020 to evaluate symptom relief and triangulate reoperation rate. Surgeries were identified by procedural code and confirmed via operative notes during the medical chart review process. Patient characteristics and operative outcomes were analyzed using descriptive statistics. IntegReview IRB, an independent institutional review board, deemed both the retrospective review and patient survey exempt from informed consent (IRB #CIGC-001; IRB #CIGC-3206). A total of 350 patients with Stage III and IV were included in the case series. The mean age of participants was 33 ± 7.8 years. Intraoperative complication rate was 2.6%; postoperative 2.3%. More than one-third (34.6%) of patients had at least 1 previous surgical procedure for endometriosis, ranging from 1 to 10 procedures. The majority (77.8%) of intraoperative complications occurred in this group. The cumulative reoperation rate for pelvic pain associated with recurring endometriosis was 3.1%. Preliminary results of the patient survey administered to the same population up to 7 years after surgery support a low reoperation rate. Future studies should aim to collect detailed quality of life measures using prospective standardized survey instruments in order to collect baseline data. Endometriotic implants should be thoroughly excised for optimal surgical outcomes.1,2 However, pelvic pathology of endometriosis and adhesions from previous surgeries may distort normal anatomy and limit the ability to visualize pelvic landmarks, impeding the use of blunt dissection.3 Dissection of the retroperitoneum enables skilled surgeons to identify critical structures, preventing unintentional injury to ureters and retroperitoneal pelvic vessels. Entering the retroperitoneum also facilitates complete excision of endometriosis resulting in a low reoperation rate.