8734 Endometriosis Surgery: Factors Associated with Complete and Incomplete Management

Abstract

<h3>Study Objective</h3> Incomplete surgery for endometriosis is associated with increased disease severity, however, there is limited data on potential reasons. This study aims to elucidate patient and surgical factors associated with previous incomplete and complete surgery. <h3>Design</h3> A retrospective cohort study of patients referred to a minimally invasive gynecologist over 1-year. Patients with complete and incomplete surgical treatments were compared. Exposure variables included referral reason, symptomatology, and severity of endometriosis and adhesions noted during surgery. <h3>Setting</h3> Tertiary-center endometriosis clinic. <h3>Patients or Participants</h3> Inclusion criteria included female gender assigned at birth, previous endometriosis surgery, and age 18 or greater. Charts were excluded if referral reason was unrelated to endometriosis. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> One-hundred and twenty-nine charts met the criteria. Common reasons for referral included endometriosis (82.9%) and pelvic pain (70.5%), while reported symptoms included pelvic pain (80.6%) and dysmenorrhea (62.8%). Surgical information was collected from the initial consultation, and 75 (58.1%) charts included operative notes. Disease severity was reported by previous surgeons in 55 (42.6%) cases: mild/minimal in 14 (14/55, 25.5%), moderate in 8 (8/55, 14.5%) and severe in 33 (33/50, 60%). Adhesions were present in 50 (38.8%) cases. Surgical management was complete in 55 (42.6%) cases and incomplete in 31 (24.0%) based on operative history. In 43 (33.3%) cases, completeness could not be determined from available information. When incomplete, reasons cited included extent of disease (9/31, 29.0%), proximity to ureter (4/31, 12.9%), bowels (4/31, 12.9%), pelvic sidewall (2/31, 6.5%), procedure beyond consent (2/31, 6.5%) and adhesions (1/31, 3.2%). In 9 (9/31, 29.0%) cases, no reason was provided by the surgeon. <h3>Conclusion</h3> This review showed that incomplete surgery was often due to disease proximity to pelvic structures noted at the time of surgery. Further analysis assessing each factors' relationship with incomplete surgery and assessment of outstanding operative notes will provide more information to decrease incomplete surgery risk.