Association between Pelvic Inflammatory Disease and Endometriosis. Outcomes on 311 Minimally-Invasive Procedures over 14 years’ Experience in a Third-level Referral Center

Abstract

Study Objective to investigate possible associations between deep infiltrating endometriosis (DIE) and pelvic inflammatory disease (PID). Design retrospective cohort analysis of surgical procedures in a tertiary care referral center. Setting Tertiary care reference center for endometriosis Patients or Participants Retrospective analysis on 17016 women submitted to laparoscopy in our Unit between January 2004 and June 2018. Interventions A total of 311 cases were considered for analysis. Intra-operative data about complications and fertility-impairing procedures, intra-, peri- and post-operative complications were recorded. The study population was divided into two groups: Group 1 included women with concomitant PID and no endometriosis (n = 115); Group 2 included women with PID and DIE (n =96). Measurements and Main Results Endometriosis had a prevalence of 63% in patients submitted to surgery for PID, significantly higher than the one reported in general population and than the one reported in a Tertiary Care Endometriosis Unit. Patients with concomitant endometriosis had statistically significant longer-lasting procedures (213.31 mins versus 88.02 mins, p <0.0001) and more intra-operative blood loss (177.9 mL versus 89.7 mL, p <0.0001). A significantly higher number of salpingectiomes was needed in group 2 patients (208 versus 80, p <0.0001). Hospital-stay was significantly longer in the patients carrying endometriosis and PID (7 versus 4 days, p<0.01). More bowel complications in group 2 when compared to group 1 (6 versus 0, p<0.05%): Also significantly more urinary complications were reported in the PID-endometriosis group (6 versus 0, p<0.05%). Conclusion This study seems to confirm an higher prevalence of PID in endometriosis patients. When PID needs to be treated surgically, intra-operative finding of DIE is significantly more represented than in general population. Intra-operative findings of PID with associated DIE show more aggressive patterns than PID alone, more frequently requiring demolitive procedures such as salpingectomy with longer operating times, higher blood loss and more complications. to investigate possible associations between deep infiltrating endometriosis (DIE) and pelvic inflammatory disease (PID). retrospective cohort analysis of surgical procedures in a tertiary care referral center. Tertiary care reference center for endometriosis Retrospective analysis on 17016 women submitted to laparoscopy in our Unit between January 2004 and June 2018. A total of 311 cases were considered for analysis. Intra-operative data about complications and fertility-impairing procedures, intra-, peri- and post-operative complications were recorded. The study population was divided into two groups: Group 1 included women with concomitant PID and no endometriosis (n = 115); Group 2 included women with PID and DIE (n =96). Endometriosis had a prevalence of 63% in patients submitted to surgery for PID, significantly higher than the one reported in general population and than the one reported in a Tertiary Care Endometriosis Unit. Patients with concomitant endometriosis had statistically significant longer-lasting procedures (213.31 mins versus 88.02 mins, p <0.0001) and more intra-operative blood loss (177.9 mL versus 89.7 mL, p <0.0001). A significantly higher number of salpingectiomes was needed in group 2 patients (208 versus 80, p <0.0001). Hospital-stay was significantly longer in the patients carrying endometriosis and PID (7 versus 4 days, p<0.01). More bowel complications in group 2 when compared to group 1 (6 versus 0, p<0.05%): Also significantly more urinary complications were reported in the PID-endometriosis group (6 versus 0, p<0.05%). This study seems to confirm an higher prevalence of PID in endometriosis patients. When PID needs to be treated surgically, intra-operative finding of DIE is significantly more represented than in general population. Intra-operative findings of PID with associated DIE show more aggressive patterns than PID alone, more frequently requiring demolitive procedures such as salpingectomy with longer operating times, higher blood loss and more complications.