Complications of Endoscopic Surgery for Adolescent Endometriosis: Prevention, Recognition, and Management

Abstract

The surgical management of adolescent endometriosis requires a multidisciplinary approach. Communication between all different specialties is essential for a successful outcome. Preoperative preparation including explanation of procedure, risks, benefits, and possible complications should be included in the informed consent. There are several laparoscopic entry techniques to access the peritoneal cavity. Complications of laparoscopic access have been reported with all different techniques. The best and safest technique depends on the expertise and experience of the operating surgeon. Complications can be minor and managed easily or they can be severe, such as vascular or gastrointestinal injuries that can result in death or severe morbidity. The anesthesiologist plays an important role in the management of adolescents with endometriosis and chronic pelvic pain. These patients may be debilitated and have multiple comorbidities. Many of them may have been receiving analgesics and opioids for a long time. Postoperative pain control is essential for a better recovery. The presence of adhesions can add to the complexity and complications of laparoscopic procedures. The role of adhesions as a cause of abdominal pain has long been a subject of debate. Incidental findings during laparoscopy may require the assistance of a pediatric or general surgeon. Meckel’s diverticulum, for instance, can cause complications and has been occasionally reported to harbor endometriosis. The role of appendectomy in the management of endometriosis and chronic pelvic pain has been controversial. Endometriosis of the appendix has been extensively reported. Moreover, the appendix itself may be the cause of the pain or create other complications.