Does the Presence of Adenomyosis Affect the Results of DEEP Infiltrating Endometriosis Surgery?

Abstract

<h3>Study Objective</h3> To evaluate the impact of adenomyosis on surgical outcomes in women with deep infiltrating endometriosis (DIE) undergoing laparoscopic surgery. <h3>Design</h3> Retrospective study including women undergoing DIE surgery during a 3-year period. <h3>Setting</h3> Referral tertiary university hospital. <h3>Patients or Participants</h3> 157 women with DIE undergoing surgery. <h3>Interventions</h3> Two expert sonographers preoperatively diagnosed DIE and adenomyosis. DIE was defined according to the criteria of the International Deep Endometriosis Analysis group, and adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DIE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien-Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. <h3>Measurements and Main Results</h3> 157 DIE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. There were no differences between groups regarding demographic characteristics, current treatment, symptoms, r-ASRM classification or type of surgery. The mean operating time was higher in the A group (237min±98.4) compared to noA group (188min±79.3) (p=0.017). The mean hospital stay was also higher in the A group compared to noA group (3.62±4.3 vs 2.55±1.79 days, p<0.05). Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.5% (noA group) (p<0.001). There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p<0.001). <h3>Conclusion</h3> Adenomyosis seems to play a detrimental role in DIE surgical procedures. It increases the risk of presenting complications in DIE surgery after controlling for demographic, clinical and surgical factors. Adenomyosis should be considered an independent preoperative risk factor of surgical complications.