Laparoscopic Management of Deep Infiltrating Endometriosis: Our Experience in 3 Years of a Multidisciplinary Group

Abstract

Study Objective: To evaluate our results in laparoscopic management of deep infiltrating endometriosis. Design: Descriptive study including 52 patients diagnosed of deep infiltrating endometriosis during the last 3 years. Diagnosis was made by clinical exam, transvaginal sonography, MRI, rectosigmoidoscopy, barium enema and cystoscopy. Disease severity was evaluated using Adamyan classification. Setting: Multidisciplinary Endometriosis Unit of Hospital 12 de Octubre (Madrid, Spain). Patients: 52 patients diagnosed of deep infiltrating endometriosis. Intervention: Deep infiltrating endometriosis of posterior compartiment was excised in 76.9%. In 6 patients a bladder nodule was excised and in two cases a partial ureteral resection and re-implantation was done. A nephrectomy was performed in one patient. We performed hysterectomy with bilateral adnexectomy in 5 patients and simple hysterectomy in another. In 17.3% we performed a segmental bowel resection followed by end-to-end anastomosis and shaving in 13.4%. Measurements and Main Results: Mean age was 33.9 years. 41.2% had previous surgery for endometriosis. Most frequent symptoms were dysmenorrhea (88.4%), dyspareunia (65.3%) and dyschesia (53.8%). Sterility was suffered by 17.6%. 2 patients presented intestinal occlusion, 5 hydronephrosis, 5 rectal bleeding and 5 dysuria. Laparoscopic approach was performed in 92.2%. Laparoconversion occurred in 7′8% Mean operating time was 238 minutes (range 90-600). No intraoperative complications were noted. A patient required re-intervention because of anastomosis leakage. Average hospital stay was 5.2 days. During the long term follow up, 84.3% referred significant reductions in preoperative symptoms. Conclusion: Multidisciplinary diagnostic and therapeutic approach (including general surgeons, urologists and radiologists) is essential in deep infiltrating endometriosis context, due to complexity and wide organic affectation of this clinical entity. Surgical treatment is still the best treatment option.