Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement.

Abstract

Study ObjectiveTo describe complications following surgery for deep endometriosis (DE) without bowel involvement and to develop a nomogram for predicting postoperative complications.DesignRetrospective studySettingTertiary referral university hospital and expert center in endometriosisPatientsTwo-hundred and twenty patients with DE without bowel involvementInterventionsLaparoscopic resection for DE without bowel involvementMeasurements and Main ResultsOperative complications were evaluated using the Clavien-Dindo classification. Voiding dysfunction was defined as a need for bladder self-catheterization lasting >1 month. Fifty-three patients (24%) had postoperative complications: 31 (14%) had a Clavien-Dindo grade I—II complication (3 grade I and 28 grade II); 11 (5%) had a grade III complication (2 grade IIIa and 9 grade IIIb); and 11 (5%) had voiding dysfunction. No grade IV—V complications were observed. Age, Enzian classification risk group, and previous surgery for endometriosis were significantly associated with postoperative complications. The predictive model had an AUC of 0.72 (95% CI, 0.70–0.74) before and 0.70 (95% CI, 0.68–72) after bootstrap sample correction. The average difference and maximal difference in predicted and calibrated probabilities of recurrence were 0.023 and 0.089% respectivelyConclusionSurgery for DE without bowel resection is associated with a relatively high incidence of voiding dysfunction and postoperative complications mainly corresponding to Clavien-Dindo grade I—II. Age, risk group of Enzian classification, and previous surgery for endometriosis are significantly associated with postoperative complications and voiding dysfunction. Our results allowed us to build a nomogram which can be used to better inform patients about the risk of DE surgery without bowel involvement