The impact of deep disease on surgical treatment of endometriosis

Objective: To compare the difficulty of surgery in patients with and without deeply infiltrating endometriosis. Study design: Prospective cohort study performed in one hospital specialized in the surgical treatment of endometriosis. 193 consecutive patients undergoing excision of all visible endometriosis by laparoscopy (176 patients, 91.2%) or by laparotomy (17 patients, 8.2%). The duration of surgery, the number of operations, the number of day-surgery operations, the need to operate with a surgeon, the ability to perform complete excision during one operation, and the ability to perform operation by laparoscopy were compared in patients with and without deep lesions. Results: The mean duration of surgery was 192 (SD 96), and 76 (SD 41) min in patients with and without deep lesions (p < 0.001). Ureterolysis (66% vs. 20%, p < 0.001), division of adhesions (92% vs. 69%, p < 0.001), and hysterectomy (32% vs., 8%, p < 0.001), were more often performed on patients with deep lesions. 41 patients (42%) with deep lesions, and 1 patient (1%) without deep lesions were operated with a surgeon (p < 0.001). Day-surgery was less often performed on patients with deep lesions (11% vs. 45%, p < 0.001). Complete excision during one operation was performed on 95% and on 97% of the patients with and without deep lesions (p=1.0). Complete excision was less often performed by laparoscopy in patients with deep lesions (79% vs. 95%, p < 0.001). Conclusions: Surgical treatment of deep lesions is more demanding and time-consuming than surgical treatment of other types of endometriosis, and collaboration with a surgeon is often necessary. Complete excision during one operation is a realistic goal for endometriosis surgery, but it is significantly less often achievable by laparoscopy in patients with deep lesions than in patients without deep lesions. (C) 2011 Elsevier Ireland Ltd. All rights reserved.