Deeply infiltrating disease in surgically treated endometriosis patients

Abstract

Objective: To examine the incidence of deeply infiltrating endometriotic lesions among surgically treated endometriosis patients, and determine clinical parameters associated with the presence of deep disease.

Design: Prospective observational study.

Setting: Regional central hospital.

Population: Patients undergoing surgical treatment of endometriosis.

Methods: Complete excision of all visible endometriotic lesions and adhesions.

Main outcome measures: The number and location of deep lesions, association between the presence of deep lesions, relevant preoperative and intraoperative factors.

Results: Of 201 surgically treated endometriosis patients, 103 (51.2%) had deep lesions, 43.3% had uterosacral ligament deep lesions, 18.4% intestinal, 15.4% rectovaginal, and 3.5% urinary bladder deep lesions. Patients with deep lesions had more often undergone previous operations for endometriosis (p<0.01), had been operated on for pelvic pain (p<0.01) and had a totally obliterated rectovaginal pouch (p<0.01), compared to patients without deep lesions. In multivariate analysis, pelvic pain as an indication for surgery (OR 3.9, 95%CI 1.8-8.9, p<0.01) and totally obliterated rectovaginal pouch (OR 4.0, 95%CI 1.7-9.4, p<0.01) were independent prognostic factors for the presence of deep disease.

Conclusions: Deeply infiltrating endometriosis is common in surgically treated endometriosis patients and should be searched for in those with persistent pelvic pain and where obliteration of the rectovaginal pouch is detected at surgery.