Nomogram predicting the likelihood of complications after surgery for deep endometriosis without bowel involvement
Open accessAbstract
STUDY OBJECTIVE: To describe complications following surgery for deep endometriosis (DE) without bowel involvement and to develop a nomogram for predicting postoperative complications. DESIGN: Retrospective study. SETTING: Tertiary referral university hospital and expert center in endometriosis. PATIENTS: Two-hundred and twenty patients with DE without bowel involvement. INTERVENTIONS: Laparoscopic resection for DE without bowel involvement. MEASUREMENTS AND MAIN RESULTS: Operative 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% respectively. CONCLUSION: Surgery 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.
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In abdominal wall endometriosis, infiltration above 5 mm of wall depth involving the parietal peritoneum may cause severe postoperative complications.
“It is worth mentioning that in abdominal wall endometriosis, when there is an infiltration above 5 mm of the wall's depth involving the parietal peritoneum, there may be severe postoperative complications [29][30][31] .”
From Abdominal Wall Endometriosis: Experience of the General Surgery Service of the Antônio Pedro University Hospital of the Universidade Federal Fluminense (2020) · cites this paper as [31]
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- Authors
- Poupon, C., Owen, C., Arfi, A., Cohen, J., Bendifallah, S., & Daraï, E.
- Affiliations
- Sorbonne Université (FR)
- Venue
- European Journal of Obstetrics & Gynecology and Reproductive Biology: X
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 3
- Pages
- 100028
- ISSN
- 2590-1613 (ISSN-L)
- PMC
- PMC6687381
- OpenAlex
- W2943722359
- Cited by
- 31
- References
- 34
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 6 · 2022: 10 · 2021: 5 · 2020: 4
- FWCI
- 4.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of Obstetrics & Gynecology and Reproductive Biology X (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- deep infiltrating endometriosis, postoperative complications, nomogram, voiding dysfunction, Clavien-Dindo classification, laparoscopic resection, Enzian classification, risk factors, recurrence prediction
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