Laparoscopic conservative surgery for stage IV symptomatic endometriosis: short-term surgical complications

Abstract

Objective To study severe endometriosis as a cause of pelvic pain, which represents one of the most challenging disorders in gynecology. Design Retrospective study. Setting Teaching hospital. Patient(s) A total of 1,363 women with severe endometriosis (revised American Society for Reproductive Medicine [rASRM] stage IV). Interventions A detailed survey of all patients with severe endometriosis (rASRM stage IV) who underwent laparoscopy at our center between January 2004 and December 2007 was carried out. Main outcome measure(s) Clinical and surgical data were retrieved and assessed according to the extent of surgery performed. Intraoperative, ultra-short, and short-term clinical complications were assessed. Results A total of 1,201 women underwent laparoscopic radical surgery with excision of all visible endometriotic lesions, with a significant improvement of symptoms at 1-month follow-up evaluation. The overall intraoperative complication rate was 2.0%. The morbidity was significantly increased when bowel surgery was performed, with a risk of intraoperative complications that was threefold higher. Of the patients who had bowel surgery, 18 (4.1%) required reintervention within the first week after surgery. Conclusion(s) We report on the safety and efficacy of laparoscopic eradication of all visible implants in cases of rASRM stage IV endometriosis when surgery is performed in a referral center.