Complications after surgery for deeply infiltrating pelvic endometriosis

Objective To evaluate the complications after surgery for deep endometriosis. Design Retrospective study. Setting Data from the CHU Estaing database and patients' charts between January 1987 and December 2007. Sample All women given surgical treatment for deep endometriosis. Methods Women who underwent surgery for deep endometriosis were reviewed for intra- and postoperative complications. Main outcome measures Primary outcomes were rates of intra- and postoperative complications. Complications were compared according to the procedure performed. Results A total of 568 women were included in the study, with a mean age of 32.4 years. The mean estimated diameter of the nodule felt by vaginal examination was 1.8 cm (ranging from 0.5 to 7 cm). Laparoscopic surgery was performed in 560 women (98.6%), and conversion was required in 2.3%. The mean operative time was 155 minutes. Intraoperative complications occurred in 12 women (2.1%), including six minor (1.05%) and six major (1.05%) complications. Postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3% (21 out of 226), compared with only 1.5% for the other women (five out of 342) (P < 0.01). Shaving presented less major postoperative complications compared with segmental resection (24 versus 6.7%; P = 0.004). Conclusions Surgery for deep endometriosis is feasible, but it is associated with major complications, especially when any type of rectal surgery must be performed.