Postoperative complications from laparoscopic treatment for suspected endometriosis could not be predicted by preoperative patient characteristics or surgical findings of advanced endometriosis, according to a retrospective cohort study.
However, the study in Acta Obstetricia et Gynecologica Scandinavica did find that adhesiolysis, ureterolysis and an increased number of total procedures were predictive of perioperative complications.
“Laparoscopic treatment of endometriosis is highly variable, depending on the goals of the patient, the extent of disease and the skills of the surgeon,” said principal investigator Nisse Clark, MD, MPH, a minimally invasive gynecologic surgeon at Massachusetts General Hospital in Boston. “For instance, a simple procedure may only require a laparoscopic survey and a peritoneal biopsy, whereas a more complex procedure may entail a radical excision of all deep-infiltrating lesions, paralleling an oncologic debulk.”
Dr. Clark pointed out that it would be helpful to understand what factors increase surgical complexity and increase a patient’s risk of a complication. “We undertook this study in hopes of identifying preoperative or intraoperative factors that would predict a complication,” she told Contemporary OB/GYN.
The cohort of 397 women underwent laparoscopic treatment of suspected endometriosis at Brigham and Women’s Hospital in Boston between 2009 and 2016. Predictors of major perioperative complications were assessed by comparing the characteristics of women who had any major intraoperative or postoperative complications to women who had no complications.
The procedures were excision of superficial endometriosis (55.4% of women), excision of deep‐infiltrating endometriosis (24.9%), fulguration of endometriosis (38.3%), hysterectomy (23.2%), ovarian cystectomy (35.5%), salpingectomy (18.6%), oophorectomy (15.1%) and bowel resection (1.0%). The women, many of whom had multiple procedures, were followed for 60 days following each surgery, during which time 4.5% (n = 18) developed a major perioperative complication.
Dr. Clark reports no relevant financial disclosures.