Women with advanced endometriosis (defined as stage III or IV endometriosis, rectovaginal endometriosis or deep-infiltrating endometriosis) were more likely to have a complication, though not a statistical significant difference. In total, 77.8% of women with a complication versus 56.7% of women without a complication had advanced endometriosis (P = 0.077).
On the other hand, women with a complication were significantly more likely to have undergone adhesiolysis or ureterolysis: 88.9% with a complication versus 52.5% without a complication for adhesiolysis (P = 0.002) and 61.1% of women with a complication versus 28.8% without a complication for ureterolysis (P = 0.003). The total number of procedures was also greater for women who had a complication: 4.3 vs. 3.2 (P = 0.003). All other procedure characteristics were comparable between women with and without complications.
“We were surprised to find that advanced endometriosis did not increase the risk of a complication with statistical significance,” Dr. Clark said. “Instead, we found that certain intraoperative procedures, such as ureterolysis and adhesiolysis, and the total number of procedures performed increased the risk of a complication.”
These procedural factors are surrogates for surgical complexity that more reliably predict complications than disease classification, according to the study. “Our study suggests that intraoperative events are the main driver of postoperative surgical outcomes,” Dr. Clark said. “One could conclude, therefore, that patients who undergo extensive laparoscopic dissection are most at risk of a complication, and thus surgeons should have heightened awareness for potential complications during or after surgery in these women.”
However, because the study did not find any preoperative patient characteristics that predicted a complication, “this limits the ability to apply these findings to patient counseling prior to surgery,” she said.
Future improvements in radiologic imaging, like assessment for deep-infiltrating disease with pelvic ultrasound and magnetic resonance imaging (MRI), “will hopefully improve our ability to identify patients at risk of requiring significant dissection and its associated risks,” he said.
Dr. Clark reports no relevant financial disclosures.