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Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Total laparoscopic hysterectomy (TLH) in the case of endometriosis may be extremely challenging. Our aim has been to analyze perioperative details and complications of TLH in women with vs. women without endometriosis.

Methods

Consecutive women who underwent TLH for endometriosis (endometriosis group) were compared with consecutive patients who had TLH for other conditions (controls) in terms of perioperative outcomes. Patients in the endometriosis group were analyzed, according to the severity of the disease.

Results

One-hundred and twelve women in the endometriosis group, 29 (25.9 %) with minimal–mild, and 83 (74.1 %) with moderate–severe stage disease (rAFS score), respectively, were compared with 572 controls. Conversion rate was 0.8 vs. 0.5 % (P = 0.51), and median operative time was 75 vs. 55 min (pxxx = x) in the endometriosis group vs. controls. Intraoperative complications were similar between groups (P = 0.56). Postoperative complications occurred in 10 (12.3 %) women in the endometriosis group vs. 12 (3.3 %) among the controls (P = 0.002). The severity of complications according to Clavien–Dindo classification system was higher in the endometriosis group (Clavien–Dindo >2: 7.5 vs. 1.9 %). The risk of organ lesions, urinary lesions, postoperative complications, and severe adverse events was significantly higher in women with moderate–severe endometriosis vs. controls. No differences between patients with minimal–mild endometriosis and controls were found.

Conclusion(s)

TLH in the case of endometriosis is associated with longer operative time and an almost fourfold increase in the risk and severity of complications compared with controls. In particular, the adjunctive risk of adverse events is specific for moderate/severe-stage disease but not for minimal/mild endometriosis.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, F. Del Ponte Hospital, University of Insubria, Piazza Biroldi, 1, 21100, Varese, Italy

    Stefano Uccella, Nicola Marconi, Jvan Casarin, Davide Sturla, Maurizio Serati, Simona Carollo, Carolina Podesta’ Alluvion & Fabio Ghezzi

  2. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy

    Marcello Ceccaroni

  3. Department of Surgery, Minimally Invasive Research Center, University of Insubria, Varese, Italy

    Luigi Boni

Authors
  1. Stefano Uccella
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  2. Nicola Marconi
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  3. Jvan Casarin
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  4. Marcello Ceccaroni
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  5. Luigi Boni
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  6. Davide Sturla
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  7. Maurizio Serati
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  8. Simona Carollo
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  9. Carolina Podesta’ Alluvion
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  10. Fabio Ghezzi
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Corresponding author

Correspondence to Stefano Uccella.

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Conflict of interest

S. Uccella declares that he has no conflict of interest. N. Marconi declares that he has no conflict of interest. J. Casarin declares that he has no conflict of interest. M. Ceccaroni declares that he has no conflict of interest. L. Boni declares that he has no conflict of interest. D. Sturla declares that he has no conflict of interest. M. Serati declares that he has no conflict of interest. S. Carollo declares that she has no conflict of interest. C. Podestà-Alluvion declares that she has no conflict of interest. F. Ghezzi declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Uccella, S., Marconi, N., Casarin, J. et al. Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy. Arch Gynecol Obstet 294, 771–778 (2016). https://doi.org/10.1007/s00404-016-4115-9

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  • DOI: https://doi.org/10.1007/s00404-016-4115-9

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