Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires
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Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires.
All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12 months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6 months after surgery.
A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0–7 and 2, 0–7, respectively) and at 12 months (3, 0–8 and 2, 0–7), compared to pre-operative levels (9, 1–10 and 3, 0–7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0–21) pre-operatively and 2 (0–18) after 6 months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2–28.9) vs. 22.7 (12.2–31) post-operatively (p = 0.004).
The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.
KeywordsLaparoscopy Deep infiltrating endometriosis Nerve sparing Bladder function Rectal function Sexual function
SU: project development, data collection and management, data analysis, and manuscript writing. BG: data collection and management, and data analysis. MS: project development. SB: data collection and management, and data analysis. NM: data collection and management, data analysis, and manuscript editing. GA: project development. VG: project development and manuscript writing. SC: data collection and management, and data analysis. SR: project development. GD: project development. GS: project development and manuscript editing. FG: project developmentand manuscript editing.
No funding was obtained for the present study.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interests to disclose.
All procedures performed 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.
Informed consent was obtained from all individual participants included in the study.
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