Major and minor complications after resection without bowel resection for deeply infiltrating endometriosis
To analyze major and minor complications following surgery for deeply infiltrating endometriosis including long-term impairment of intestinal, bladder, and sexual function.
Patients who had undergone resection for deeply infiltrating endometriosis without anterior rectal resection between 2001 and 2011 were included (n = 134). Clinical and surgical data, as well as minor and major complications, were recorded. A questionnaire was sent to the patients and to a healthy control group (n = 100).
Major complications occurred in 3.7% and minor complications in 12.7% of the patients. Surgical revision was necessary in five cases. The questionnaire response rate was 66.4%, with a mean follow-up period of 75.6 months. Weak urinary flow was reported by 26.4% of the patients; a feeling of residual urine by 16.1%; constipation by 13.5%; more than one bowel movement/day by 16.9%; insufficient lubrication during intercourse by 30.3%. The findings for weak urinary flow, feeling of residual urine, and insufficient lubrication differed significantly from the control group. Subgroup analysis did not identify any statistical associations between questionnaire responses and dyspareunia or dysmenorrhea as reasons for surgery, or previous endometriosis surgery in the patient’s history.
The major and minor complication rates were consistent with or lower than the literature data. Few studies have investigated complication rates associated with treatment for endometriosis in the sacrouterine ligaments and/or the rectovaginal septum. The high rates of impaired bladder function and sexual function after endometriosis surgery, as well as inadequate data, make further prospective studies on this topic necessary.
KeywordsDeeply infiltrating endometriosis Minor complications Rectovaginal septum Major complications Bladder function Sexual function
The contribution of N. Topal to this publication was performed in partial fulfillment of the requirements for obtaining the degree of Doctor of Medicine. Parts of the study published here have been used for her doctoral thesis at the Medical Faculty of the Friedrich-Alexander University Erlangen-Nuremberg (FAU).
JL: project development, manuscript writing, data analysis. NT: data collection, postgraduate research. WA: statistician. TH: data collection. SPR: project development. MWB: data analysis. SB: data analysis, project development.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
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.
Informed consent was obtained from all individual participants included in the study.
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