Endometriosis involving the Sacral Plexus and Sciatic Nerve

Laparoscopic excision of deep endometriosis involving the sacral roots and sciatic nerve improves women's quality of life.

Key Points

Highlights:

• In nerve-sparing surgery for endometriosis, the ability to perform the surgery in a reasonable operative time, an ability to identify the early signs and symptoms of potential complications after surgery, and to accurately manage them in time are important.

Importance:

• This study underlines the importance of the parameters that are important for providing the best outcomes for patients with sacral plexus and sciatic nerve.

What's done here:

• Preoperative complaints, intraoperative findings, surgical procedures, and postoperative outcomes in 52 patients managed for deep endometriosis involving the sacral plexus and sciatic nerve were assessed.

Key Results:

• Sensory or motor complaints, including bladder dysfunction, may go on over months or years after laparoscopic management of deep endometriosis.
• Patients with deep endometriosis involving the sacral plexus and sciatic nerve should be referred to expert centers.

Limitations:

• This is a retrospective study without a control group.
• The patient number is small.
• Multiple deep endometriosis localizations recorded in this series are heterogeneous.
• There are difficulties in showing an exact relationship between specific localizations and corresponding symptoms.

Lay Summary

Endometriosis rarely involves the sacral and sciatic nerves.

A retrospective analysis led by Rouen University Hospital, France and Aarhus University Hospital, Denmark, published in the Journal of Minimally Invasive Gynecology, has evaluated preoperative complaints, intraoperative findings, surgical procedures, and postoperative outcomes in patients managed for deep endometriosis involving the sacral plexus and sciatic nerve.

The study, which used data from 49 women with deep endometriosis involving the sacral roots and 3 women with deep endometriosis involving the sciatic nerve, revealed that laparoscopic management of deep endometriosis involving these nerves improves patients’ symptoms and overall quality of life.

Sciatic pain was identified in 43 women, pudendal neuralgia in 11 women, paresthesia in 18 women, and leg motor weakness in 14 cases. Decompression (92.3%), excision of the epineurium by shaving (5.8%), and intraneural excision (1.9%) were the main surgical procedures performed on the pelvic nerves. Surgical procedures on the digestive tract (82.7%) and the urinary tract (46.2%) were also carried out. Rectovaginal fistula rate was found to be high (13.5%). Bladder dysfunction requiring ≥3 weeks’ self-catheterization was observed in 14 cases and >12 weeks’ self-catheterization in 3 cases. In 17.2% of the patients de novo hypoesthesia, hyperesthesia, or allodynia were seen.

Significant improvement in the quality of life was observed in a one-year follow-up. It is important to note that the ovarian and fallopian tubes were found to be rarely involved in the current series. In 47% of the cases, the cumulative pregnancy rate was 77.2% after natural conception.

The team led by Dr. Roman recommends referring women with deep endometriosis involving the sacral plexus and sciatic nerve to expert centers. They also underlined the importance of the ability to perform surgery in a reasonable operative time, and an ability to identify the early signs and symptoms of potential complications after surgery and to accurately manage them in time.

Research Source: https://pubmed.ncbi.nlm.nih.gov/33130224/