Will I Have Complications After Endometriosis Surgery?

The rate is low, confirmed a new study.

Key Points

Highlights:

• Complications after surgery to treat deep infiltrating endometriosis are relatively low.

Importance:

• Deep infiltrating endometriosis usually involves several organs, treatment is difficult and may require a multidisciplinary approach.
• It is important to know the likelihood of developing complications following surgery in order to make informed choices about this treatment option.

What's done here:

• This is a retrospective study included 134 patients underwent laparoscopic surgery for deep infiltrating endometriosis excluding those with bowel resection between 2001 and 2011. 
• Researchers used a questionnaire to assess bladder and bowel movement and sexual function, 89(66.4%) returned the questionnaire. Control group composed of 100 reproductive age women without the history of endometriosis. The mean follow-up period was 75.6 months.
• Major complications include intraoperative organ injury, suture insufficiency, fistula, severe infection, bleeding requiring transfusion, thromboembolic events, organ failure, those events requiring repeat surgery and death.
• Minor complications were slight to moderate infections, first or second-degree urinary obstruction, and time-limited complications with slight to moderate effect on the patient general condition.

Key results:

• Major complications following surgery occurred in five patients (3.7%); minor complications following surgery occurred in 17 patients (12.7%).
• 26.4% of patients experienced weak urinary flow, 16.1% had a feeling of incomplete bladder emptying,  and 30.3% reported insufficient lubrication during intercourse; which were statistically different from the control group. No statistically significant differences were detected in terms of constipation and bowel movement.

Limitations:

• The strengths of the study are the rather large number of patients with a rather long follow-up period.
• However, this is a retrospective study, hence it is unable to identify the causes of urinary and sexual complaints, namely whether they are due to endometriosis itself or to the surgical treatment. 

Lay Summary

The rate of complications after surgery to treat deep infiltrating endometriosis is low, confirmed a study by researchers in Germany.

It is important to know whether major or minor complications following surgery are likely to develop and what the outcome will be for abdominal functions such as those related to urinary and bowel movement and sexual activity. Complications can affect patients’ quality of life and information on the likelihood of developing them can help doctors and patients decide on whether surgery is the right treatment option. 

Deep infiltrating endometriosis can affect many organs, causing them to stick together or to become scarred. This causes pain and other symptoms usually treated with laparoscopy surgery. 

In this study, 134 patients with deep infiltrating endometriosis affecting the rectovaginal septum or the tissue that separates the vagina and the rectum and/or sacrouterine ligaments, the connection between the sacrum and the uterus, were examined. All patients underwent surgery in a specialist endometriosis center in Germany. The patients volunteered to answer a questionnaire about six years after surgery, examining the bladder, bowel, and sexual functions. To understand whether possible complaints were higher in these patients compared to the general population, a group of 100 women without a history of endometriosis or hysterectomy was included as a control and asked the same questions. 

The results of the survey showed that a total of 17 patients (12.7 percent of all patients) experienced minor complications following surgery, and five patients (3.7 percent of all patients) had major complications. The majority of complications were related to infections. Additionally, 26.4 percent of patients stated that their urinary flow was weak, slow, or prolonged, 16.1 percent had a feeling of incomplete bladder emptying, and 30.3 percent reported insufficient lubrication during intercourse. These three areas differed significantly from the control group. There were no significant differences in relation to questions about constipation (13.5 percent of patients versus 11 percent of controls) or bowel movements more than once a day (16.9 percent of patients versus 12 percent of controls).

The researchers concluded that the number of major and minor complications following surgery were generally consistent with previous data in the literature. However, they added that the high rates of impaired bladder function and sexual function after endometriosis surgery, and the retrospective nature of the findings, which are then unable to discriminate whether those complaints are the consequence of endometriosis or of the operation, call for further studies on the topic.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30191419