Surgical treatment in a large single center cohort of patients with deep infiltrating endometriosis (DIE)

Objectives:

DIE is the most challenging type of endometriosis and laparoscopic surgery is considered gold standard. In order to achieve a complete resection extensive surgical procedures have to be performed in the majority of DIE patients. The aim of this project was to retrospectively identify DIE patients treated at our hospital and to study surgical treatment at a large single centre endometriosis clinic.

Materials and methods:

A retrospective chart review was performed in all patients surgically treated for deep infiltrating endometriosis at the Tuebingen University Women's hospital during 2005 to 2015.

Results:

524 patients underwent DIE surgery, in all cases a laparoscopic approach was chosen. In 2.1% a conversion to open surgery was necessary due to extensive adhesions resulting from previous surgeries. Mean duration of DIE-surgery was 149.3 minutes, a complete resection was possible in 98.6% of cases. In 42% of cases extended intestinal procedures such as bowel-shaving (25.2%), segment resection (6.3%) and disc resection (2.1%) were necessary. Extended urological procedures had to be performed in 12.6% of cases with partial resection and new implantation of the ureter in 4.2% of cases.

Conclusion:

Our study could show that although complex surgery to completely resect DIE is needed this can be done laparoscopically. This emphasizes the need to perform surgical treatment for DIE in specialized endometriosis centers with an interdisciplinary approach. Clinical follow-up studies will allow us to investigate recurrence rates and the impact of DIE surgery on pain relief and pregnancy outcome.