Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery

Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery

Tummers, Fokkedien H.M.P. (Leiden University Medical Center)
Peltenburg, Sophie I. (Leiden University Medical Center)
Metzemaekers, Jeroen (Leiden University Medical Center)
Jansen, F.W. (TU Delft Medical Instruments & Bio-Inspired Technology; Leiden University Medical Center)
Blikkendaal, Mathijs D. (Haaglanden Medical Center; Reinier de Graaf Gasthuis)

2023

Purpose: Patients often undergo repeat surgery for endometriosis, due to recurrent or residual disease. Previous surgery is often considered a risk factor for worse surgical outcome. However, data are scarce concerning the influence of subsequent endometriosis surgery. Methods: A retrospective study in a centre of expertise for endometriosis was conducted. All endometriosis subtypes and intra-operative steps were included. Detailed information regarding surgical history of patients was collected. Surgical time, intra-operative steps and major post-operative complications were obtained as outcome measures. Results: 595 patients were included, of which 45.9% had previous endometriosis surgery. 7.9% had major post-operative complications and 4.4% intra-operative complications. The patient journey showed a median of 3 years between previous endometriosis surgeries. Each previous therapeutic laparotomic surgery resulted on average in 13 additional minutes (p = 0.013) of surgical time. Additionally, it resulted in more frequent performance of adhesiolysis (OR 2.96, p < 0.001) and in a higher risk for intra-operative complications (OR 1.81, p = 0.045), however no higher risk for major post-operative complications (OR 1.29, p = 0.418). Previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery showed no association with surgical outcomes. Regardless of previous surgery, disc and segmental bowel resection showed a higher risk for major post-operative complications (OR 3.64, p = 0.017 respectively OR 3.50, p < 0.001). Conclusion: Previous therapeutic laparotomic endometriosis surgery shows an association with longer surgical time, the need to perform adhesiolysis, and more intra-operative complications in the subsequent surgery for endometriosis. However, in a centre of expertise with experienced surgeons, no increased risk of major post-operative complications was observed.

Complications
Endometriosis
Patient journey
Recurrence
Repeat surgery

http://resolver.tudelft.nl/uuid:56c27dcc-5c3f-4b62-a901-094714c3589e

https://doi.org/10.1007/s00404-023-07193-4

0932-0067

Archives of Gynecology and Obstetrics, 308 (5), 1531-1541

Institutional Repository

journal article

© 2023 Fokkedien H.M.P. Tummers, Sophie I. Peltenburg, Jeroen Metzemaekers, F.W. Jansen, Mathijs D. Blikkendaal