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

Journal Article (2023)
Author(s)

Fokkedien H.M.P. Tummers (Leiden University Medical Center)

Sophie I. Peltenburg (Leiden University Medical Center)

Jeroen Metzemaekers (Leiden University Medical Center)

Frank Jansen (TU Delft - Medical Instruments & Bio-Inspired Technology, Leiden University Medical Center)

Mathijs Blikkendaal (Reinier de Graaf Gasthuis, Haaglanden Medical Center)

Research Group
Medical Instruments & Bio-Inspired Technology
Copyright
© 2023 Fokkedien H.M.P. Tummers, Sophie I. Peltenburg, Jeroen Metzemaekers, F.W. Jansen, Mathijs D. Blikkendaal
DOI related publication
https://doi.org/10.1007/s00404-023-07193-4
More Info
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Publication Year
2023
Language
English
Copyright
© 2023 Fokkedien H.M.P. Tummers, Sophie I. Peltenburg, Jeroen Metzemaekers, F.W. Jansen, Mathijs D. Blikkendaal
Research Group
Medical Instruments & Bio-Inspired Technology
Issue number
5
Volume number
308
Pages (from-to)
1531-1541
Reuse Rights

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Abstract

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.