Deeply infiltrating disease in surgically treated endometriosis patients.

OBJECTIVE

To examine the incidence of deeply infiltrating endometriotic lesions among surgically treated endometriosis patients, and determine clinical parameters associated with the presence of deep disease.

DESIGN

Prospective observational study.

SETTING

Regional central hospital.

POPULATION

Patients undergoing surgical treatment of endometriosis.

METHODS

Complete excision of all visible endometriotic lesions and adhesions.

MAIN OUTCOME MEASURES

The number and location of deep lesions, association between the presence of deep lesions, relevant preoperative and intraoperative factors.

RESULTS

Of 201 surgically treated endometriosis patients, 103 (51.2%) had deep lesions, 43.3% had uterosacral ligament deep lesions, 18.4% intestinal, 15.4% rectovaginal, and 3.5% urinary bladder deep lesions. Patients with deep lesions had more often undergone previous operations for endometriosis (p<0.01), had been operated on for pelvic pain (p<0.01) and had a totally obliterated rectovaginal pouch (p<0.01), compared to patients without deep lesions. In multivariate analysis, pelvic pain as an indication for surgery (OR 3.9, 95%CI 1.8-8.9, p<0.01) and totally obliterated rectovaginal pouch (OR 4.0, 95%CI 1.7-9.4, p<0.01) were independent prognostic factors for the presence of deep disease.

CONCLUSIONS

Deeply infiltrating endometriosis is common in surgically treated endometriosis patients and should be searched for in those with persistent pelvic pain and where obliteration of the rectovaginal pouch is detected at surgery.