title: Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification.
abstract: OBJECTIVE
  To assess the results of complete surgical excision for patients with painful functional symptoms in a context of histologically proven deeply infiltrating endometriosis (DIE).
  
  
  METHODS
  Retrospective analysis (Canadian Task Force classification II-2).
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  One hundred thirty-two patients with pelvic pain symptoms and histologically proved DIE. The DIE lesions were classified according to surgical classification: uterosacral ligaments (USL), vagina, bladder, or intestine.
  
  
  METHODS
  Complete surgical excision of DIE lesions.
  
  
  RESULTS
  A retrospective analysis was made of medical, operative, and pathologic reports as well as of questionnaires mailed to patients. Efficiency of surgical excision was assessed according to two methods: objective evaluation (numerical rating scale) and subjective evaluation (patients were asked to classify the improvement after surgery with one of the following: excellent, satisfactory, slight, or no improvement). For each symptom, the mean scores according to the numerical rating scale were significantly lower postoperatively. The difference between the preoperative and postoperative scores was 5.2 points +/- 3.6 for dysmenorrhea, 4.6 points +/- 3.1 for deep dyspareunia, 4.4 points +/- 3.7 for painful defecation during menstruation, 4.9 +/- 3.2 for lower urinary tract symptoms during menses, and 4.6 points +/- 3.4 for noncyclic chronic pelvic pain. Comparable results were observed for patients in each group according to the surgical classification of their DIE lesions: USL (n = 78 patients); vagina (n = 25 patients); bladder (n = 13 patients); and intestine (n = 16 patients). Subjective evaluation showed that the improvement was considered to be excellent in 40.2% of women (53 patients), satisfactory in 42.4% (56 patients), slight in 14.4% (19 patients), and nonexistent in 3.0% (4 patients). The patients' characteristics (i.e., age, gravidity, parity, body mass index, preoperative medical treatment, follow-up after surgery, number and location of DIE lesions, revised American Fertility Society stage, associated endometrioma) did not differ significantly according to whether the improvement was considered to be excellent (Group A: 53 patients) or not (Group B: 79 patients). Among the infertile patients (n = 78; 59.1%), there was no difference in pain improvement if the patient was pregnant or not in the 42 women who achieved pregnancy after the surgery.
  
  
  CONCLUSIONS
  Complete surgical excision of DIE lesions results in a statistically significant reduction in painful functional symptoms. These results are observed whatever the main location of DIE lesions. The patients' preoperative characteristics have no significant influence on the result.
authors.affiliation: Assistance Publique, Hopitaux de Paris, Service de Gynécologie Obstétrique II, Unité de Chirurgie Gynécologique, CHU Cochin Port-Royal, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chopin
authors.forename: Marco
authors.initials: M
authors.lastname: Vieira
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
authors.forename: Hervé
authors.initials: H
authors.lastname: Foulot
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Jöel
authors.initials: J
authors.lastname: Coste
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mignon
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D000328:Adult; D001956:Broad Ligament / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004715:Endometriosis / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology; D011336:Probability; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000473:pathology / Q000601:surgery*; D014623:Vaginal Diseases / Q000473:pathology / Q000601:surgery*