Surgical treatment of deep endometriosis and risk of recurrence.
OBJECTIVE
To evaluate the risk of recurrence of deep endometriosis after conservative surgery.


METHODS
Retrospective analysis (Canadian Task Force classification II-3).


METHODS
Tertiary care university hospital.


METHODS
One hundred fifteen symptomatic patients operated on in our department from 1996 through 2002 with postoperative follow-up of at least 12 months.


METHODS
All patients underwent conservative surgery for deep infiltrating endometriosis.


RESULTS
Risk factors for recurrence of symptoms and clinical findings and for repeated surgery were evaluated by univariate and multivariate analysis. During follow-up, we observed 28 patients with pain recurrence and 15 patients with recurrent clinical findings, and 12 patients required reoperation for deep endometriosis. Recurrence rates of pain and clinical findings during 36 months were 20.5% and 9%, respectively. Multivariate analysis showed that only age was a significant predictor of pain recurrence (OR 0.9, 95% CI 0.81-0.99, p<.05), enhancing the risk in younger patients. Recurrence of clinical signs of deep endometriosis was predicted by obliteration of the pouch of Douglas (OR 1.46, 95% CI 1.16-16.2, p<.05). Reoperation for deep endometriosis was predicted only by the incompleteness of first operation (OR 21.9, 95% CI 3.2-146.5, p<.001).


CONCLUSIONS
Our study indicates that age, obliteration of the pouch of Douglas, and surgical completeness may have a significant influence on the recurrence of the disease.
Vignali
Michele
M
Department of Obstetrics and Gynaecology, University of Milano, Macedonio Melloni Hospital, Milano, Italy. michele.vignali@unimi.it
Bianchi
Stefano
S
Candiani
Massimo
M
Spadaccini
Giovanna
G
Oggioni
Giulia
G
Busacca
Mauro
M
D000206:Actuarial Analysis; D000328:Adult; D004312:Douglas' Pouch / Q000601:surgery; D004715:Endometriosis / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome