Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible?
BACKGROUND
Little is known about the morbidity associated with laparoscopic complete excision of endometriosis in terms of urinary, digestive and sexual function.


METHODS
We performed a prospective non-randomized study in 45 patients with laparoscopic complete excision of all detectable foci of endometriosis with segmental bowel resection using a non nerve-sparing technique (control group-group A n=20) and a nerve-sparing technique (case group-group B n=25). At initial gynaecological evaluation, and at follow-up details on dysmenorrhoea, pelvic pain, dyspareunia and dyschezia were evaluated using an interview-based questionnaire (10-point analogue rating scale: 0=absent, 10=unbearable).


RESULTS
The mean (+/-SD) follow-up period was 15.3+/-10 months (range, 8.8-23 months) for group A and 3.5+/-2.1 months (range, 0.3-5.2 months) for group B. In the immediate postoperative course, in group A three women required blood transfusion vs seven women in group B (P=0.003). The median time to resume the voiding function was significantly shorter in group B (12.5 vs 3.0 days; P<0.01). At the time of follow-up a higher proportion of patients in group B were 'very satisfied' than those in group A (87.7% vs 59.0%, P=0.013).


CONCLUSIONS
Laparoscopic nerve-sparing complete excision of endometriosis seems to be feasible and offers good results in terms of bladder morbidity reduction with apparently higher satisfaction than classical technique. Larger series with longer follow-up are needed to confirm our results.
Landi
S
S
Department of Obstetrics and Gynecology, Ospedale Sacro Cuore, Via Don A.Sempreboni 5, 37024 Negrar (Verona), School of Medicine, University of Bologna, Italy.
Ceccaroni
M
M
Perutelli
A
A
Allodi
C
C
Barbieri
F
F
Fiaccavento
A
A
Ruffo
G
G
McVeigh
E
E
Zanolla
L
L
Minelli
L
L
D000328:Adult; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D004717:Endometrium / Q000294:innervation* / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010149:Postoperative Pain; D012086:Reoperation; D013153:Splanchnic Nerves / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome