title: Deeply infiltrating disease in surgically treated endometriosis patients.
abstract: 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.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Regional central hospital.
  
  
  METHODS
  Patients undergoing surgical treatment of endometriosis.
  
  
  METHODS
  Complete excision of all visible endometriotic lesions and adhesions.
  
  
  METHODS
  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.
authors.affiliation: Department Obstetrics and Gynecology, Päijät-Häme Central Hospital, Lahti, Finland. marjaleena.setala@fimnet.fi
authors.forename: Marjaleena
authors.initials: M
authors.lastname: Setälä
authors.forename: Hanna
authors.initials: H
authors.lastname: Savolainen
authors.forename: Jyrki
authors.initials: J
authors.lastname: Kössi
authors.forename: Tapio
authors.initials: T
authors.lastname: Ranta
authors.forename: Juha
authors.initials: J
authors.lastname: Mäkinen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001062:Appendectomy; D004715:Endometriosis / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007246:Infertility / Q000209:etiology; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010049:Ovarian Diseases / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D017699:Pelvic Pain / Q000209:etiology; D010532:Peritoneal Diseases / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D014570:Urologic Diseases / Q000473:pathology / Q000601:surgery; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery; D014623:Vaginal Diseases / Q000473:pathology / Q000601:surgery