Laparoscopic management of bowel endometriosis: predictors of severe disease and recurrence.
OBJECTIVE
The identification of highstage and recurrent cases of bowel endometriosis is critical, because these cases require careful surgical planning. We aim to describe the clinical characteristics of women with bowel endometriosis, our principles in laparoscopic  management of this pathology, and to identify predictors of severe disease and recurrence.


METHODS
This was a retrospective study of 193 patients with pathologically confirmed bowel endometriosis.


RESULTS
Predictors of higher-stage endometriosis include a history of  previous laparoscopic surgery (P=.04) and a presenting complaint of abnormal uterine bleeding (P=.01). The higher the stage of endometriosis, the more likely there would be coexistent urinary tract endometriosis (P=.02), a need for enterolysis (P=.002), ovarian cystectomy (P<.001), and bowel  resection (P=.01) performed during laparoscopy. Patients with higher body mass index (BMI) had significantly higher recurrence rates of endometriosis compared to those with lower BMI (P=.002). Within our cohort, 87% of our patients achieved amelioration of symptoms by the end of the first  postoperative month.


CONCLUSIONS
Our study confirms that laparoscopic management of bowel endometriosis is safe and effective. We found 2 statistically significant predictors of higher-stage disease that should prompt careful surgical planning. Obesity is associated with a higher  rate of recurrence of endometriosis.
Department of Obstetrics and Gynecology, Stanford University Medical Center, Palo Alto, CA, USA. cnezhat@stanford.edu
Camran
C
Nezhat
Babak
B
Hajhosseini
Louise P
LP
King
D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome