Fast-track surgery in intestinal deep infiltrating endometriosis.
OBJECTIVE
To evaluate the length of hospital stay (LOS) and the readmission rate in patients undergoing laparoscopic surgery to treat intestinal deep infiltrating endometriosis (DIE) with application of the concepts of fast-track surgery.


METHODS
Retrospective study of women undergoing laparoscopic treatment of intestinal DIE (Canadian Task Force classification II-3).


METHODS
Tertiary referral private hospital.


METHODS
We evaluated 161 women who underwent laparoscopic surgery between January 2010 and April 2013 for complete treatment of intestinal DIE, via either conservative surgery (rectal shaving, mucosal skinning, or anterior disk resection) or radical surgery (segmental bowel resection). After surgery, all specimens were sent for pathologic examination to confirm the presence of endometriosis.


RESULTS
Patients were divided into 2 groups according to type of surgery (conservative [n = 102] or radical [n = 59]), and LOS and readmission rate were measured in both groups. Median LOS was shorter in the conservative group compared with the segmental bowel resection group (19 vs 28 hours; p < .001). Ninety-two patients (90.2%) in the conservative surgery group were discharged to home on the first postoperative day, compared with only 38 patients (64.4%) in the segmental bowel resection group. Overall, the readmission rate was low (3.1%): 6.8% in the segmental bowel resection group and 1% in the conservative group (p = .04; odds ratio, 7.34; 95% confidence interval, 0.8-67.3); however, the need for repeat operation was similar in both groups (3.4% vs 1%; p = .28; odds ratio, 3.54; 95% confidence interval, 0.31-39.95).


CONCLUSIONS
Implementation of fast-track concepts in the laparoscopic treatment of intestinal DIE resulted in a short LOS and low readmission rate in both the segmental bowel resection and conservative surgery groups.
Department of Gynecology, Sugisawa Medical Center, Curitiba, Paraná, Brazil; Department of Gynecology, Vita Batel Hospital, Curitiba, Paraná, Brazil. Electronic address: williamkondo@yahoo.com.
William
W
Kondo
Department of Gynecology, Vita Batel Hospital, Curitiba, Paraná, Brazil.
Reitan
R
Ribeiro
Department of Gynecology, Sugisawa Medical Center, Curitiba, Paraná, Brazil; Department of Gynecology, Vita Batel Hospital, Curitiba, Paraná, Brazil.
Monica Tessmann
MT
Zomer
D000328:Adult; D001938:Brazil; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
ERP; Endometriosis; Fast track; Laparoscopy; Multimodal