title: Association of history of surgery for endometriosis with severity of deeply infiltrating endometriosis.
abstract: OBJECTIVE
  To assess whether a history of surgery for endometriosis could be considered as a marker for disease severity.
  
  
  METHODS
  This cross-sectional study included 780 women with histologically proven endometriosis who underwent surgery. We compared 309 patients with a history of surgery for endometriosis (study group) with 471 patients who did not receive prior surgical intervention (control group). Multivariate logistic regression was performed to assess the risk of deeply infiltrating endometriosis (defined by invasion of the muscularis by endometriotic tissue).
  
  
  RESULTS
  Patients with a history of surgery displayed an increased prevalence of deeply infiltrating endometriosis (242 patients [78.3%] compared with 210 patients [44.6%], respectively; P<.001). Moreover, the study group showed significantly higher stage, mean total (P<.001), and mean adhesions (P<.001) scores based on the American Society for Reproductive Medicine classification system. Furthermore, history of previous surgery remained independently associated with the presence of deeply infiltrating endometriosis (compared with superficial endometriosis and ovarian endometrioma grouped together) in multivariate regression analysis, which adjusted for preoperative pain scores, age, body mass index, smoking habits, oral contraceptive pill use, infertility, and parity (adjusted odds ratio 2.96, 95% confidence interval 1.99-4.39; P<.001). The number of previous surgeries for endometriosis correlated significantly with lesion severity. Among women presenting with deeply infiltrating endometriosis (n=452), surgical history was significantly associated with a higher mean number of deeply infiltrating endometriosis lesions (3.1 ± 1.9 compared with 2.6 ± 1.8; P=.001) and with increased severity of deeply infiltrating endometriosis lesions, especially in the case of intestinal lesions (159 patients [66.0%] compared with 77 patients [37%], P<.001).
  
  
  CONCLUSIONS
  A history of surgery for endometriosis correlates with the presence and severity of deeply infiltrating endometriosis, which underlines the necessity of a thorough preoperative assessment and a complete information of these patients before undertaking subsequent surgeries.
  
  
  METHODS
  : II.
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, Centre Hospitalier Universitaire Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Inserm, Unité de Recherche U1016, Université Paris Descartes, Faculté de Médecine, EA 1833, ERTi, AP-HP, CHU cochin, and Université Paris Descartes, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, Centre Hospitalier Universitaire Cochin, Department of Digestive and Endocrine Surgery, Paris, France.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Sibiude
authors.forename: Pietro
authors.initials: P
authors.lastname: Santulli
authors.forename: Louis
authors.initials: L
authors.lastname: Marcellin
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D000328:Adult; D000367:Age Factors; D004715:Endometriosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome