title: Deep Retraction Pockets, Endometriosis, and Quality of Life.
abstract: OBJECTIVE
  The purpose of this study was to examine if deep retraction pockets (DRPs) in the posterior cul-de-sac and uterosacral ligaments could be a manifestation of endometriosis and if excision of these pockets improves pain symptoms and quality of life.
  
  
  METHODS
  Prospective cohort study Canadian Task Force Classification, II-3.
  
  
  METHODS
  Preoperative data, operative data, and follow-up data were collected prospectively at the Center for Endometriosis at Saint Louis University, a referral center for the surgical management of endometriosis.
  
  
  RESULTS
  The 107 consecutive patients who presented with preoperative deep dyspareunia were included in the study, and the median postoperative follow-up was 13 months. Endometriosis was confirmed histologically in any location excised in 88/107 (82.2%) of the women, and 31 DRPs were excised from 25 women with DRPs in the posterior cul-de-sac or uterosacral ligaments, of which 15/31 (48.4%) had endometriosis. Of the 10 DRPs without visible surface lesions, 3 (30.0%) had endometriosis on histology. Pain symptoms and quality of life significantly improved after excision surgery, whether or not DRPs were present. Women who had endometriosis in their DRP also had significant improvement in deep dyspareunia and chronic pelvic pain and quality of life. Results did not differ when patients who took postoperative hormonal suppression were removed from the analyses.
  
  
  CONCLUSIONS
  Patients had significantly improved pain symptoms and quality of life after excision surgery, whether or not DRPs were present. This study demonstrated that a DRP may be a manifestation of endometriosis (even with a clear surface of the pocket), so that DRPs should be excised to achieve optimal excision of endometriosis.
authors.affiliation: Division of Gynecologic Surgical Subspecialties, Department of Obstetrics, Gynecology, and Women's Health, Center for Endometriosis, Saint Louis University , St. Louis, MO , USA.
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Yeung
authors.affiliation: School of Medicine, Saint Louis University , St. Louis, MO , USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Logan
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University , St. Louis, MO , USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gavard
keywords: Allen-Masterson window; atypical endometriosis; deep dyspareunia; endometriosis; excision surgery; peritoneal window; quality of life; retraction pocket