Previous endometriosis surgery a risk factor for worse surgical outcomes

Key takeaways:

• Patients with previous endometriosis surgeries should be considered at risk for intraoperative complications.
• No increased postoperative complication risk was found with any subtype of previous surgery.

Previous laparotomic therapeutic endometriosis surgery was associated with longer surgery time, need for adhesiolysis and more intraoperative complications, researchers reported in Archives of Gynecology and Obstetrics.

“In line with literature of non-endometriosis surgery, our hypothesis is that extensive previous endometriosis surgeries result in worse surgical outcomes,” Fokkedien H. M. P. Tummers, MD, from the department of gynecology at Leiden University Medical Center in the Netherlands, and colleagues wrote. “To optimize counseling of the patient and preoperative planning, more detailed information regarding the risk of previous endometriosis surgeries and surgical outcomes is necessary.”

Tummers and colleagues conducted a retrospective study of 595 women (mean age, 36.2 years) with various endometriosis subtypes and intraoperative steps. Researchers collected detailed information on each patient’s surgical history and obtained surgical time, intraoperative steps and major postoperative complications.

Overall, 45.9% of the women had previous endometriosis surgery, and of these, 11% had three or more previous surgeries with a median of 3 years between previous endometriosis surgeries. In total, 7.9% of women had major postoperative complications and 4.4% had intraoperative complications.

Median surgical time was 90 minutes. Having previous laparotomic endometriosis surgery was associated with increased surgical time by 13 minutes on average (P = .013).

Women with previous endometriosis surgeries had a higher likelihood of requiring adhesiolysis compared with women without previous surgery (30% vs. 18.8%; P = .001). Both previous laparotomic (P < .001) and laparoscopic (P = .04) endometriosis surgeries were linked to the need for adhesiolysis.

Twenty-nine intraoperative complications were reported (4.4%), and most were visceral complications. More intraoperative complications were observed among women with previous endometriosis surgery compared with women without previous surgery (6.2% vs. 2.8%; P = .046).

In addition, major postoperative complications were observed among 6.9% of women. Researchers noted that there was no higher risk for major postoperative complications with previous therapeutic laparotomic endometriosis surgery (P = .418), laparoscopic endometriosis surgery (P = .853), laparotomic non-endometriosis surgery (P = .963) and laparoscopic non-endometriosis surgery (P = .14).

Having previous therapeutic laparoscopic endometriosis surgery, laparotomic and laparoscopic non-endometriosis surgery had no associations with surgical outcomes. Disc (P = .017) and segmental (P < .001) bowel resection were associated with a higher risk for major postoperative complications regardless of previous endometriosis surgery.

“Patients with previous laparotomic therapeutic endometriosis surgery need to be considered to be at risk for intraoperative complications,” the researchers wrote. “However, in experienced hands, this does not lead to a higher risk for postoperative complications.”