Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis.
Deep infiltrating endometriosis
Multidisciplinary care pathway
Postoperative complications
Journal
Archives of gynecology and obstetrics
ISSN: 1432-0711
Titre abrégé: Arch Gynecol Obstet
Pays: Germany
ID NLM: 8710213
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
received:
26
09
2022
accepted:
17
12
2022
medline:
19
4
2023
pubmed:
30
12
2022
entrez:
29
12
2022
Statut:
ppublish
Résumé
To assess the quality of care following the establishment of a multidisciplinary care pathway for patient operated on for deep pelvic endometriosis with digestive impairment. We conducted a retrospective monocentric study of patients suffering from deep infiltrating endometriosis, treated in Gynaecological Department at Toulouse University Hospital from January 2018 to December 2020. We compared our results to those of our previous study, Gornes et al. which showed a postoperative complication occurred in 37.8% of the cases and a postoperative severe complication according to the Clavien-Dindo classification (grades 3b) rate of 18.3%. 98 patients were included. Our study shows a clear decrease in postoperative complications with an overall complication rate of 19.4% and severe complications (grades 3b) of 4.1%. The rate of complication appeared to be significantly less frequent in the case of shaving in relation to other digestive procedures (p = 0.008) and in the case of a lesion of < 20 mm by MRI (p = 0.01). The use of multidisciplinary surgical care was more frequent in the case of multiple locations (66.7% vs. 41.8%, p = 0.07) and was more frequent in the case of transmural damage with echo endoscopy (and to a lesser degree in the case of damage of the muscularis or mucous membrane) (p = 0.05). Multidisciplinary care of endometriosis with digestive damage appears to be indispensable. The intraoperative intervention of a skilled digestive surgeon of bowel endometriosis helps create the best balance between effectiveness-complications-functional prognosis, with a reduction of severe postoperative complications.
Identifiants
pubmed: 36581714
doi: 10.1007/s00404-022-06899-1
pii: 10.1007/s00404-022-06899-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1459-1468Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Working Group of Esge E et al (2020) Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020(1):hoaa002
doi: 10.1093/hropen/hoaa002
Gornes H et al (2020) Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients. Arch Gynecol Obstet 302(2):383–391
doi: 10.1007/s00404-020-05604-4
pubmed: 32500217
Parra RS, Feitosa MR, Feres O (2021) Postoperative complications after deep bowel endometriosis surgery: Is the surgical technique the only one to blame? Arch Gynecol Obstet 304(5):1381–1382
doi: 10.1007/s00404-020-05890-y
pubmed: 33226487
Clavien PA et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
doi: 10.1097/01.sla.0000133083.54934.ae
pubmed: 15273542
pmcid: 1360123
Nicolaus K et al (2020) Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 301(3):699–706
doi: 10.1007/s00404-019-05425-0
pubmed: 31989287
Hudelist G et al (2018) Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis—a prospective cohort study. Acta Obstet Gynecol Scand 97(12):1438–1446
doi: 10.1111/aogs.13436
pubmed: 30080244
Malzoni M et al (2016) Feasibility and safety of laparoscopic-assisted bowel segmental resection for deep infiltrating endometriosis: a retrospective cohort study with description of technique. J Minim Invasive Gynecol 23(4):512–525
doi: 10.1016/j.jmig.2015.09.024
pubmed: 26455526
Bendifallah S et al (2021) Surgical outcomes after colorectal surgery for endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol 28(3):453–466
doi: 10.1016/j.jmig.2020.08.015
pubmed: 32841755
Roman H et al (2020) Early postoperative complications in a multidisciplinary surgical center exclusively dedicated to endometriosis: a 491-patients series. Gynecol Obstet Fertil Senol 48(6):484–490
pubmed: 32173597
Roman H, Group F (2017) A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: a multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod 46(2):159–165
doi: 10.1016/j.jogoh.2016.09.004
pubmed: 28403973
Roman H et al (2020) Risk of bowel fistula following surgical management of deep endometriosis of the rectosigmoid: a series of 1102 cases. Hum Reprod 35(7):1601–1611
doi: 10.1093/humrep/deaa131
pubmed: 32619233
pmcid: 7368398
Braund S et al (2021) Risk of postoperative stenosis after segmental resection versus disk excision for deep endometriosis infiltrating the rectosigmoid: a retrospective study. J Minim Invasive Gynecol 28(1):50–56
doi: 10.1016/j.jmig.2020.04.034
pubmed: 32360656
Wolthuis AM et al (2014) Bowel endometriosis: colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol 20(42):15616–15623
doi: 10.3748/wjg.v20.i42.15616
pubmed: 25400445
pmcid: 4229526
Malzoni M et al (2020) Preoperative ultrasound indications determine excision technique for bowel surgery for deep infiltrating endometriosis: a single high-volume center. J Minim Invasive Gynecol 27(5):1141–1147
doi: 10.1016/j.jmig.2019.08.034
pubmed: 32007640
Wolthuis AM, Tomassetti C (2014) Multidisciplinary laparoscopic treatment for bowel endometriosis. Best Pract Res Clin Gastroenterol 28(1):53–67
doi: 10.1016/j.bpg.2013.11.008
pubmed: 24485255
Abrao MS et al (2015) Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 21(3):329–339
doi: 10.1093/humupd/dmv003
pubmed: 25618908
Roman H et al (2015) Full-thickness disc excision in deep endometriotic nodules of the rectum: a prospective cohort. Dis Colon Rectum 58(10):957–966
doi: 10.1097/DCR.0000000000000447
pubmed: 26347968
Simoens S et al (2011) Endometriosis cost assessment (the endocost study): a cost-of-illness study protocol. Gynecol Obstet Invest 71(3):170–176
doi: 10.1159/000316055
pubmed: 21160141
Ugwumadu L et al (2017) The role of the multidisciplinary team in the management of deep infiltrating endometriosis. Gynecol Surg 14(1):15
doi: 10.1186/s10397-017-1018-0
pubmed: 28890677
pmcid: 5570783