Association Between Previous Surgical Treatment and Outcomes of Repeat Endometriosis Surgery

Women with previous therapeutic surgeries for endometriosis are likely to experience more intraoperative complications, greater need for adhesiolysis with longer duration of subsequent surgery, according to a study reported in the Archives of Gynecology and Obstetrics.¹

A retrospective study was conducted by Tummers and coauthors, which included patients (mean age, 36.2 years) attending a center of expertise for endometriosis. Women with all endometriosis subtypes were included. The surgical history of the patients, inclusive of surgical time, intra operative steps and postoperative complications was collated in detail. Through this study, the researchers aimed to assess various outcome measures, including surgical time, intra-operative steps, and major post-operative complications in order to gain insights into the surgical management of endometriosis and its associated outcomes in the studied population.

Out of the 595 patients included, 45.9% had previously undergone a surgery for endometriosis, of which  11% had had ≥3 previous surgeries. There was a gap of 3 years (median) between the earlier surgeries. Almost ~8% patients had experienced major post-operative complications, while 4.4% had intra-operative complications.

The need for adhesiolysis was greater in women with history of previous endometriosis surgery compared to those without previous endometriosis surgery. The median duration of surgery was 90 minutes. The study found that each previous therapeutic laparotomic surgery led to an average increase of 13 minutes in surgical time. The likelihood of adhesiolysis increased nearly 3-folds in women with previous endometriosis surgeries with odds ratio (OR) of 2.96. The incidence rate of intraoperative complications was 6.2% in the previous endometriosis surgery group vs 2.8% in women without previous surgery. While the risk of intra-operative complications was nearly doubled (OR 1.81), there was no significant increase in the risk of major post-operative complications (OR 1.29).

Previous therapeutic laparoscopic endometriosis surgery, as well as laparotomic and laparoscopic non-endometriosis surgery were not correlated with surgical outcomes. Patients who underwent bowel disc resection and segmental bowel resection were at a higher risk for post-operative complications with OR of 3.64 and 3.50 respectively, irrespective of previous endometriosis surgery.

The findings of the study suggest that previous therapeutic laparotomic endometriosis surgery is associated with longer surgical time with more patients requiring adhesiolysis. These patients are also at higher risk of developing intra-operative complications in subsequent surgeries for endometriosis. This study also highlights the need for a good surgical history for better planning and patients counselling. It is important to note that in a center of expertise with experienced surgeons, no increased risk of major post-operative complications was observed. This suggests that the expertise and skill of the surgical team may play a crucial role in mitigating the potential risks and ensuring favorable post-operative outcomes, despite the challenges posed by previous surgeries for endometriosis.

Reference

1.    Tummers FHMP, et al. Evaluation of the effect of previous endometriosis surgery on clinical and surgical outcomes of subsequent endometriosis surgery. Arch Gynecol Obstet. 2023 Nov;308(5):1531-1541. doi: 10.1007/s00404-023-07193-4.