Skip to main content
SpringerLink
Log in

Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

We aimed to assess post-operative complications based on the Clavien–Dindo classification system following routine laparoscopic treatment of all stages of endometriosis.

Methods

A retrospective cohort study was carried out to identify women who underwent laparoscopic complete resection of newly diagnosed endometriosis between 2013 and 2016. 401 patients were identified using hospital database search software, and electronic files were reviewed. The stages of endometriosis had been classified according to the revised score of the American Society of Reproductive Medicine (rASRM) and the Enzian classification in cases of deep infiltrating endometriosis. Post-operative complications were recorded based on the Clavien–Dindo classification. Multivariate regression analysis was used to investigate the impact of the stages of endometriosis and surgical steps on complications.

Results

Grade III complications requiring surgical, endoscopic, or radiological intervention occurred in only 1.7% of patients and were significantly associated with rASRM stage IV (OR 1.8). Grade II complications (blood transfusion, total parenteral nutrition) occurred in 18.7% of patients. rASRM stage IV (OR 2.0), hysterectomy (OR 3.2), conversion to laparotomy (OR 11.1), and bowel resection (OR 27.6) were significantly associated with increased risk of grade II complications. rASRM stages I–III did not show an effect on post-operative complications or hospital stay.

Conclusions

Clavien–Dindo complication grading was readily applicable to laparoscopic removal of endometriosis of all stages. Higher Clavien–Dindo grades correctly reflected clinically relevant complications and were associated with deep infiltrating endometriosis, stage IV endometriosis, bowel surgery, or hysterectomy. Clavien–Dindo classification can be recommended for evaluation of laparoscopic endometriosis surgery outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Soliman AM, Yang H, Du EX, Kelley WC (2016) The direct and indirect costs associated with endometriosis: a systematic literature review. Hum Reprod 31(4):712–722

    Article  Google Scholar 

  2. Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, Chen Z, Fujimoto VY, Varner MW, Trumble A, Giudice LC, ENDO study working group (2011) Incidence of endometriosis by study population and diagnostic method: the ENDO Study. Fertil Steril 96(2):360–365

    Article  Google Scholar 

  3. Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W, European Society of Human Reproduction, and Embyrology (2014) ESHRE guideline: management of women with endometriosis. Hum Reprod 29(3):400–412

    Article  CAS  Google Scholar 

  4. Uccella S, Marconi N, Casarin J, Ceccaroni M, Boni L, Sturla D, Serati M, Carollo S, Podesta-Alluvion C, Ghezzi F (2016) Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy. Arch Gynecol Obstet 294(4):771–778

    Article  Google Scholar 

  5. Righarts A, Osborne L, Connor J, Gilett W (2018) The prevalence and potential determinants of dysmenorrhoea and other pelvic pain in women: a prospective study. BJOG 125:1532–1539

    Article  CAS  Google Scholar 

  6. Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68(4):585–596

    Article  CAS  Google Scholar 

  7. Haas D, Wurm P, Shamiyeh A, Shebl O, Chvatal R, Oppelt P (2013) Efficacy of the revised Enzian classification: a retrospective analysis: does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian? Arch Gynecol Obstet 287(5):941–945

    Article  Google Scholar 

  8. Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications and clinical outcome. Arch Surg 144(3):234–239

    Article  Google Scholar 

  9. Hirsch M, Begum MR, Paniz É, Barker C, Davis CJ, Duffy JMN (2018) Diagnosis and management of endometriosis: a systematic review of international and national guidelines. BJOG 125:556–564

    Article  CAS  Google Scholar 

  10. de Paula AM, Borrelli GM, Kho RM, Abrao MS (2017) The current management of deep endometriosis. A systematic review. Minerva Ginecol 69(6):587–596

    Google Scholar 

  11. Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L (2010) Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 24(1):63–67

    Article  Google Scholar 

  12. Tarjanne S, Heikinheimo O, Mentula M, Härkki P (2015) Complications and long-term follow-up on colorectal resection in the treatment of deep infiltrating endometriosis extending to bowel wall. Acta Obstet Gynecol Scand 94(1):72–79

    Article  Google Scholar 

  13. Zilberman S, Ballester M, Touboul C, Chéreau E, Sèbe P, Bazot M, DaraÏ E (2013) Partial colpectomy is a risk factor for urologic compliactions of colorectal resection for endometriosis. J Minim Invasive Gynecol 20(1):49–55

    Article  Google Scholar 

  14. Dousset B, Leconte M, Borghese B, Millischer AE, Roseau G, Arkwright S, Chapron C (2010) Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg 251(5):887–895

    Article  Google Scholar 

  15. Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Darai E (2008) Urinary complications after surgery for posterior deep infiltrating endometriosis are related to the extent of dissection and to uterosacral ligaments resection. J Minim Invasive Gynecol 15(2):235–240

    Article  Google Scholar 

  16. Riiskjær M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, -Hansen M (2016) Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG 123:1360–1367

    Article  Google Scholar 

  17. Radosa MP, Meyberg-Solomayer G, Radosa J, Vorwergk J, Oettler K, Mothes A, Baum S, Juhasz-Boess I, Petri E, Solomayer EF, Runnebaum IB (2014) Standardised registration of surgical complications in laparoscopic-gynaecological therapeutic procedures using the Clavien–Dindo classification. Geburtsh Frauenheilk 74(8):752–758

    Article  CAS  Google Scholar 

  18. Johnson NP, Hummelshoj J, Adamson GD, Keckstein J, Taylor HS, Abrao MS, Bush D, Kiesel L, Tamimi R, Timms KL, Rombauts L, Giudice LC, World Endometriosis Society Sao Paulo Consortium (2017) World Endometriosis Society consensus on the classification of endometriosis. Human Reprod 32(2):315–324

    Article  Google Scholar 

  19. Maccio A, Chiappe G, Kotsonis P, Nieddu R, Lavra F, Serra M, Onnis P, Sollai G, Zamboni F, Madeddu C (2016) Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures. Arch Gynecol Obstet 294(3):525–531

    Article  Google Scholar 

  20. Andres MP, Borrelli GM, Abrao MS (2018) Endometriosis classification according to pain symptoms: can the ASRM classification be improved? Best Pract Res Clin Obstet Gynaecol 51:111–118

    Article  Google Scholar 

  21. Renner SP, Kessler H, Topal H, Proske K, Adler W, Burghaus S, Haupt W, Beckmann MW, Lermann J (2017) Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 295(5):1277–1285

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Dr. Klaus Bühler, Scientific-Clinical Centre for Endometriosis of the University Hospitals of Saarland, Saarbrücken, for assistance in project development.

Funding

No external funding was obtained for this study.

Author information

Author notes

  1. Jorge Jimenez-Cruz

    Present address: Department of Obstetrics and Prenatal Medicine, University Women’s Hospital Bonn, Bonn, Germany

Authors and Affiliations

  1. Department of Gynecology and Reproductive Medicine, University Women’s Hospital Jena, Jena University Hospital, Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany

    Kristin Nicolaus, Stefan Zschauer, Dominik Bräuer, Jorge Jimenez-Cruz, Matthias Rengsberger, Herbert Diebolder & Ingo B. Runnebaum

  2. Institute of Medical Statistics, Informatics and Documentation, University Hospital, Friedrich-Schiller-University Jena, Jena, Germany

    Thomas Lehmann

Authors
  1. Kristin Nicolaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefan Zschauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dominik Bräuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jorge Jimenez-Cruz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Matthias Rengsberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Herbert Diebolder
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ingo B. Runnebaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KN: protocol/project development, data collection and data management, and manuscript writing/editing. SZ: data collection. DB: data collection. JJ-C: statistics and data management. TL: statistics. MR: project development. HD: project development. IBR: manuscript writing/editing.

Corresponding author

Correspondence to Ingo B. Runnebaum.

Ethics declarations

Conflict of interest

There are no competing interests to declare.

Ethical approval

This research project was covered by the study approval for data use and clinical studies of the General Ethics Commission, Faculty of Medicine, Jena University Hospital, Germany (no. 2018-1072). An additional ethical approval from the Ethics Commission of the Faculty of Medicine, Jena University Hospital, Germany, was not required because the analysed data were anonymised.

Informed consent

A declaration of consent of the patients is available.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nicolaus, K., Zschauer, S., Bräuer, D. et al. Extensive endometriosis surgery: rASRM and Enzian score independently relate to post-operative complication grade. Arch Gynecol Obstet 301, 699–706 (2020). https://doi.org/10.1007/s00404-019-05425-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-019-05425-0

Keywords

Search

Navigation