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Archives of Gynecology and Obstetrics

, Volume 298, Issue 3, pp 639–647 | Cite as

Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires

  • Stefano Uccella
  • Baldo Gisone
  • Maurizio Serati
  • Sara Biasoli
  • Nicola Marconi
  • Gloria Angeretti
  • Valerio Gallotta
  • Silvia Cardinale
  • Stefano Rausei
  • Gianlorenzo Dionigi
  • Giovanni Scambia
  • Fabio Ghezzi
General Gynecology
  • 32 Downloads

Abstract

Purpose

Radical eradication of deep infiltrating endometriosis (DIE) is associated with a high risk of iatrogenic autonomic denervation and pelvic dysfunction. Our aim was to prospectively analyze peri-operative details and post-operative functional outcomes (in terms of pain relief and bladder, rectal, and sexual function) among women operated for DIE of the posterior compartment with nerve-sparing technique, using the visual analogue scale and validated questionnaires.

Methods

All women undergoing laparoscopic nerve-sparing eradicative surgery for DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included. Pain scores [using Visual Analogue Scale (VAS) scores] were collected before surgery and 6 and 12 months after surgery. Functional outcomes in terms of bladder, rectal, and sexual function, were evaluated using validated questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered pre-operatively and 6 months after surgery.

Main results

A total of 34 patients were included. Twenty-eight (82.4%) of them had already undergone a previous abdominal surgery for endometriosis. Bowel resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic pain were significantly decreased after surgery both at 6 (median 3, range 0–7 and 2, 0–7, respectively) and at 12 months (3, 0–8 and 2, 0–7), compared to pre-operative levels (9, 1–10 and 3, 0–7, respectively) (p < 0.0001). No differences were found in terms of urinary function between pre- and post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0–21) pre-operatively and 2 (0–18) after 6 months (p = 0.72). The pre-operative total FSFI score was 19.1 (1.2–28.9) vs. 22.7 (12.2–31) post-operatively (p = 0.004).

Conclusions

The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.

Keywords

Laparoscopy Deep infiltrating endometriosis Nerve sparing Bladder function Rectal function Sexual function 

Notes

Author contributions

SU: project development, data collection and management, data analysis, and manuscript writing. BG: data collection and management, and data analysis. MS: project development. SB: data collection and management, and data analysis. NM: data collection and management, data analysis, and manuscript editing. GA: project development. VG: project development and manuscript writing. SC: data collection and management, and data analysis. SR: project development. GD: project development. GS: project development and manuscript editing. FG: project developmentand manuscript editing.

Funding

No funding was obtained for the present study.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interests to disclose.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Stefano Uccella
    • 1
    • 2
  • Baldo Gisone
    • 2
  • Maurizio Serati
    • 2
  • Sara Biasoli
    • 2
  • Nicola Marconi
    • 3
  • Gloria Angeretti
    • 4
  • Valerio Gallotta
    • 1
  • Silvia Cardinale
    • 2
  • Stefano Rausei
    • 5
  • Gianlorenzo Dionigi
    • 6
  • Giovanni Scambia
    • 1
    • 7
  • Fabio Ghezzi
    • 2
  1. 1.Department of Woman and Child HealthFondazione Policlinico Universitario A. Gemelli I.R.C.C.S.RomaItaly
  2. 2.Department of Obstetrics and GynecologyUniversity of Insubria, F. Del Ponte HospitalVareseItaly
  3. 3.Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
  4. 4.Radiology Unit, Department of Surgical and Morphological SciencesUniversity of InsubriaVareseItaly
  5. 5.Department of SurgeryGallarate HospitalGallarateItaly
  6. 6.Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”University Hospital “G. Martino”, University of MessinaMessinaItaly
  7. 7.Università Cattolica del Sacro CuoreRomaItaly

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