Laparoscopic conservative surgery for stage IV symptomatic endometriosis: short-term surgical complications

Objective: To study severe endometriosis as a cause of pelvic pain, which represents one of the most challenging disorders in gynecology. Design: Retrospective study. Setting: Teaching hospital. Patient(s): A total of 1,363 women with severe endometriosis (revised American Society for Reproductive Medicine [rASRM] stage IV). Interventions: A detailed survey of all patients with severe endometriosis (rASRM stage IV) who underwent laparoscopy at our center between January 2004 and December 2007 was carried out. Main Outcome Measure(s): Clinical and surgical data were retrieved and assessed according to the extent of surgery performed. Intraoperative, ultra-short, and short-term clinical complications were assessed. Results: A total of 1,201 women underwent laparoscopic radical surgery with excision of all visible endometriotic lesions, with a significant improvement of symptoms at 1-month follow-up evaluation. The overall intraoperative complication rate was 2.0%. The morbidity was significantly increased when bowel surgery was performed, with a risk of intraoperative complications that was threefold higher. Of the patients who had bowel surgery, 18 (4.1%) required reintervention within the first week after surgery. Conclusion(s): We report on the safety and efficacy of laparoscopic eradication of all visible implants in cases of rASRM stage IV endometriosis when surgery is performed in a referral center. (Fertil Steril (R) 2010;94:1218-22. (C) 2010 by American Society for Reproductive Medicine.)