Abstract
Purpose
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.
Methods
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%.
Results
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).
Conclusions
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.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EC, AW and VS. The first draft of the manuscript was written by EC, AW and VS, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Weyl, A., Sevy, V., Lepage, B. et al. Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis. Arch Gynecol Obstet 307, 1459–1468 (2023). https://doi.org/10.1007/s00404-022-06899-1
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DOI: https://doi.org/10.1007/s00404-022-06899-1