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. 2023 May;307(5):1459-1468.
doi: 10.1007/s00404-022-06899-1. Epub 2022 Dec 30.

Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis

Ariane Weyl #  1   2 , Virginie Sevy #  3 , Benoît Lepage  4 , Fabien Vidal  5 , Sylvain Kirzin  6 , Yann Tanguy Legac  1 , Florence Lesourd  7 , Anna Gosset  7 , Jérome Capdet  8 , Pierre Leguevaque  9 , Barbara Bournet  10 , Françoise Lenfant  2 , Thibaut Brierre  11 , Hugo Gornes  12 , Etienne Buscail  13 , Elodie Chantalat  14   15
Affiliations

Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis

Ariane Weyl et al. Arch Gynecol Obstet. 2023 May.

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.

Keywords: Deep infiltrating endometriosis; Multidisciplinary care pathway; Postoperative complications.

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References

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