Surgical treatment of deep endometriosis and risk of recurrence

STUDY OBJECTIVE: To evaluate the risk of recurrence of deep endometriosis after conservative surgery. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: Tertiary care university hospital. PATIENTS: One hundred fifteen symptomatic patients operated on in our department from 1996 through 2002 with postoperative follow-up of at least 12 months. INTERVENTION: All patients underwent conservative surgery for deep infiltrating endometriosis. MEASUREMENT AND MAIN RESULTS: Risk factors for recurrence of symptoms and clinical findings and for repeated surgery were evaluated by univariate and multivariate analysis. During follow-up, we observed 28 patients with pain recurrence and 15 patients with recurrent clinical findings, and 12 patients required reoperation for deep endometriosis. Recurrence rates of pain and clinical findings during 36 months were 20.5% and 9%, respectively. Multivariate analysis showed that only age was a significant predictor of pain recurrence (OR 0.9, 95% CI 0.81-0.99, p <.05), enhancing the risk in younger patients. Recurrence of clinical signs of deep endometriosis was predicted by obliteration of the pouch of Douglas (OR 1.46, 95% CI 1.16-16.2, p <.05). Reoperation for deep endometriosis was predicted only by the incompleteness of first operation (OR 21.9, 95% CI 3.2–146.5, p <.001). CONCLUSION: Our study indicates that age, obliteration of the pouch of Douglas, and surgical completeness may have a significant influence on the recurrence of the disease.