Minimally-invasive multidisciplinary treatment of deep endometriosis: 103 cases

Background: Endometriosis is a multifactorial disease which can cause severe pelvic pain that can impact everyday life. In addition, the complex of pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity is a common cause of infertility. The treatment of this disease should be individualized according to the clinical situation and to the level of impairment. This study aims to define the role of surgery in the treatment of deep endometriosis with intestinal localization, particularly whether surgery is capable or not to improve painful symptoms, disease recurrence, and fertility. Methods: In this retrospective clinical single-arm study, from March 2017 to March 2022, we included all patients who underwent to surgical intervention involving bowel resection for deep endometriosis. To analyze the effects of surgery in improving symptoms a standardized questionnaire, based on the verbal rating scale (VRS) [0–4], was given pre-operatively on the first gynecological visit and post-operatively at least 6 months from intervention. In addition, each patient seeking a pregnancy before surgery was contacted at the end of the follow-up to find out whether she had a full-term pregnancy or not. Results: A total of 103 patients undergoing surgery for deep endometriosis involving the intestinal tract were included in the present study. The indication for surgery was given based on the severity of the symptoms, the desire for pregnancy, or a combination of the two. The 28.9% of the patients became completely asymptomatic after intervention and reported a clear decrease in the intensity of the painful symptomatology. The average pre-operative VRS score was 1.37, in the post-operative period, the average VRS score was 0.4, a difference that was statistically significant. About fertility, we observed a 20% increase after surgery. Conclusions: Deep endometriosis is an aggressive form of endometriosis which has a great impact in patients’ quality of life. Medical therapy control symptoms without a real resolution of them. This study emphasizes as surgical minimally invasive treatment represents the gold standard for the cure of deep endometriosis with excellent results on infertility and symptoms improvement.