Surgical management of endometriotic women with pregnancy intention in France: A national snapshot of centers performing a high volume of endometriosis procedures

Antoine Netter (1, 2) , Hervé Dechaud (3) , Gautier Chêne (4) , Thomas Hebert (5) , Gil Dubernard (6) , Émilie Faller (7) , Renaud Benichou (8) , Charles Chapron (9, 10) , Michel Canis (11, 12) , Horace Roman (13, 14)

1 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
2 IMBE - Institut méditerranéen de biodiversité et d'écologie marine et continentale
3 DEFE - Développement Embryonnaire, Fertilité et Environnement
4 HFME - Hôpital Femme Mère Enfant [CHU - HCL]
5 Service de Gynécologie-Obstétrique [CHRU Tours]
6 Service de Gynécologie et Obstétrique [Hôpital de la Croix-Rousse - HCL]
7 Les Hôpitaux Universitaires de Strasbourg (HUS)
8 Polyclinique Jean Villar [Bruges, France]
9 Service de Gynécologie Obstétrique II et Médecine de la Reproduction [Paris]
10 IC UM3 (UMR 8104 / U1016) - Institut Cochin
11 Service de Gynécologie [CHU Clermont-Ferrand]
12 IP - Institut Pascal
13 Aarhus University Hospital
14 Centre d’Endométriose [Clinique Tivoli Ducos, Bordeaux]

Objective: To provide a snapshot of the surgical management of endometriosis in French high-volume activity centers. Methods: Analysis of prospectively collected data between November 2015 and May 2017 in 21 centers with a high volume of endometriosis surgery in France. Each facility could include up to 40 patients undergoing laparoscopy for endometriosis. Data were collected before and two months after surgery. Results: 361 patients were enrolled in the study. Twenty-seven patients (7.48%) were lost to follow-up at the month 2 visit. Endometriosis stage was I-II in 33.70% of patients and III-IV in 66.30%. Uterosacral ligament resection was the most frequently performed procedure (50.97%) followed by rectal surgery (31.58%), ovarian procedures for endometrioma, procedures for ureters (21.33%) and the bladder (11.91%). Antiadhesion agents were employed in 215/361 (59.56%) patients. The median length of hospital stay after surgery was 2 (IQR 1 − 4) days. Post-operative complications were recorded in 9.34% of patients. Rectovaginal fistulae occurred in 8 patients (2.41%), pelvic abscess in 4 (1.20%) and bladder atony in 3 (0.90%). 17 patients (5.14%) required a second surgical procedure after a median time of 31 days (IQR 9 − 81). Two months after surgery, 95.09% of patients reported being satisfied or very satisfied with the surgery. Conclusion: Our study shows that surgical management of endometriosis in centers with a high volume of endometriosis surgery, mainly concerns women presenting with severe disease and deep localizations, with an overall risk of major complications inferior to 10% and a high rate of patient satisfaction.

Keywords: Endometriosis; Laparoscopy; Deep endometriosis; Referral center; Survey

Domains: Humanities and Social Sciences; Life Sciences [q-bio]; Human health and pathology; Gynecology and obstetrics

Antoine Netter, Hervé Dechaud, Gautier Chêne, Thomas Hebert, Gil Dubernard, et al.. Surgical management of endometriotic women with pregnancy intention in France: A national snapshot of centers performing a high volume of endometriosis procedures. Journal of Gynecology Obstetrics and Human Reproduction, 2021, 50 (8), pp.102130. ⟨10.1016/j.jogoh.2021.102130⟩. ⟨hal-03400640⟩