Significant Improvement in Diagnosis and Surgical Management of Deep-Infiltrating Endometriosis after Formation of a Specialized Unit: A Chilean Experience

Abstract

Objective: The goal of this research was to assess diagnosis and laparoscopic management of deep-infiltrating endometriosis after formation of a specialized unit in the Clínica Santa María, Santiago, Chile. Outcomes were compared with the current authors' results prior to the new unit. Materials and Methods: This retrospective study used prospectively collected data of 137 patients with pathology-proven deep-infiltrating endometriosis. The patients were divided into 2 groups: A had patients operated on prior to the unit's formation (n = 39) and B had patients operated on after the unit's formation (n = 98). Surgical and fertility outcomes were compared. Results: All procedures were performed laparoscopically without conversions. A significant increase in use of preoperative imaging (p < 0.001) and revised American Fertility Society staging (p = 0.01) occurred after the unit's formation. Bowel involvement was significantly higher in Group B (12.8% versus 38.8%; p < 0.004). There were also fewer incomplete resections (28.2% versus 2%; p < 0.001), lower recurrence rates (20.5% versus 6.1%; p = 0.02), and fewer reoperations (10.3% versus 1%; p < 0.02) since the unit's formation. Complication rates were similar in both groups. One-year pregnancy rates were similar, but time-to-pregnancy was shorter in Group B (12 versus 6.2 months; p = 0.02). Median follow-up was 49.3 versus 14.4 months for Groups A and B, respectively (p < 0.001). In Group A, 79% of the patients experienced relevant symptom reductions versus 94% in Group B (p = 0.02). Conclusions: Surgical management of deep-infiltrating endometriosis in specialized units improves perioperative outcomes significantly.