Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires

PURPOSE: Radical eradication of deep infiltrating endometriosis (DIE) is
associated with a high risk of iatrogenic autonomic denervation and pelvic
dysfunction. Our aim was to prospectively analyze peri-operative details and
post-operative functional outcomes (in terms of pain relief and bladder, rectal,
and sexual function) among women operated for DIE of the posterior compartment
with nerve-sparing technique, using the visual analogue scale and validated
questionnaires.
METHODS: All women undergoing laparoscopic nerve-sparing eradicative surgery for
DIE nodules of the posterior compartment ≥ 4 cm ± bowel resection were included.
Pain scores [using Visual Analogue Scale (VAS) scores] were collected before
surgery and 6 and 12 months after surgery. Functional outcomes in terms of
bladder, rectal, and sexual function, were evaluated using validated
questionnaires (i.e., ICIQ-UISF, NBD score, and FSFI) administered
pre-operatively and 6 months after surgery.
MAIN RESULTS: A total of 34 patients were included. Twenty-eight (82.4%) of them
had already undergone a previous abdominal surgery for endometriosis. Bowel
resection was performed in 16 (47.1%) patients. Median VAS score levels of pelvic
pain were significantly decreased after surgery both at 6 (median 3, range 0-7
and 2, 0-7, respectively) and at 12 months (3, 0-8 and 2, 0-7), compared to
pre-operative levels (9, 1-10 and 3, 0-7, respectively) (p < 0.0001). No
differences were found in terms of urinary function between pre- and
post-operative ICIQ-SF questionnaires. In no cases, bladder self-catheterization
was needed at the 6-and 12-month follow-up. Median NBD score was 3.5 (0-21)
pre-operatively and 2 (0-18) after 6 months (p = 0.72). The pre-operative total
FSFI score was 19.1 (1.2-28.9) vs. 22.7 (12.2-31) post-operatively (p = 0.004).
CONCLUSIONS: The nerve-sparing approach is effective in eradicating DIE of the
posterior compartment, with satisfactory pain control, significant improvement of
sexual function, and preservation of bladder and rectal function.