Hum. Reprod. Advance Access originally published online on January 31, 2006
Human Reproduction 2006 21(3):774-781; doi:10.1093/humrep/dei324
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Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible?
Departments of 1 Obstetrics and Gynecology and 2 General Surgery, Ospedale Sacro Cuore, Via Don A.Sempreboni 5, 37024 Negrar (Verona), 3 School of Medicine, University of Bologna, Italy, 4 Nuffield Department of Obstetrics and Gynaecology, University of Oxford, UK and 5 Department of Cardiology, University of Verona, Italy
6 To whom correspondence should be addressed. E-mail: luca.minelli{at}sacrocuore.it
BACKGROUND: Little is known about the morbidity associated with laparoscopic complete excision of endometriosis in terms of urinary, digestive and sexual function. METHODS: We performed a prospective non-randomized study in 45 patients with laparoscopic complete excision of all detectable foci of endometriosis with segmental bowel resection using a non nerve-sparing technique (control group–group A n = 20) and a nerve-sparing technique (case group–group B n = 25). At initial gynaecological evaluation, and at follow-up details on dysmenorrhoea, pelvic pain, dyspareunia and dyschezia were evaluated using an interview-based questionnaire (10-point analogue rating scale: 0 = absent, 10 = unbearable). RESULTS: The mean (±SD) follow-up period was 15.3 ± 10 months (range, 8.8–23 months) for group A and 3.5 ± 2.1 months (range, 0.3–5.2 months) for group B. In the immediate postoperative course, in group A three women required blood transfusion vs seven women in group B (P = 0.003). The median time to resume the voiding function was significantly shorter in group B (12.5 vs 3.0 days; P < 0.01). At the time of follow-up a higher proportion of patients in group B were ‘very satisfied’ than those in group A (87.7% vs 59.0%, P = 0.013). CONCLUSIONS: Laparoscopic nerve-sparing complete excision of endometriosis seems to be feasible and offers good results in terms of bladder morbidity reduction with apparently higher satisfaction than classical technique. Larger series with longer follow-up are needed to confirm our results.
Key words: complete excision/endometriosis/morbidity/nerve-sparing/voiding disorders
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