The necessity of ureterolysis during laparoscopic excision of deep infiltrating endometriosis lesions

Background: Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. Comparing with incomplete excision, the complete excision of deep infiltrative endometriosis has been shown that can significantly decrease post-operative pain, recurrence rate and also postoperative complications. We aimed to demonstrate the frequency of ureterolysis in deep endometriosis laparoscopic surgeries in order to do complete excision of deep endometriosis lesions and to reduce damage to ureters during these difficult surgeries.Methods: 201 patients with main chief compliant of dysmenorhea and dysparuenea (measured by verbal analog scale) were referred to our center for laparoscopic surgery. We defined expected difficulty of the surgery and also difficulty and complication score of the surgery which were scored for each patient (0=the least difficulty or complications and 10=the greatest difficulty or complications). We used a logistic regression model to analyze the correlation between doing uretrolysis with the scores of dysmenorhea , dysparuonea , expected difficulty , difficulty and complications of the surgery. Mann–Whitney and independent t test were also used for relation of doing uretrolysis with dysmenorrhea ,dysparounea and expected difficulty scores.Result: Mean age of patients was 31.17 years (SE=0.416). Mean dysmenorhea score in non uretrolysis and ureterolysis groups were 3.97±0.657 and 6.92±0.236 respectively. Also, mean dysparuonea score for non-ureterolysis and ureterolysis groups were 1.91±2.87 and 2.47±3.16 respectively. The overall percentage of our logistic regression model was 90%. There was a significant correlation between doing uretrolysis and difficulty score of surgery (b=0.698 p=0.007) and complication score (β=0.896,p=0.021). There was significant relationship between uretrolysis and dysmenorhea score( p=0.000), uretrolysis and dysparuonea score was not significant(p=0.348)(independent t test p= o.312). Only 61 patients had expected difficulty score. Mean expected difficulty for non uretrolysis and for uretrolysis group was ( 6.29±o.993) and ( 8.17±0.274) respectively. There was significant relationship between doing uretrolysis and expected difiiculy score (p=0.02).Conclusion: Doing ureterolysis in endometriosis laparoscopic surgeries significantly can increase difficulty of our surgeries but it significantly can decrease postoperative complications

کلیدواژه ها:

Deep infiltrating endometriosis ، Pelvic pain ، Recurrence ، Uretrolysis ، Endometriosis