Systematization of Laparoscopic Surgery for Deep Endometriosis.

The objective of the study is to show that a qualified team and the systematization of the surgical technique help to decrease the number of complications in laparoscopic surgery for deep endometriosis. Retrospective cohort during the period between 2017 to 2020. Laparoscopic operating room with patient in semi-gynecological position. 355 women with deep endometriosis. Surgeries were performed by the same team, with the same systematization. In all cases were performed cavity review, oophoroplasty and ovarian fixation, ureterolysis, hypogastric nerves identification and bowel disease treatment, and endometrial nodules exeresis. Postoperative complications, hospitalization time, fistulas, etc. were evaluated. Of all the 355 surgery patients of the group, 86,98% had bowel disease, 40,82% had urinary tract disease, 24,85% ovary disease, 1,77% diaphragmatic disease, 3,55% parametrium injuries, concurrent or not. A percentage of 15,97% hysterectomies were performed, out of the total of 355 patients. The techniques used to treat bowel disease were rectosigmoidectomy in 15,38% of the cases, shaving in 39,05% of the cases, circular stapling in 14,79% of the cases, appendectomy in 17,15% of the cases, and right colectomy in 0,59% of the cases. Only one protective colostomy was performed in one of the cases (0,59%) due to the height of the wound when compared to the anal verge, and no drains were used in any of the cases. The average hospitalization time was 3 days (2 to 10), and no blood transfusions were required. On postoperative, there were 0,59% of cases with rectovaginal fistulas and 0,59% of cases with intestinal perforation. The data showcased in our group review showed that deep endometriosis surgery is a high complexity procedure and should be performed by surgeons with a comprehensive experience in anatomy, together with multidisciplinary surgeons and systematizing the surgery technique, to achieve better results. [ABSTRACT FROM AUTHOR]