Postoperative Pregnancy Outcomes Following Laparoscopic Surgical Management in Women with Stage III/IV Endometriosis: A Single-Center Follow-Up Study.

IF 1.4 Q3 OBSTETRICS & GYNECOLOGY Gynecology and Minimally Invasive Therapy-GMIT Pub Date : 2023-06-13 eCollection Date: 2023-07-01 DOI:10.4103/gmit.gmit_132_22

Maya Fujii, Akemi Koshiba, Fumitake Ito, Izumi Kusuki, Jo Kitawaki, Taisuke Mori

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Abstract

Objectives: The effects of laparoscopic surgical management in women with stage III/IV endometriosis remain controversial. The standard extent of resection for stage III/IV endometriosis with deep endometriosis to treat endometriosis-associated infertility is debatable. This study aimed to assess the postoperative pregnancy outcomes following a routine surgical intervention for stage III/IV endometriosis patients.

Materials and methods: Patients with stage III/IV endometriosis who underwent conservative laparoscopic surgery at our hospital between January 2010 and December 2018 were retrospectively analyzed. Statistical analyses were performed to determine the correlations between endometriosis features and postoperative pregnancy outcomes.

Results: Of 256 patients enrolled, 94 wished to conceive. Exclusion criteria: ≥40 years, adenomyosis, partners with infertility issues. Finally, 71 women were included. The overall postoperative pregnancy rate was 76.1% (n = 54): 49 and five from non-assisted reproductive technology (ART) and ART, respectively. The postoperative pregnancy rate in patients diagnosed with infertility presurgery (40/71) was 70.0% (n = 28): 24 (non-ART) and four (ART). The endometriosis fertility index (EFI) score was higher in the pregnant than in the nonpregnant group (P = 0.03). The EFI score and surgical score of EFI were higher in the non-ART than in the ART group (P = 0.04; P = 0.02); in the infertile group, they were higher in the pregnant than in the nonpregnant group (P = 0.018; P = 0.027).

Conclusion: Our postoperative pregnancy rate after conservative laparoscopic surgery for patients with stage III/IV endometriosis compared favorably with previous reports. EFI was a significant predictor of postoperative pregnancy. Our surgical approach to maintain a high surgical score of EFI might help treat endometriosis-associated infertility.

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III/IV期子宫内膜异位症妇女腹腔镜手术后妊娠结局：一项单中心随访研究。

目的：腹腔镜手术治疗III/IV期子宫内膜异位症的效果仍然存在争议。III/IV期子宫内膜异位症合并深度子宫内膜异位治疗子宫内膜异位相关不孕的标准切除范围是有争议的。本研究旨在评估III/IV期子宫内膜异位症患者常规手术干预后的妊娠结局。材料和方法：对2010年1月至2018年12月在我院接受保守腹腔镜手术的III/IV期子宫内膜异位症患者进行回顾性分析。进行统计分析以确定子宫内膜异位症特征与术后妊娠结局之间的相关性。结果：在256名入选患者中，94人希望怀孕。排除标准：≥40岁，子宫腺肌病，伴不孕。最后，包括71名妇女。术后总妊娠率为76.1%（n=54）：非辅助生殖技术（ART）和ART分别为49和5。术前诊断为不孕的患者的术后妊娠率（40/71）为70.0%（n=28）：24例（非ART）和4例（ART）。妊娠组子宫内膜异位症生育指数（EFI）评分高于非妊娠组（P=0.03）。非ART组的EFI评分和手术评分高于ART组（P=0.04；P=0.02）；在不孕组中，妊娠组的妊娠率高于非妊娠组（P=0.018；P=0.027）。EFI是术后妊娠的重要预测因素。我们维持EFI高手术评分的手术方法可能有助于治疗子宫内膜异位症相关不孕。

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