Laparoscopic Neurolysis for Deep Endometriosis with Somatic Nerves Involvement: A Prospective Cohort Study on 402 Patients Treated in a Third-Level Referral Center

Study Objective To review efficacy and feasibility of laparoscopic decompression and neurolysis for endometriosis involving sacral plexus and/or somatic nerves on a large case series. Design Prospective case-series, single-centre, single-surgeon study on 402 patients. Setting Department of Obstetrics and Gynecology, IRCCS Sacro Cuore Don Calabria Hospital, Verona - Italy. Patients or Participants In a 9-year period, 402 consecutive patients with deep infiltrating endometriosis (DIE) complaining of recurrent sciatica and ano-genital pain were treated by laparoscopic decompression or neurolysis of sacral roots and somatic nerves. The median follow up was 44,7 months. Interventions All the procedures were performed by a gynecologic pelvic surgeon skilled in neuro-anatomy (M.C.) Decompression and neurolysis of the involved neural structures was achieved by means of a tranperitoneal medial approach, by means of a lateral approach from the ileolumbar space, or with both the approaches in a combined technique. Nerve-sparing radical excision of DIE was performed laparoscopically in all cases. Measurements and Main Results In all of the 402 patients a laparoscopic evidence of nervous compression of somatic structures and infiltration of their fascial envelope was shown, whereas in 89 patients (22.1%) the same structures were deeply infiltrated, towards the assonal and peri-nevral planes. In all of the patients a surgical whole decompression and partial neurolysis of nervous structures was performed, where in 89 (22.1 %) cases a complete neurolysis was required. Complete relief from neurologic symptoms was achieved in all patients at 6 month after surgery, whereas post-operative neuritis was reported in 78 patients (19.4%) and successfully treated with steroids or/and anti-epileptic and opioids drugs. Conclusion Laparoscopic retroperitoneal nerve-sparing approach to endometriosis extending to the pelvic wall with somatic nerve compression proved to be a feasible and safe procedure, effective in pain relief, recovery of impaired neurological functions and neuromotoric impairment symptoms of the pelvis and the leg.