2515 Surgical Outcomes in 202 Patients Undergoing Laparoscopic Surgery for Endometriosis Over Three Years in a Referral Centre in Porto, Portugal

Study Objective To evaluate surgical and clinical outcomes of women undergoing surgery for endometriosis. Design A review of patients undergoing surgery for endometriosis from 1stJanuary 2016 to 31stMarch 2019. Setting Centro Materno Infantil do Norte (CMIN) a tertiary referral centre in Porto. Patients or Participants Electronic database was searched with the keyword “Endometriosis.” Of 237 cases, 202 were included in the final study. Interventions Of 202 patients,195 (96.5%) had radical laparoscopic surgery for all visible lesions of endometriosis, including deep infiltrating endometriosis (DIE), 5(2.4%) needed conversion to laparotomy, while 2(0.9%) cases surgery had to be deferred. Measurements and Main Results Majority (193, 95.5%) had normal BMI and 198 (98%) were in reproductive age group. The main complaint was dysmenorrhea (n=187, 92.5%) followed by dyspareunia (n=144, 71.2%). Majority of cases (n =168, 83%) were AFS stage IV disease. Bowel disease predominated in 54 patients (26.7%); of which 24 (11.8%) had bowel resection +/- protective ileostomy, 27 (13.3%) had rectal shaving, while 1 (0.49%) underwent discoid resection. Four (1.98%) had bladder disease and underwent resection and repair. Five (2.4%) had ureteral disease needing ureteral excision (n=3, 1.48%) or excision of peri-ureteral nodule (n=1, 0.49%). One patient had severe disease encasing the lower third of ureter, deferring surgery. Twenty-six (12.8%) required cystectomy, 65 (32%) had recto-vaginal disease, 24(10.8%) underwent hysterectomy/ nodule excision for uterine endometriosis, 13 (6.4%) had uterosacral disease and 9 (4.4%) had peritoneal disease. There were no major intraoperative complications, except for one case (0.49%) of iatrogenic injury to ureter. Mean follow up was 11.08 months. Majority (n=181, 89.6%) were symptom-free, 21(10.3%) reported severe symptoms. Five (23.8%) of these had recurrence on MRI. Conclusion Radical laparoscopic surgery with multidisciplinary care in the context of a tertiary care centre results in low complication rates and good clinical outcomes.