Surgical outcomes according to the degree of parametrial dissection with hysterectomy for deep endometriosis.

Abstract

Background: There is no standardisation of the degree of parametrial dissection and excision with hysterectomy in the presence of deep endometriosis (DE).

Objectives: To apply an anatomical classification of dorso-lateral parametrectomy to hysterectomy for DE and correlate with postoperative complications and functional outcomes.

Methods: Women with histologically confirmed DE who underwent hysterectomy with varying degrees of parametrectomy were retrospectively identified. Dorso-lateral parametrectomy was classified as follows: superficial (medial to presacral fascia), deep type 1 (beyond the presacral fascia), type 2 (caudal to medial rectal artery), and type 3 (laterally and deeply the hypogastric fascia). Statistical analysis was performed to correlate the degree of parametrial dissection with operative complications and functional outcomes at 6 months.

Main outcome measures: Incidence of intra- and postoperative complications; changes in gastrointestinal, urinary, and sexual function; pain improvement.

Results: Eighty-nine patients underwent parametrectomy with hysterectomy: superficial extended hysterectomy (EH) with superficial parametrectomy (EHSP, n=52), deep EH with deep parametrectomy type 1 (EHDP1, n=19), deep type 2 (EHDP2, n=12), and deep type 3 (EHDP3, n=6). Eight patients (8.9%) had intraoperative complication of which 5/52 (9.6%) underwent EHSP, 1/19 (5.3%) EHDP1, 2/12 (16.7%) EHDP2. Bladder voiding dysfunction occurred in 11 patients (12.3%) with higher incidences of 6/19 (31.6%) undergoing EHDP1 and 1/6 (16.7%) EHDP3 (P=0.016). Pain outcomes significantly improved across all groups (P<0.001).

Conclusions: This classification of parametrectomy at the time of hysterectomy for DE offers a framework for assessing surgical complexity and outcomes. While substantial pain relief is observed, bladder dysfunction remains a significant concern, especially when parametrectomy extends beyond the presacral fascia.

What is new?: This classification for modified radical hysterectomy provides a method to standardise the description of parametrectomy for DE, facilitating more precise correlations between the extent of disease in the parametria and functional outcomes.