Deep infiltrating endometriosis-related quality of life after laparoscopic excision: A prospective cohort study from Latin America using validated questionnaires

Abstract

Introduction

Deep infiltrating endometriosis (DIE) is associated with substantial impairment in health-related quality of life (HRQoL), affecting pain, emotional well-being, sexual functioning, and daily activities. Previous studies have shown that laparoscopic surgical excision may improve HRQoL in women with symptomatic DIE. However, evidence simultaneously assessing disease-specific and generic HRQoL using minimal clinically important differences (MCID) -based interpretation in Latin American women with DIE remains limited. We therefore aimed to evaluate changes in HRQoL at 6 and 12 months after laparoscopic excision of DIE in two high-volume Latin American referral centers, using the Endometriosis Health Profile-30 (EHP-30), including its sexual intercourse module, and the EuroQol-5D (EQ-5D), applying their MCID thresholds.

Materials and Methods

This prospective cohort study was conducted at two academic referral centers in Colombia and Argentina between 2021 and 2023. Women with imaging-confirmed deep infiltrating endometriosis undergoing laparoscopic excision after failed medical therapy, or as first-line treatment due to organ involvement, were included. HRQoL was assessed preoperatively and at 6 and 12 months postoperatively using the validated EHP-30, including its sexual intercourse module, and EQ-5D questionnaires. Surgical findings were classified using the Enzian classification system, complications according to Clavien–Dindo, and HRQoL changes were interpreted using established MCID thresholds.

Results

Of 159 eligible patients, 120 completed baseline and at least one postoperative assessment. Mean age was 36.7 years, and 47.5% had previous endometriosis surgery. At 6 months, all EHP-30 domains improved significantly (p < .001), with the greatest median reductions in pain (−29.54; 95% CI, −36.36 to −27.27), control and powerlessness (−29.17; 95% CI, −41.66 to −20.83), and sexual functioning (−20.00; 95% CI, −30 to −10). Improvements were sustained at 12 months, with changes meeting or exceeding the published MCID thresholds in all domains, except control and powerlessness, which fell just short of one of the two available thresholds. The EQ-5D index improved at 6 months (+0.28; 95% CI, 0.21–0.42) and 12 months (+0.35; 95% CI, 0.18–0.42; both p < .001), exceeding the proposed MCID at both timepoints. Major postoperative complications (Clavien–Dindo grade ≥ III) occurred in 8.3% of patients.

Conclusion

This Latin American cohort showed sustained, clinically meaningful improvements in multiple HRQoL domains, including sexual functioning, after laparoscopic excision of DIE. Interpreting changes from validated disease-specific and generic instruments against MCID thresholds supports the role of surgical excision in symptomatic DIE refractory to medical therapy.