In this month’s BJOG (February 2011), the Clermont-Ferrand group report the results of 568 operations for advanced endometriosis – sometimes called “deep infiltrating endometriosis” (Kondo et al.). It shows high rates of serious complications (2.1% intra-operative, 13.9% postoperative). These were young women (mean age 32.4 years) ) though their parity ranged from 0 to 7 children. The report does not go into the rates of persistent or recurrent pain.
These rates in a top surgical unit are not surprising. The tissues of the rectum and vagina are seriously injured in these women with most losing their nerve supply and sticking to other visceral surfaces. In other studies recurrent pain occurs in 10-50% of patients by five years follow-up – because of the changes in the brain and spinal cord that accompany injuries to nerves in your pelvic organs. We know that persistent straining during defaecation accounts for some of these clinical presentations and difficult vaginal deliveries account for many of the others. Both are entirely preventable. The question arises as to the merits of such surgery in such young women. Is it better to maintain women on GnRH agonists or lesser forms of surgery ?