A study conducted in Texas and published in the Journal of Minimally Invasive Gynecology revealed that women with underlying endometriosis experience more complications during and after hysterectomy.
Hysterectomy Credit: BruceBlaus
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus develops outside the uterus. It affects 1 in 10 women, or nearly 10% of all women worldwide, or 190 million females of reproductive age.
Hysterectomy, or removal of the uterus, is an operation to remove the uterus. It can be performed for various medical reasons, such as fibroids causing pain, discomfort, debilitating bleeding, cancer, prolapse, etc.
Read Also: OSU Researchers Use Nanoparticles to Locate and Eliminate Endometriosis Lesions
Increased risk of complications after hysterectomy
The researchers used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). This database is provided by more than 700 U.S. hospitals. It contains information on the periods before surgery (preoperative), during surgery (intraoperative), and 30 days after surgery (postoperative) for patients undergoing outpatient and inpatient procedures.
Among the selected surgeries, 127,556 hysterectomies performed for reasons other than cancer between January 1, 2014, and December 31, 2019, were identified. Of these, 19,618 (about 15.4 percent) were associated with endometriosis diagnosed before or during surgery.
After comparing data for patients with and without endometriosis, a postoperative complication rate was found to be about 1.8 percent higher (9.9 percent vs. 8.1 percent). This increase was modest but significant. Complications ranged from minor (urinary tract and incisional infections) to major (sepsis, blood transfusions, and postoperative readmissions). However, no significant differences were found in 30-day mortality or reoperations.
Surgery often takes longer
It also appears that surgeries on women with endometriosis generally take longer. In addition, they often needed other surgeries at the same time as the hysterectomy, including operations to remove adhesions caused by endometriosis tissue, gastrointestinal surgeries such as appendectomies or bowel resections, and surgeries involving structures around the uterus (ovaries, fallopian tubes, and pelvic floor ligaments).
According to study leader Kimberly Kho, professor of Obstetrics and Gynecology and director of the Association for Minimally Invasive Gynecologic Surgery at UT Southwestern, “This study confirms what many of us in gynecology and surgery knew, but needed a large number of surgical cases to confirm: patients with endometriosis are at increased risk of complications if they undergo hysterectomy.”
It further states that “these data confirm the need for preoperative diagnostic tools to anticipate and plan complex endometriosis surgeries so that neither patients nor surgeons are surprised or caught off guard by the complexity of the surgery when they are in the operating room.”
Final Thoughts
The research highlights the complexities associated with endometriosis in patients undergoing hysterectomy. With a 1.8 percent higher postoperative complication rate in patients diagnosed with endometriosis, the importance of comprehensive preoperative assessment is evident. Additional surgeries required by endometriosis patients further emphasize the need for thorough surgical planning. Dr. Tampiwa Chebani of Gilmore Health noted, “Endometriosis presents unique challenges during hysterectomy. Adequate preoperative diagnostics and anticipatory surgical strategies are pivotal in optimizing patient outcomes.” This research reinforces the necessity for improved diagnostic tools and surgical protocols for patients with endometriosis undergoing hysterectomy.
Read Also: Adagrasib a Promising New Treatment for Lung, Pancreatic, Endometrial, Ovarian and Colon Cancers
References
Wang, E. B., Chang, S., Bossa, D., Rosero, E. B., & Kho, K. A. (2023). Surgical Complications among Benign Hysterectomies. Journal of Minimally Invasive Gynecology. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX. https://doi.org/10.1016/j.jmig.2023.09.003
