Perioperative Morbidity and Recurrence After One‐Stage Laparoscopic Resection for Multicompartment Deep Endometriosis: A Multicentre Cohort Study
Flavia Pagano, Pál Botond Sík, Sara Imboden, Attila Bokor, Michael D. MuellerABSTRACT
Objective
To evaluate perioperative morbidity, factors associated with postoperative complications and documented recurrence after one‐stage laparoscopic resection for multicompartment deep endometriosis.
Design
Retrospective multicentre cohort study.
Setting
Two tertiary referral centres specialised in endometriosis surgery (Bern, Switzerland; Budapest, Hungary).
Population
A total of 299 consecutive patients with pathologically confirmed deep endometriosis undergoing one‐stage laparoscopic resection between January 2017 and December 2025.
Interventions
One‐stage laparoscopic resection of multicompartment deep endometriosis.
Measurements and Main Results
Clinically relevant postoperative complications were defined as Clavien–Dindo Grade ≥ II. Multivariable logistic regression assessed associated factors. Recurrence‐free survival was evaluated using Kaplan–Meier analysis in patients with an available recurrence time or censoring time. Postoperative complications occurred in 36/299 patients (12.0%), including 35/299 (11.7%) with Grade ≥ II complications and 14/299 (4.7%) with Grade ≥ IIIb complications. Greater #ENZIAN deep endometriosis anatomical extent was independently associated with clinically relevant complications (adjusted odds ratio 1.51 per additional involved compartment, 95% confidence interval 1.04–2.18). Documented recurrence occurred in 43/299 patients (14.4%) and 26/299 (8.7%) underwent reoperation for recurrence. Follow‐up duration was available for 231/299 patients (77.3%). Recurrence‐free survival did not differ significantly according to bowel (log‐rank p = 0.431) or bladder surgical technique ( p = 0.116).
Conclusion
Greater #ENZIAN deep endometriosis anatomical extent was independently associated with clinically relevant postoperative complications following one‐stage surgery for multicompartment deep endometriosis, suggesting that overall anatomical disease extent may better reflect surgical complexity than involvement of a single anatomical site. These findings support the role of anatomical disease extent in preoperative counselling and individualised surgical planning.