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

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

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

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.

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

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).

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.

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.