Surgical considerations in the management of deep endometriosis across different age groups: A retrospective study

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Abstract

Aim. To assess the age, clinical, medical history, and surgical characteristics of patients with deep infiltrative endometriosis (DIE), depending on the presence of ovarian endometrioid cysts (EC) and the localization of infiltrates.

Materials and methods. A cross-sectional retrospective study of 265 patients aged 19–49 with DIE was conducted. The patients were divided into the following groups: DIE without EC (n = 161) and DIE combined with EC (n = 104). Within the groups, age-specific subgroups were identified based on the localization of the endometrioid infiltrate: colorectal endometriosis, urinary tract endometriosis, and endometriosis of other localizations. Menstrual and reproductive functions, clinical symptoms, surgical history, and extension and type of surgical procedures were assessed. The t-test and Fisher's exact test were used.

Results. The mean age of patients was 35.5 ± 6.0 years, while DIE was statistically significantly more likely to be detected at the age of 30–39 years. The leading symptoms were chronic pelvic pain, dysmenorrhea, and intestinal symptoms. 38.1% (n = 101) of women had a history of surgery for endometriosis, and they constituted a higher proportion in the DIE without EC group (44.1% vs 28.9%; p = 0.01). In this group, ovarian resections, excision, and coagulation of external genital, retrocervical, and uterosacral endometriosis, as well as urinary tract surgery and segmental bowel resections, were performed more often.

Conclusion. Deep endometriosis predominantly affects women of reproductive age and is associated with repeated and traumatic surgeries. Surgery in patients with DIE due to the technical difficulty should be performed by a multidisciplinary team, and is associated with severe complications caused by damage to organs and anatomical structures. The data obtained emphasize the need to use comprehensive programs to prevent adhesion formation in such patients, including the use of bovhyaluronidase azoximer.

About the authors

Natalya A. Buralkina

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Author for correspondence.
Email: natalyaburalkina@yandex.ru
ORCID iD: 0000-0001-5109-6725

D. Sci. (Med.)

Russian Federation, Moscow

Mariam A. Vardanyan

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology

Email: natalyaburalkina@yandex.ru
ORCID iD: 0009-0002-4619-1431

Graduate Student

Russian Federation, Moscow

Natalya A. Chekeneva

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology; Sechenov First Moscow State Medical University (Sechenov University)

Email: natalyaburalkina@yandex.ru
ORCID iD: 0009-0008-6645-6648

Applicant; Obstetrician-Gynecologist, Ultrasound Doctor

Russian Federation, Moscow; Moscow

Mariia D. Salnikova

Pirogov Russian National Research Medical University (Pirogov University)

Email: natalyaburalkina@yandex.ru

Student

Russian Federation, Moscow

References

  1. Щукина Н.А., Буянова С.Н. Современный взгляд на диагностику и лечение эндометриоза. РМЖ. Мать и дитя. 2014;14:1002-5 [Shchukina NA, Buianova SN. Sovremennyi vzgliad na diagnostiku i lechenie endometrioza. RMZh. Mat' i ditia. 2014;14:1002-5 (in Russian)].
  2. Линде В.А., Ермолова Н.В., Маркарьян И.В., и др. Новые подходы в диагностике и лечении эндометриоза. Главный врач. Гинекология. 2013;4(35):15-8 [Linde VA, Ermolova NV, Markar'ian IV, et al. Novye podkhody v diagnostike i lechenii endometrioza. Glavnyi vrach. Ginekologiia. 2013;4(35):15-8 (in Russian)].
  3. Доброхотова Ю.Э., Маркова Э.А., Хлынова С.А., Нариманова М.Р. Эндометриоз. Обзор клинического протокола под разным углом зрения (дискуссия). РМЖ. Мать и дитя. 2024;7(2):89-97 [Dobrokhotova IuE, Markova EA, Khlynova SA, Narimanova MR. Endometrioz. Obzor klinicheskogo protokola pod raznym uglom zreniia (diskussiia). RMZh. Mat' i ditia. 2024;7(2):89-97 (in Russian)]. doi: 10.32364/2618-8430-2024-7-2-1
  4. Адамян Л.В., Курило Л.Ф., Шуляк И.Ю. Фолликулогенез яичников женщин с некоторыми формами эндометриоза. Проблемы репродукции. 2009;15(1):78-85 [Adamian LV, Kurilo LF, Shuliak IIu. Follikulogenez iaichnikov zhenshchin s nekotorymi formami endometrioza. Problemy reproduktsii. 2009;15(1):78-85 (in Russian)].
  5. Ramírez-Pavez TN, Martínez-Esparza M, Ruiz-Alcaraz AJ, et al. The Role of Peritoneal Macrophages in Endometriosis. Int J Mol Sci. 2021;22(19):10792. doi: 10.3390/ijms221910792
  6. Marquardt RM, Kim TH, Shin JH, Jeong JW. Progesterone and Estrogen Signaling in the Endometrium: What Goes Wrong in Endometriosis? Int J Mol Sci. 2019;20(15):3822. doi: 10.3390/ijms20153822
  7. Coccia ME, Rizzello F, Mariani G, et al. Impact of endometriosis on in vitro fertilization and embryo transfer cycles in young women: a stage-dependent interference. Acta Obstet Gynecol Scand. 2011;90(11):1232-8. doi: 10.1111/j.1600-0412.2011.01247.x
  8. Somigliana E, Infantino M, Candiani M, et al. Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications. Hum Reprod. 2004;19(1):168-71. doi: 10.1093/humrep/deg513
  9. Wahl KJ, Orr NL, Lisonek M, et al. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med. 2020;8(2):274-81. doi: 10.1016/j.esxm.2020.01.002
  10. Raftery AT. Regeneration of parietal and visceral peritoneum in the immature animal: a light and electron microscopical study. Br J Surg. 1973;60(12):969-75. doi: 10.1002/bjs.1800601214
  11. Gómez-Gil V, García-Honduvilla N, Pascual G, et al. Peritoneal adhesion formation and reformation tracked by sequential laparoscopy: optimizing the time point for adhesiolysis. Surgery. 2010;147(3):378-91. doi: 10.1016/j.surg.2009.10.011
  12. Yu SL, Singh S, Chen HW, et al. Intra-abdominal adhesion formation induces anti-oxidative injury, enhances cell proliferation, and prevents complement-mediated lysis. Wound Repair Regen. 2008;16(3):388-98. doi: 10.1111/j.1524-475X.2008.00378.x
  13. Cahill RA, Wang JH, Soohkai S, Redmond HP. Mast cells facilitate local VEGF release as an early event in the pathogenesis of postoperative peritoneal adhesions. Surgery. 2006;140(1):108-12. doi: 10.1016/j.surg.2006.01.020
  14. Chen S, Liu Y, Zhong Z, et al. Peritoneal immune microenvironment of endometriosis: Role and therapeutic perspectives. Front Immunol. 2023;14:1134663. doi: 10.3389/fimmu.2023.1134663
  15. Zhang H, Sheng S, Pan Z, et al. Immune and endocrine regulation in endometriosis: what we know. Journal of Endometriosis and Uterine Disorders. 2023;4:100049. doi: 10.1016/j.jeud.2023.100049
  16. Карева Е.Н., Донсков С.В. Гиалуроновая кислота и гиалуронидаза: от молекулярных механизмов к клиническому применению. Гинекология. 2025;27(2):157-71 [Kareva EN, Donskov SV. Pharmacological aspects of hyaluronic acid metabolism: A review. Gynecology. 2025;27(2):157-71 (in Russian)]. doi: 10.26442/20795696.2025.2.203308
  17. Practice Committee of the American Society for Reproductive Medicine. Control and prevention of peritoneal adhesions in gynecologic surgery. Fertil Steril. 2006;86(5 Suppl. 1):S1-5. doi: 10.1016/j.fertnstert.2006.07.1483
  18. Adamyan L, Pivazyan L, Krylova E, et al. Hyaluronic acid in the prevention of adhesions after gynecological surgery: systematic review and meta-analysis. Journal of Endometriosis and Uterine Disorders. 2024;6:100070. doi: 10.1016/j.jeud.2024.100070
  19. Fazel Anvari-Yazdi A, Badea I, Chen X. Biomaterials in Postoperative Adhesion Barriers and Uterine Tissue Engineering. Gels. 2025;11(6):441. doi: 10.3390/gels11060441
  20. Ярмолинская М.И., Сельков С.А., Мануйлова Т.Ю., и др. Эффективность применения протеолитического препарата Лонгидаза в комбинированном лечении спаечного процесса у больных наружным генитальным эндометриозом. Иммунология. 2015;2:116-21 [Iarmolinskaia MI, Sel'kov SA, Manuilova TIu, et al. Effektivnost' primeneniia proteoliticheskogo preparata Longidaza v kombinirovannom lechenii spaechnogo protsessa u bol'nykh naruzhnym genital'nym endometriozom. Immunologiia. 2015;2:116-21 (in Russian)].
  21. Оразов М.Р., Радзинский В.Е., Хамошина М.Б., и др. Эффективность комплексной терапии тазовой боли, ассоциированной с аденомиозом. Трудный пациент. 2020;4:34-40 [Orazov MR, Radzinskii VE, Khamoshina MB, et al. Effektivnost' kompleksnoi terapii tazovoi boli, assotsiirovannoi s adenomiozom. Trudnyi patsient. 2020;4:34-40 (in Russian)].
  22. Стрижаков А.Н., Пирогова М.Н., Шахламова М.Н., и др. Профилактика и лечение спаечного процесса после оперативного лечения апоплексии яичника. Российский вестник акушера-гинеколога. 2015;2:36-42 [Strizhakov AN, Pirogova MN, Shahlamova MN, Voloshhuk I.N., et al. Profilaktika i lechenie spaechnogo processa posle operativnogo lechenija apopleksii jaichnika. Rossijskij vestnik akushera-ginekologa. 2015;2:36-42 (in Russian)].
  23. Кузнецов М.Р., Болдин Б.В., Родионов С.В., и др. Профилактика стеноза сосудистых анастомозов при хирургическом лечении хронических облитерирующих заболеваний артерий нижних конечностей. Хирургия. 2010;11:56-61 [Kuznecov MR, Boldin BV, Rodionov SV, et al. Profilaktika stenoza sosudistyh anastomozov pri hirurgicheskom lechenii hronicheskih obliterirujushhih zabolevanij arterij nizhnih konechnostej. Hirurgija. 2010;11:56-61 (in Russian)].
  24. Pakhomova A, Pershina O, Bochkov P, et al. Anti-Inflammatory and Antifibrotic Potential of Longidaze in Bleomycin-Induced Pulmonary Fibrosis. Life (Basel). 2023;13(9):1932. doi: 10.3390/life13091932
  25. Ярмолинская М.И., Радзинский В.Е., Оразов М.Р., и др. Оценка эффективности бовгиалуронидазы азоксимера в комбинированном лечении больных наружным генитальным эндометриозом на основании результатов многоцентрового проспективного неинтервенционного исследования (ISLAND). Гинекология. 2021;23(5):392-401 [Yarmolinskaya MI, Radzinsky VE, Orazov MR, et al. Evaluation of bovhyaluronidase azoxymer efficacy in combined treatment of patients with endometriosis based on the results of multicenter prospective non-interventional study (ISLAND). Gynecology. 2021;23(5):392-401 (in Russian)]. doi: 10.26442/20795696.2021.5.201211

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