(122) Surgical Management and Postoperative Complications in Adolescents with Pathology Proven Endometriosis

Background: Adolescents with significant dysmenorrhea may have endometriosis. When medical management is unsuccessful or unsatisfactory, some choose laparoscopy alone or with other procedures to potentially diagnose and/or treat endometriosis. ACOG calls for a shared medical decision making regarding diagnostic laparoscopy. However, risks associated with laparoscopy specific to this patient population are not well described. This multi-institutional study sought to characterize intraoperative management and complications for adolescents with pathology confirmed endometriosis.

Methods: Preliminary review of patients < 22 years by 6 of 8 tertiary care pediatric hospitals was completed. Patients were identified through pathology records. Demographics, operative intervention, and postoperative complications were extracted. Descriptive statistics were computed.

Results: Among 225 patients, median age was 15.8 years (IQR: 14.6, 17.4) at first presentation to gynecology and 17.1 years (IQR: 15.6, 18.3) at the time of index operation. Laparoscopic lesion ablation (57.3%) was more commonly performed than excision (26.7%) and 5.3% of patients underwent laparoscopy without additional interventions. The most common concurrent procedure was hormonal intrauterine system placement (LNG-IUS, 53.8%). Concurrent endoscopy was performed in 2.2% of cases and appendectomy in 0.9%. The most common postoperative complication within 30 days was pain, impacting 6.7% of patients. Additional narcotics were prescribed in 4.0% and hospital admission was required in 2.7% of patients. One patient had a venous thromboembolism. No patients had postoperative bleeding that required operative intervention. Patients infrequently required reoperation (12.0%) and median interval to reoperation was 1.4 years (IQR: 0.8, 1.9). Of those undergoing reoperation, the most common indication was LNG-IUS placement (37.0%), followed by laparoscopic ablation of endometriosis (33.3%), and laparoscopic excision of endometriosis (25.9%).

Conclusions: This study provides evidence-based data to aid in counseling patients and families considering laparoscopy. Surgical ablation of endometriotic lesions was performed more commonly than excision. Many patients had LNG-IUS insertion at the time of their primary laparoscopy. Concurrent endoscopy at the time of diagnostic laparoscopy was feasible in this patient population. Pain greater than anticipated was the most common postoperative concern seen in 6.7% of patients. Few patients required reoperation. The most common indication for reoperation was LNG-IUS insertion, followed by ablation and then excision of endometriosis. Complications were uncommon.