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• Posted October 31, 2023

Endometriosis Can Complicate a Hysterectomy

Patients living with endometriosis are more likely to have complications during and after a hysterectomy, new research indicates.

Knowing that, surgeons should be prepared for these problems from the outset, the researchers from University of Texas Southwestern Medical Center noted.

Among the surgical complications are the need for blood transfusions and increased risk of infection.

"This study affirms what many of us in gynecology and surgery have known but needed large numbers of surgical cases to substantiate: that patients with endometriosis are at increased risk of complications if they have a hysterectomy,"said study leader Dr. Kimberly Kho, a professor of obstetrics and gynecology and associate chief of gynecology at UT Southwestern.

Endometriosis is a painful condition that affects about 15% of women and is a major cause of infertility. It causes tissue similar to that in the uterine lining to grow outside the womb, and hysterectomy is a frequent solution, Kho said.

About 600,000 hysterectomies are performed every year in the United States, according to the U.S. Centers for Disease Control and Prevention.

The surgery involves removing the uterus, usually due to cancer diagnosis; to treat noncancerous growths called fibroids, and to treat uterine prolapse, in which pelvic floor muscles and ligaments fail to support the uterus.

In the study, the authors used data from the American College of Surgeons National Surgical Quality Improvement Program database, which includes information provided by more than 700 hospitals. The information covers 150 variables that describe outcomes for patients before, during and 30 days after surgery for patients undergoing major outpatient and inpatient surgeries.

The team identified more than 127,000 hysterectomies between Jan. 1, 2014, and Dec. 31, 2019, for reasons other than cancer.

Among these, about 15.4% were associated with endometriosis that had either been diagnosed before surgery or had been recognized during surgery.

The study found the incidence of all postoperative complications was about 1.7% higher in patients with endometriosis.

This included minor complications such as urinary tract and wound infections, and major issues including sepsis, blood transfusions and postoperative readmissions.

Patients with endometriosis were also more likely to have longer procedures and need other surgical procedures at the time of their hysterectomy.

These included gastrointestinal surgeries, such as appendectomies or bowel resections, and surgeries affecting ovaries, fallopian tubes and pelvic floor ligaments.

The findings were published recently in the Journal of Minimally Invasive Gynecology.

The authors noted that the training for gynecological surgeons in the United States often underestimates the time and skill necessary to care for patients with endometriosis, especially when the degree of the condition isn't anticipated in advance or when endometriosis isn't diagnosed before surgery.

"These data support the need for preoperative diagnostic tools to be able to anticipate and plan for complex endometriosis surgeries so that neither patients nor surgeons are surprised or unprepared for the complexity of a procedure when they are in the operating room,"Kho said in a university news release. "We also need to ensure that surgeons have the requisite skills and are prepared to deal with these often complex cases."

More information

The U.S. Office on Women's Health has more on endometriosis.

SOURCE: UT Southwestern Medical Center, news release, Oct. 25, 2023