Complications following surgeries for endometriosis: A systematic review protocol

PLOS ONE · 7 authors, 6 centres

AI SUMMARY

FIDELITY 100%

POPULATIONFemale patients with any type of endometriosis, excluding those with concomitant gynecological cancer or other benign gynecologic surgeries such as myomectomy

INTERVENTIONAll types of surgeries for managing endometriosis

COMPARISONNot applicable (single-arm studies; comparisons between surgical approaches, procedures, etc. will be explored in subgroup analyses)

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This systematic review protocol aims to pool complication rates and identify determinants of complications following various endometriosis surgeries. The review will include cohort studies and trials from 2011 onward, focusing on perioperative and postoperative outcomes. Findings will help inform patients and clinicians about surgical risks and identify women at higher risk of complications.

Full summary

4,432 CHARS

**Background:** Endometriosis is a chronic gynecological disease affecting 5–10% of women of reproductive age, characterized by endometrial glands and stroma outside the uterus. It causes infertility, dyspareunia, intestinal disorders, and pelvic pain. Surgical management includes laparoscopy and laparotomy, with laparoscopy preferred due to better visualization and shorter recovery. Perioperative and postoperative complications include bleeding, infection, thrombophlebitis, pulmonary embolism, and bowel or urinary tract injury. Reported complication rates range from 0.4% to 4.7%. Factors such as laparotomy, conversion to laparotomy, invasive procedures (e.g., hysterectomy, bowel/bladder resection, ureteric surgery), severity of endometriosis (r-ASRM staging, ENZIAN classification), high-level care centers, surgeon expertise, previous surgery, and complex procedures may influence complication risk. However, complication rates across different surgeries and their determinants remain unclear. This systematic review aims to describe complication rates and identify determinants.

**Methods:** The protocol is registered in PROSPERO (CRD42021293865) and follows Cochrane Handbook and PRISMA guidelines. Eligibility criteria: prospective/retrospective cohort studies or trials of endometriosis surgeries with ≥30 participants, conducted after 2011, reporting perioperative and/or postoperative complications. Exclusions: gynecological cancer, concomitant benign gynecologic surgeries (e.g., myomectomy). No language restrictions. Databases: Medline (PubMed), Embase, Cochrane Library, Web of Science, Google Scholar. References and conference abstracts will be checked; gynecological experts may identify additional studies. Two independent reviewers will screen titles/abstracts and full texts; disagreements resolved by a third reviewer. Non-English articles will be translated. Data extraction by two independent reviewers using a standardized form piloted on 3 studies. Data items: study characteristics (year, location, design, sample size, follow-up), participant characteristics (age, comorbidities, BMI, surgical history, previous endometriosis surgery, parity, symptoms, race/ethnicity, severity, level of care, surgeon expertise), intervention details (surgical route, procedure type, indication), and outcomes (any complications, number with postoperative complications, major/minor complications, follow-up duration, measurement timing). Risk of bias assessed using ROBINS-I by two independent reviewers, with third reviewer for disagreements.

**Key Results:** This is a protocol; no results are reported yet. The planned analysis will pool cumulative incidences of complications using DerSimonian and Laird random-effects method. Risk ratios with 95% confidence intervals will assess relationships between potential determinants (age, BMI, surgical history, previous surgery, complex procedures, parity, race/ethnicity, high-level care centers, surgeon expertise, severity) and complications. Severity classified by r-ASRM or ENZIAN. Level of care: rural/community/regional vs. academic/national/specialized vs. unknown/mixed. Surgeon expertise categories will be created if needed. Complications classified by Clavien-Dindo (grades I-II minor, III-IV major, V death). Subgroup analyses: surgical approach (laparotomy vs. laparoscopy), surgical procedure (hysterectomy, complex techniques including bowel/urinary resection, multiple procedures, shaving/disc excision), type of endometriosis (superficial vs. deep/extensive; stages 1–4), indication (infertility, pain, other), complications considered (severe only vs. any; perioperative vs. postoperative vs. any). Adenomyosis information collected if available. Sensitivity analyses restricted to low risk of bias studies. Heterogeneity assessed with Cochran’s Q and I² (low 0–40%, moderate 30–60%, substantial 50–90%, considerable 75–100%). Publication bias assessed via funnel plots.

**Clinical Implications:** This systematic review will provide comprehensive complication rates for various endometriosis surgeries, enabling patients to make informed decisions. Identifying determinants of complications will help clinicians recognize women at higher risk, potentially optimizing perioperative care and reducing adverse outcomes. The review will also highlight gaps in evidence and guide future research to improve surgical practices for endometriosis.

PICO

PPOPULATION

Female patients with any type of endometriosis, excluding those with concomitant gynecological cancer or other benign gynecologic surgeries such as myomectomy

IINTERVENTION

All types of surgeries for managing endometriosis

OOUTCOME

Perioperative and postoperative complications (composite of any intraoperative and postoperative complications, including hemorrhage, organ injury, nerve damage, open surgery conversion, mortality, reintervention, readmission, length of surgery, length of hospital stay)

STUDY TYPE

systematic_review

SPECIALTY

gynecology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10204940

Complications following surgeries for endometriosis: A systematic review protocol

PLOS ONE

READ THE FULL PAPER

ABSTRACT

Background Endometriosis is a common gynecological condition with a wide range of symptoms, including infertility, dyspareunia, intestinal disorders, and pelvic pain. Laparoscopy and laparotomy are used widely for diagnosing and managing endometriosis. We will conduct a systematic review and meta-analysis with the aims of reporting complications rates following each type of surgeries for endometriosis and determinants of complications. Method We will search Medline (via PubMed), Embase, the Cochrane Library, Web of Science, and Google Scholar for both retrospective and prospective cohorts or trials of at least 30 participants reporting perioperative and postoperative complications for endometriosis surgeries. We will restrict the studies to those conducted after 2011, to be representative of current practices, and will exclude studies of surgeries for gynecological cancer, or other concomitant benign gynecologic surgeries such as myomectomy. Two reviewers will independently screen references and select eligible studies. A standardized form will be used to collect data related to the baseline characteristics, potential determinants of complications, types of interventions, and outcomes. Cumulative incidences of complications will be pooled using DerSimonian and Laird random-effects method. The relation between potential determinants and complications will be reported with risk ratios and their 95% of confidence intervals. Subgroup analysis of surgical approach, surgical procedure, superficial and deep infiltrating endometriosis, and the indication of surgery will be conducted. Sensitivity analyses restricted to studies with low risk of bias will be performed. Discussion This systematic review will provide information on the rates of complications for different surgical approaches and procedures for the treatment of endometriosis. It will contribute to inform patients when making decisions regarding their care. Identifying potential determinants of complications will also help to improve care by identifying women being at higher risk of complications. Trial registration Systematic review registration: CRD42021293865 .

CITATION EXPORT

Foruzan Bahrami, Sarah Maheux-Lacroix, Olga Bougie et al.. Complications following surgeries for endometriosis: A systematic review protocol. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0285929

AUTHORS

7 · 6 CENTRES

Foruzan Bahrami, Sarah Maheux-Lacroix, Olga Bougie, Amélie Boutin, Diego Raimondo, Diego Raimondo, Diego Raimondo

1 Reproduction, Mother and Youth Health Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
2 Department of Obstetrics and Gynaecology, Université Laval, Quebec City, Quebec, Canada
3 Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario, Canada
4 Population Health and Optimal Health Practices Unit, CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
5 Department of Pediatrics, Université Laval, Quebec City, Quebec, Canada
Dipartimento di Scienze Mediche e Chirugiche (DIMEC), Orsola Hospital, ITALY

EDITOR / REVIEWER

Diego Raimondo