SURGICAL CLASSIFICATION OF ENDOMETRIOSIS REVISITED

Objective: To propose new approaches to the classification of the disease based on the analysis of 2352 operations of patients with endometriosis performed in the department over 10 years. Materials and methods: A total of 12125 operations were performed in the surgical department. Surgeries for endometriosis accounted for 19.4% of them (2352/12 125). In 81.9% of cases, endometriosis was the main indication for surgical treatment. The mean age of the patients was 34.1±6.03 years. There were the following forms of the disease: ovarian endometriosis in 13.9% of cases, superficial endometriosis in 49.4% of cases, deep endometriosis with the lesion of the underlying layers of the peritoneum (muscular, submucosal, subperitoneal) in 58.3% of cases, nodular adenomyosis (the size of adenomyotic nodule exceeding 2 cm) in 3.6% of cases. Results: We proposed a new approach to the classification of endometriosis based on the depth of the lesion and type of surgical technology. The patients with stage 1 (superficial endometrioid heterotopias with a lesion depth not exceeding one layer) amounted to 25.7%; the rate of patients with stage 2 (endometriosis with the lesion of two layers (peritoneum, muscle/abdominal layers of any anatomical structure)) was 43.3%; stage 3 (endometriosis with the lesion of all layers of any anatomical structure, but without organ dysfunction) was noted in 17.2% of cases; stage 4 (endometriosis with the lesion of all layers of any anatomical structure and organ dysfunction) was detected in 7.1% of patients. Different methods of surgical treatment of endometriosis were applied, depending on the depth of the lesion: coagulation was used in 95% of patients with stage 1 lesion, excision was used only in 5% of cases with peritoneal confluent lesion. The main method of surgical treatment of patients with stage 2 was excision (100%) followed by suturing or coagulation. The clinical picture of the disease was determined not by the number of foci but by the depth of the lesion since the neurovascular unit was involved. The main method of removal of foci in patients with stage 3 (endometriosis of all layers of the organ but without impairment of its function) was excision/resection, and the method of restoring the integrity of the organ/tissue was suturing/anastomosis. In case of damage to all layers and organ dysfunction (stricture, angulation, damage to neighboring organs), the extent of surgical treatment was expanded to resection in 95% and removal of the organ in 5% of cases. Conclusion: This classification of endometriosis is relevant as the severity of endometriosis is assessed not due to the extension of the lesion but according to its depth. The use of this classification may help to identify the severity of the course of the disease most accurately and to predict further treatment tactics and rehabilitation which can improve reproductive outcomes and quality of life.

endometriosis, classification, surgical treatment, coagulation, excision, resection, genital endometriosis, extragenital endometriosis, scoring system, stage, severity, superficial endometriosis, deep endometriosis