FCO-210 Is there still a place for staging laparoscopy – minimising risk – An experience of a tertiary BSGE accredited centre of 2 years

Endometriosis surgery can be one of the most complex operations surgeons perform, requiring a multidisciplinary (MDT) approach between colorectal, urology, fertility, radiology and other disciplines to optimise surgical planning prior to surgery. 

Methods

We reviewed 300 cases of complex endometriosis over a two-year period which have gone through robust multidisciplinary discussion to finalise plan for surgical management. All MDT outcomes were analysed to measure the accuracy of surgical decisions. Surgical decisions were divided into two major categories: Gynaecology-team only surgery or joint surgery with another team (colorectal, or urology). Further analysis of joint cases with urology was also performed. 

Results

Radiological interpretation of MRI imaging and MDT discussions led to decisions for endometriosis surgeries to be carried out by an experienced endometriosis surgeon or in a joint setting with colorectal surgery. The decision for joint surgery was based on involvement of rectal muscularis, bowel lumen narrowing, multiple bowel lesions or additional risk factors such as inflammatory bowel disease. 

Surgical planning decisions were accurate in 138 out of 150 cases, indicating 92% accuracy of correctly identifying surgical complexity. In the remaining 10 cases, disease was found to be less or more than described by the MRI which led to emergency intra-operative review by colorectal surgeons. Two cases were converted to two-stage surgery and returned for joint surgeries at a later date. 

Conclusion 

MDT has a central role in the surgical planning of complex endometriosis cases. There is no place for routine staging laparoscopies in the modern management of complex endometriosis.