Perioperative Morbidity and Recurrence After One-Stage Laparoscopic Resection for Multicompartment Deep Endometriosis: A Multicentre Cohort Study

Flavia Pagano, Pál Sík, Pál Botond Sík, Sara Imboden, Attila Bokor, Mueller MD, Michael D. Mueller
BJOG: An International Journal of Obstetrics & Gynaecology · 2026 · doi:10.1111/1471-0528.70366 · PMID:42972913 · W7225171096
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In a multicentre cohort of 299 patients with deep endometriosis, one-stage laparoscopic resection yielded a 12% complication rate and 14.4% recurrence, where greater anatomical extent predicted complications but surgical technique did not affect recurrence-free survival.

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Abstract

OBJECTIVE: To evaluate perioperative morbidity, factors associated with postoperative complications and documented recurrence after one-stage laparoscopic resection for multicompartment deep endometriosis. DESIGN: Retrospective multicentre cohort study. SETTING: Two tertiary referral centres specialised in endometriosis surgery (Bern, Switzerland; Budapest, Hungary). POPULATION: A total of 299 consecutive patients with pathologically confirmed deep endometriosis undergoing one-stage laparoscopic resection between January 2017 and December 2025. INTERVENTIONS: One-stage laparoscopic resection of multicompartment deep endometriosis. MEASUREMENTS AND MAIN RESULTS: Clinically relevant postoperative complications were defined as Clavien-Dindo Grade ≥ II. Multivariable logistic regression assessed associated factors. Recurrence-free survival was evaluated using Kaplan-Meier analysis in patients with an available recurrence time or censoring time. Postoperative complications occurred in 36/299 patients (12.0%), including 35/299 (11.7%) with Grade ≥ II complications and 14/299 (4.7%) with Grade ≥ IIIb complications. Greater #ENZIAN deep endometriosis anatomical extent was independently associated with clinically relevant complications (adjusted odds ratio 1.51 per additional involved compartment, 95% confidence interval 1.04-2.18). Documented recurrence occurred in 43/299 patients (14.4%) and 26/299 (8.7%) underwent reoperation for recurrence. Follow-up duration was available for 231/299 patients (77.3%). Recurrence-free survival did not differ significantly according to bowel (log-rank p = 0.431) or bladder surgical technique (p = 0.116). CONCLUSION: Greater #ENZIAN deep endometriosis anatomical extent was independently associated with clinically relevant postoperative complications following one-stage surgery for multicompartment deep endometriosis, suggesting that overall anatomical disease extent may better reflect surgical complexity than involvement of a single anatomical site. These findings support the role of anatomical disease extent in preoperative counselling and individualised surgical planning.

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