Deep Infiltrating Endometriosis is Frequent in All Stages of Endometriosis and the Depth of Infiltration Influences Surgical Parameters Proportionally

Abstract

Background

Deep infiltrating endometriosis (DIE) in contrast to superficial endometriosis is known to cause intense pain-related symptoms depending on the anatomic region and depth of infiltration. Despite the known impact of DIE, clinical comparison to superficial endometriosis is difficult to accomplish because no DIE classification is used regularly and the rASRM score does not consider DIE adequately.

Methods

We regularly use the ENZIAN classification to group DIE additionally to the rASRM score. The surgical treatment of patients without prior known endometriosis from January 2006 to December 2008 was evaluated in relation to the classification systems used.

Results

The study population included 100 patients and all were scored according to the rASRM score. Forty-two percent (42/100) presented with DIE and were additionally classified to the ENZIAN score. In all rASRM stages of endometriosis, a high rate of over 33% DIE was found with a maximum of 80% in stage 4 patients. Patient characteristics did not differ between patients with superficial EM and DIE. Laparoscopy was the main surgical approach regardless of the type of endometriosis. The presence of intra-abdominal adhesions, duration of excisional surgery and hospital stay correlated with the depth of infiltration according to the ENZIAN.

Conclusions

This is the first study to reveal that the presence of DIE is an unexpectedly frequent finding in all rASRM stages. Though patient characteristics do not differ between DIE and superficial EM, the surgical parameters for adequate excisional surgery are significantly different and proportionally influenced by the depth of infiltration.