Intraoperative Care and Complications of Symptomatic Adolescent and Young Adult Patients Undergoing Laparoscopy to Diagnose and/or to Treat Endometrioses: A Multi-Institutional Review

Study Objective: This multi-institutional, retrospective study explores the risks of laparoscopy for diagnosis and treatment of endometriosis to facilitate shared medical decision-making in patients age < 22 years old with chronic pain considering surgery. Methods: A retrospective review of patients less than 22 years old who had surgically proven endometriosis at eight pediatric hospitals was completed. Patient demographics, operative interventions, concurrent procedures, and complications were evaluated. Results: There were 284 patients with pathologically confirmed endometriosis with a median age of 16.86 years (15.51, 18.06). During the index procedure, diagnostic biopsy alone was performed (35.92%), followed by ablation (29.93%), excision (20.07%), excision and ablation (12.68%), and cryoablation (1.41%). Most common procedures performed concurrently included LNG-IUS placement (58.10%), ovarian cystectomy (11.27%), endoscopy (1.76%), and appendectomy (1.41%). Most patients (86.27%) experienced no postoperative complications within 30 days of the procedure. Significant postoperative pain was seen in 14 patients (4.93%) with 9 patients (3.17%) requiring additional narcotics and 5 patients (1.76%) requiring admission for pain control. One patient experienced a venous thromboembolism (0.35%). Reoperation rate was 12.32% with a median interval of 1.7 years (IQR: 0.93, 4) from initial surgery. Conclusions: We demonstrate that laparoscopy for diagnosis and/or treatment of endometriosis has low complication and reoperation rates in adolescent and young adult patients. Performing concurrent indicated procedures, particularly LNG-IUS placement, is safe and should be considered to avoid additional anesthesia exposure and cost. Anticipatory guidance regarding postoperative pain may be beneficial in this patient population. This evidence-based data aids in shared medical decision-making.