Prevalence of endometriosis in women undergoing laparoscopic surgery for various gynecological indications in a Jordanian referral center: understanding the epidemiology of a major female health problem | BMC Women’s Health


Study the demographics of a sample

A total of 460 patients who underwent gynecologic laparoscopic surgery between 2015 and 2020 were included in this study, with a mean age of 33.09 (± 7.45) years (SD). Characteristics of the sample included, including age; BMI; parity; and the number of miscarriages, ectopic pregnancies and cesarean sections are shown in Table 1.

Table 1 Main demographic characteristics of the patients included in the study sample

Overall prevalence of endometriosis

The overall prevalence of endometriosis in all patients was 13.7% (Table 2). Diagnostic laparoscopy was the most common procedure performed in 251 (54.6%) patients. Infertility was the most common indication in 177 (38.5%) patients. The diagnosis was made by the surgeon, identifying the characteristics of the endometriosis. Based on the description of the lesions provided in the patient charts, the type of endometriosis was determined (subtle, typical, cystic or deep) by the surgeon during the procedure. Histopathologic examination of suspected endometriotic tissue samples was available for 13 patients (21% of those with clinical signs of endometriosis) and, when available, there was 100% agreement with clinical findings. These were patients who, prior to surgery, had consented to excision of the cystic lesion or to oophorectomy and for whom an intraoperative diagnosis of ovarian endometrioma was made on the basis of gross appearance. This was then confirmed by histopathology for all cases. The histopathological examination was performed by one of two pathologists with particular interest and expertise in gynecological diseases.

Table 2 Numbers and percentages of patients with and without signs of endometriosis during laparoscopy

Eighteen (28.6%) patients underwent some form of surgical treatment (resection of the endometrioma, removal of endometriotic lesions or adhesiolysis at the time of primary operation), as there was a previous suspicion of the presence of pathology; therefore, patients consented to further surgical management. For another 10 patients (15.9%), they were recommended to undergo further surgery to treat endometriosis as a second stage procedure after obtaining the appropriate consent and preparing the patient. In the remaining patients, the finding of endometriosis was not associated with disease-related symptoms; it was therefore considered as an accessory, not requiring surgical treatment at this stage.

Tables 3 and 4 contain the types of laparoscopic surgeries that were performed on the sample of patients in this study and their indications.

Table 3 Types of laparoscopic surgeries performed on 460 patients
Table 4 Indications for laparoscopic surgeries performed in 460 patients

By comparing the frequency of endometriosis between the different groups, we found a statistically significant difference in the prevalence of endometriosis in patients undergoing laparoscopy according to the indication (p = 0.020), as detailed in Table 5. On the post hoc Z test for proportions, the difference was most significant for family planning, where the 37 (100%) patients undergoing laparoscopy for family planning indication were negative , and for chronic pelvic pain, where 5 (31.3%) endoscopies were positive. The condition was most often found when the indication for laparoscopy was chronic pelvic pain (31.3%), followed by infertility (16.9%), recurrent miscarriages (16.7%), ovarian cyst (16%), diagnosis after suspected perforation (9.7%)) and ectopic pregnancy (4.3%). No cases of endometriosis have been identified in those undergoing laparoscopy for family planning purposes, such as tubal ligation.

Table 5 Numbers and percentages of patients with versus without signs of endometriosis according to the indication for laparoscopy

Prevalence of endometriosis by type of laparoscopic procedure

Comparing different procedures with the presence of endometriosis, we did not find a significant difference (p = 0.059). Table 6 details the frequencies. A total of 50% of those who underwent laparoscopic-assisted vaginal hysterectomy had endometriosis; however, as only two patients were included in this group, it may not be very representative. Endometriosis was found in 15.9% of patients who underwent diagnostic laparoscopy, followed by those who underwent laparoscopic ovarian cystectomy (14.9%). Less commonly, the finding of endometriosis was associated with laparoscopic salpingectomy or salpingostomy (8.3%), and no cases of endometriosis were identified in patients who underwent laparoscopic oophorectomy or ligation of the ovaries. tubes.

Table 6 Numbers and percentages of patients with versus without signs of endometriosis according to the type of laparoscopic intervention

Prevalence of endometriosis by age, BMI, parity, number of miscarriages, ectopic pregnancies and cesarean sections

As shown in Table 7, the mean age of patients with endometriosis was 31.97 (SD 6.55) years, while it was 33.27 (SD 7.58) years for those without endometriosis. . This difference was not statistically significant (p= 0.155).

Table 7 Numbers and averages of patients with versus without signs of endometriosis according to the type of laparoscopic intervention

In this study population, no significant association was found between the patient’s body mass index (BMI) and the presence of endometriosis (p= 0.13). The mean BMI for patients with a positive endometriosis result was 26.4 (SD 4.3) kg / m2, while it was 27.0 (SD 4.7) kg / m2 for those without endometriosis (Table 7).

Of the 460 participants, obstetric history data was available for 436 patients. Endometriosis was significantly higher in patients with a lower number of parities (p= 0.008) and cesarean sections (p= 0.035) (Table 8). Regarding parity, endometriosis was found in patients with parities up to 4, with no cases of endometriosis found in the large multipara. The prevalence in nulliparous women was 19%. It was 19.7% for women with parity of one, 5.3% for women with parity of two, 19.0% for women with parity of 3, and 2.4% for women. with a parity of 4.

Table 8 Numbers and percentages of patients with versus without signs of endometriosis according to parity and number of miscarriages, ectopic pregnancies and cesarean sections

The prevalence of endometriosis was highest among women who had never had a cesarean section (17.4%), with those who had one to five cesarean sections having a lower prevalence than in the overall study population.

The prevalence of endometriosis was highest among those who had had no miscarriage (16.6%), followed by those who had had one (11.7%), three (8.3%) or two (3.6%) miscarriages. None of the patients who had four or more miscarriages had endometriosis. Regarding ectopic pregnancy, the prevalence was 15.1% for those who had never had an ectopic pregnancy and 33.3% for those who had had two ectopic pregnancies, while ‘none of the patients with a history of ectopic pregnancy had the disease. The association between endometriosis and the number of ectopic pregnancies and miscarriages was not found to be statistically significant.

We performed logistic regression analysis to find factors associated with endometriosis at the multivariate level. We have included variables with pvalue pvalues ​​of 0.036 and 0.046, respectively). Their odds ratios were 0.8 (95% CI 0.65-0.9) and 0.54 (95% CI 0.3-0.9), respectively.

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