Postoperative outcomes following surgery for deep endometriosis of the
sacral plexus and sciatic nerve: a 52-patient consecutive series
Background: Surgical management of deep endometriosis infiltrating
pelvic nerves may allow an overall improvement in pain and neurologic
disorders. Objective: To assess 1-year postoperative outcomes of surgery
for deep endometriosis involving sacral roots and the sciatic nerve.
Study Design: Retrospective study including 52 women undergoing surgery
for deep endometriosis involving sacral roots and the sciatic nerve. We
assessed 1-year postoperative outcomes. Results: Deep endometriosis
involved sacral roots in 49 women (94.2%) and the sciatic nerve in 3
cases (5.8%). Sciatic pain was recorded in 43 women (82.7%), pudendal
neuralgia in 11 women (21.2%) and leg motor weakness in 14 cases
(27%). Surgical procedures carried out on pelvic nerves included
complete releasing and decompression (92.3%), excision of epineurium
(5.8%) and intraneural excision (1.9%). Additional procedures involved
the digestive tract in 82.7% of cases and the urinary tract in 46.2%.
Rectovaginal fistula occurred in 13.5% of cases. Self-catheterisation
was required in 14 cases (27%) at 3 weeks after surgery, and in only 3
women (5.8%) 12 months later. One-year follow up showed significant
improvement in quality of life using SF36 and standardised
gastrointestinal scores. De novo hypoesthesia, hyperaesthesia or
allodynia were recorded in 9 women (17.2%). The cumulative pregnancy
rate was 77.2% following natural conception in 47%. Conclusions:
Laparoscopic management of deep endometriosis involving sacral roots and
the sciatic nerve improves patient symptoms and overall quality of life.
Although pain reduction may be rapid following surgery, other sensory or
motor complaints including bladder dysfunction may be recorded over
months or years.