ArticleFacts, views & vision in ObGyn2026
Surgical outcomes according to the degree of parametrial dissection with hysterectomy for deep endometriosis.
Article in Facts, views & vision in ObGyn, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: There is no standardisation of the degree of parametrial dissection and excision with hysterectomy in the presence of deep endometriosis (DE). Objectives: To apply an anatomical classification of dorso-lateral parametrectomy to hysterectomy for DE and correlate with postoperative complications and functional outcomes. Methods: Women with histologically confirmed DE who underwent hysterectomy with varying degrees of parametrectomy were retrospectively identified. Dorso-lateral parametrectomy was classified as follows: superficial (medial to presacral fascia), deep type 1 (beyond the presacral fascia), type 2 (caudal to medial rectal artery), and type 3 (laterally and deeply the hypogastric fascia). Statistical analysis was performed to correlate the degree of parametrial dissection with operative complications and functional outcomes at 6 months. Main Outcome Measures: Incidence of intra- and postoperative complications; changes in gastrointestinal, urinary, and sexual function; pain improvement. Results: Eighty-nine patients underwent parametrectomy with hysterectomy: superficial extended hysterectomy (EH) with superficial parametrectomy (EHSP, n=52), deep EH with deep parametrectomy type 1 (EHDP1, n=19), deep type 2 (EHDP2, n=12), and deep type 3 (EHDP3, n=6). Eight patients (8.9%) had intraoperative complication of which 5/52 (9.6%) underwent EHSP, 1/19 (5.3%) EHDP1, 2/12 (16.7%) EHDP2. Bladder voiding dysfunction occurred in 11 patients (12.3%) with higher incidences of 6/19 (31.6%) undergoing EHDP1 and 1/6 (16.7%) EHDP3 ( Conclusions: This classification of parametrectomy at the time of hysterectomy for DE offers a framework for assessing surgical complexity and outcomes. While substantial pain relief is observed, bladder dysfunction remains a significant concern, especially when parametrectomy extends beyond the presacral fascia. What is New?: This classification for modified radical hysterectomy provides a method to standardise the description of parametrectomy for DE, facilitating more precise correlations between the extent of disease in the parametria and functional outcomes.
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