Anatomical distribution of deeply infiltrating endometriosis: Surgical implications and proposition for a classification

Charles Chapron, Arnaud Fauconnier, Marco Vieira, Habib Barakat, B. Dousset, Valeria Pansini, M. C. Vacher-Lavenu, J. B. Dubuisson

Research output: Contribution to journalArticlepeer-review


Background: Deeply infiltrating endometriosis (DIE) is recognized as a specific entity responsible for pain. The distribution of locations and their contribution to surgical management has not been previously studied. Methods: Medical, operative and pathological reports of 241 consecutive patients with histologically proven DIE were analysed. DIE lesions were classified as: (i) bladder, defined as infiltration of the muscularis propria; (ii) uterosacral ligaments (USL), as DIE of the USL alone; (iii) vagina, as DIE of the anterior rectovaginal pouch, the posterior vaginal fornix and the retroperitoneal area in between, and (iv) intestine, as DIE of the muscularis propria. Results: A total of 241 patients presented 344 DIE lesions: USL (69.2%; 238); vaginal (14.5%; 50); bladder (6.4%; 22); intestinal (9.9%; 34). The proportion of isolated lesions differed significantly according to the DIE location: 83.2% (198) for USL DIE; 56.0% (28) for vaginal DIE; 59.0% (13) for bladder DIE; 29.4% (10) for intestinal DIE (P <0.0001). The total number of DIE lesions varied significantly according to the location (P <0.0001). In 39.1% of cases (9/23) intestinal lesions were multifocal. Only 20.6% (seven cases) of intestinal DIE were isolated and unifocal. Conclusions: Multifocality must be considered during the pre-operative work-up and surgical treatment of DIE. We propose a surgical classification based on the locations of DIE. Operative laparoscopy is efficient for bladder, USL and vaginal DIE. However, indications for laparotomy still exist, notably for bowel lesions.

Original languageEnglish
Pages (from-to)157-161
Number of pages5
JournalHuman Reproduction
Issue number1
Publication statusPublished - Jan 1 2003


  • Deep endometriosis
  • Deeply infiltrating endometriosis
  • Operative laparoscopy
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Developmental Biology
  • Obstetrics and Gynaecology
  • Reproductive Medicine


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