INTRODUCTION: Surgical experience and hospital procedure volumes have been associated with the risk of severe complications in expert centers for endometriosis in France. However, little is known about other certified units in Central European countries. MATERIAL AND METHODS: This retrospective observational study included 937 women who underwent surgery for colorectal endometriosis between January 2018 and January 2020 in 19 participating expert centers for endometriosis. All women underwent complete excision of colorectal endometriosis by rectal shaving, discoid or segmental resection. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification system including anastomotic leakage, fistula, pelvic abscess and hematoma. Surgical outcomes of centers performing less than 40 (group 1), 40-59 (group 2) and ≥60 procedures (group 3) over a period of 2 years were compared. RESULTS: The overall complication rate of grade III and IV complications was 5.1% (48/937), with rates of anastomotic leakage, fistula formation, abscess and hemorrhage in segmental resection, discoid resection and rectal shaving, respectively, as follows: anastomotic leakage 3.6% (14/387), 1.4% (3/222), 0.6% (2/328); fistula formation 1.6% (6/387), 0.5% (1/222), 0.9%; (3/328); abscess 0.5% (2/387), 0% (0/222) and 0.6% (2/328); hemorrhage 2.1% (8/387), 0.9% (2/222) and 1.5% (5/328). Higher overall complication rates were observed for segmental resection (30/387, 7.8%) than for discoid (6/222, 2.7%, P = 0.015) or shaving procedures (12/328, 3.7%, P = 0.089). No significant correlation was observed between the number of procedures performed and overall complication rates (rSpearman = -0.115; P = 0.639) with a high variability of complications in low-volume centers (group 1). However, an intergroup comparison revealed a significantly lower overall severe complication rate in group 3 than in group 2 (2.9% vs 6.9%; P = 0.017) without significant differences between other groups. CONCLUSIONS: A high variability in complication rates does exist in centers with a low volume of activity. Major complications may decrease with an increase in the volume of activity but this effect cannot be generally applied to all institutions and settings.

Brussels IVF Center for Reproductive Medicine Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium

Department of Gynecologic Endocrinology and Reproductive Medicine Medical University of Innsbruck Innsbruck Austria

Department of Gynecology and Obsterics Medical University Hospital Münster Münster Germany

Department of Gynecology and Obsterics Medical University of Bern Inselspital Bern Switzerland

Department of Gynecology and Obsterics Medical University of Vienna Vienna Austria

Department of Gynecology and Obstetrics Kepler Medical University of Linz Linz Austria

Department of Gynecology and Obstetrics Pius Hospital Universitätsmedizin Oldenburg Carl von Ossietzky University of Oldenburg Oldenburg Germany

Department of Gynecology Center for Endometriosis Hospital St John of God; Rudolfinerhaus Private Clinic and Campus Vienna Austria

Department of Obstetrics and Department of Gynecology Rhineland Clinic Dormagen Germany

Department of Obstetrics and Department of Gynecology University of Prague Prague Czech Republic

Department of Obstetrics and Department of Gynecology University of Tübingen Tübingen Germany

Department of Obstetrics and Gynecology Johanna Etienne Hospital Neuss Germany

Department of Obstetrics and Gynecology Martin Luther Hospital Berlin Berlin Germany

Department of Obstetrics and Gynecology Medius Klinik Ostfildern Ostfildern Germany

Department of Obstetrics and Gynecology Technical University Dresden Dresden Germany

Department of Obstetrics and Gynecology University Saarland Homburg Germany

Department of Obstetrics and Gynecology Vidiakliniken Diakonissen Hospital Karlsruhe Karlsruhe Germany

Department of Obstetrics and Gynecology with Center for Oncological Surgery Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin and Berlin Institute of Health Berlin Germany

Department of Obstetrics and Gynecology Znojmo District Hospital Znojmo Czech Republic

Gynecological Practice Drs Keckstein Villach Austria

Praxisklinik am Rosengarten Mannheim Germany

Statistix Institute Klagenfurt Austria

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