Risk factors for intraoperative adhesion in ovarian endometriosis patients

Endometriosis is a common gynecological disease that can cause pelvic adhesions. Severe adhesions increase the difficulty of surgery, resulting in prolonged operation time, increased intraoperative bleeding, and increased complications such as surgical injury. Preoperative preparation can be improved if the severity of adhesions in a patient can be predicted. This study aimed to identify independent risk factors for moderate-to-severe pelvic adhesions in patients with ovarian endometriosis and evaluate the predictive performance of routine preoperative clinical and laboratory parameters for adhesion severity. A retrospective review of the medical records at our hospital was conducted to identify patients with ovarian endometriosis confirmed by pathology between January 2018 and September 2024. We collected data on age, presence of dysmenorrhea or chronic pelvic pain, location and size of ovarian cysts, routine blood tests, coagulation tests, and tumor marker tests. The patients were categorized into the no or mild adhesion group and the moderate-to-severe adhesion group based on the modified American Society for Reproductive Medicine scoring system. In this study, 128 patients were included in the no or mild adhesion group, whereas 186 patients were included in the moderate-to-severe adhesion group. There were no significant differences in body mass index size, or pain symptoms between the 2 groups. However, age, cyst location, and revised American Fertility Society stage were significantly different. When comparing routine blood tests, coagulation tests, and tumor marker tests, we found that the levels of neutrophil-to-lymphocyte ratio, cancer antigen 125 (CA125), cancer antigen 19-9 (CA19-9), and fibrinogen (FIB) were significantly higher in the moderate-to-severe adhesion group than in the group with no or mild adhesion ( P < .05). The multivariate logistic regression analysis revealed that location, age, and FIB status were independent risk factors for ovarian endometriosis. Advanced age, bilateral ovarian cysts, and elevated preoperative FIB levels are independent risk factors for moderate-to-severe pelvic adhesions in patients with ovarian endometriosis.