Arch Gynecol Obstet. 2026 Aug 6;313(1):246. doi: 10.1007/s00404-026-08545-6.
ABSTRACT
OBJECTIVE: To evaluate whether preoperative clinical Enzian scoring and digital rectal examination improve accuracy of operative time prediction and surgical outcomes in women undergoing surgery for endometriosis.
DESIGN: Prospective, randomized, multicenter pilot trial.
SETTING: Three urban teaching hospitals certified as endometriosis centers.
PATIENTS: A total of 107 women undergoing surgery for endometriosis.
INTERVENTIONS: The participants were randomly assigned to three groups: Group 1 underwent clinical Enzian scoring combined with digital rectal examination (DRE); Group 2 underwent clinical Enzian scoring only; and Group 3 underwent digital rectal examination only. All patients received standard transvaginal ultrasound examinations.
MAIN OUTCOME MEASURES: The primary endpoint was defined as an absolute difference of ≤ 10 min between the estimated and the actual operative time. Secondary end points included conversion to laparotomy, abandonment of the operation, complete resection rate, need for secondary surgery, correspondence between the preoperative Enzian assessment and intraoperative findings, and postoperative pain (visual analog scale) and patient satisfaction.
RESULTS: The primary endpoint was achieved in 9 patients (23.7%) in Group 1, 16 patients (47.1%) in Group 2, and 15 patients (42.9%) in Group 3. Exploratory comparison of the three groups did not demonstrate a statistically significant difference in the proportion of accurate operative time estimations. Secondary endpoints, including conversion rate, abandonment of the operation, complete resection rate, reoperation rate, and patient-reported outcomes, were also comparable across the groups.
CONCLUSIONS: The results demonstrate that neither diagnostic strategy provided a measurable advantage in predicting operative time or improvement of surgical outcome parameters.
STUDY REGISTRATION NUMBER: DRKS00040760.
PMID:42560420 | DOI:10.1007/s00404-026-08545-6
