Functional and Surgical Outcomes of Nerve-Sparing Approaches in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis.

OBJECTIVE

To evaluate the surgical safety and functional outcomes of nerve-sparing surgery in the management of deep infiltrating endometriosis (DIE).

DATA SOURCES: PubMed, Embase, Scopus, and LILACS were searched from January 2000 to August 2025 for studies evaluating nerve-sparing surgery in women with surgically confirmed DIE.

METHODS OF STUDY SELECTION: A systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines. Eligible studies included women with surgically confirmed DIE who underwent nerve-sparing procedures. Two reviewers independently screened studies and extracted data. Pooled estimates with 95% confidence intervals were calculated, and statistical heterogeneity was assessed using the I² statistic.

TABULATION, INTEGRATION AND

RESULTS

Sixteen studies involving 1,623 women were included. The pooled conversion rate to open surgery was 0.3%, while intraoperative and postoperative complication rates were 1.5% and 9.8%, respectively. Urinary voiding dysfunction occurred in 6.9% of patients, and Low Anterior Resection Syndrome occurred in 10.2%. The pooled postoperative Female Sexual Function Index score was 22.3. Substantial heterogeneity was observed across several functional outcomes.

CONCLUSION

Nerve-sparing surgery for DIE appears feasible and is associated with acceptable surgical and functional outcomes. However, the current evidence is limited, and substantial heterogeneity precludes conclusions regarding equivalence or superiority compared with conventional surgery. Further well-designed prospective and comparative studies are needed.