Deeply infiltrating endometriosis presents an endometriotic lesion penetrating the retroperitoneal space or wall of pelvic organs to a depth of at least 5mm. Most of the patients presented at follow-up had a retroverted and retroflexed uterus. The laparoscopic hysteropexy to correct the uterine position significantly improved the symptoms.

The retrodisplacement of the uterus (retroflexion and/or retroversion) may be connected with pelvic pain symptoms and posterior deep infiltrating endometriosis (DIE). The earliest studies in symptomatic women with retrodisplacement of the uterus showed the efficacy of hysteropexy for pain symptoms improvement. This study evaluated the sonographic, clinical and surgical outcomes of a hysteropexy technique.

Laparoscopic round ligament plication and tilting of the fundus portion of uterus in women with uterine retrodisplacement and posterior deep infiltrating endometriosis was executed. A total of 42 symptomatic women were enrolled. The sonographic data of every participant (angle of uterine version and uterine flexion, uterine mobility) was examined before and after surgery with transvaginal and transperineal approaches. Women were also observed at 1, 6 and 12 months after surgery for pain symptoms using a numerical rating scale (dyspareunia, dysmenorrhoea, and chronic pelvic pain), intraoperative data and surgical complications.

Additional mean operative time of hysteropexy method was 8 ± 3 min. At an early follow-up, both the uterine angles were significantly reduced. At 12-month follow-up, seven patients (16.7%) showed a retroverted uterus, while 12 (28.6%) showed a retroflexed uterus; the sliding sign continued negative in four patients (9.5%). A significant improvement of symptoms was observed during the follow-up.

Laparoscopic hysteropexy appears as a useful additional surgical procedure, which can temporarily correct the uterine position to reduce the risk of postoperative adhesions.