{"paper_id":"29a7552a-7819-4a37-b31f-6e220be296b8","body_text":"Germini DE | Volume 1; Issue 2 (2022) | Mapsci-ACTCR-1(2)-011 | Research Article \nCitation: Reina AM, Serigiolle LC, Nagao JM, Germini DE. Quality 0f Life After Video Laparoscopic Segmentary Colectomy for \nIntestinal Endometriosis. Arch Clin Trial & Case Rep. 2022;1(2):65-70. \nDOI: https://doi.org/10.37191/Mapsci-ACTCR-1(2)-11 \nArchives of Clinical Trials and Case Reports \nReina AM, et al., 2022-Arch Clin Trial & Case Rep \nResearch Article \n \n \nQuality of Life After Video  \nLaparoscopic Segmentary \nColectomy for Intestinal \nEndometriosis \nAna Maria Reina, Leonardo Carvalho Serigiolle, \nJessica Mayumi Nagao  and Demetrius Eduardo \nGermini* \nAbstract \nBackground: Intestinal endometriosis (IE) is a chronic \nestrogen-dependent disease characterized by endometrial \nstroma outsi de the uterine cavity. It affects 10 to 15% of \nwomen and may present with pelvic pain and worsening \nquality of life. Treatment can be surgical, such as video \nlaparoscopic segmental colectomy (VSC).  \nObjective: To evaluate the quality of life of patients af ter \nVSC for treatment of intestinal endometriosis.  \nMethod: This is an observational, longitudinal, and retrospective study carried out through a review of \nmedical records and a telephone interview with patients who underwent laparoscopic segmental \ncolectomy in a private hospital between 2016 and 2020.  \nResults: 43 patients were studied, of whom 30 (70%) complained of having impaired daily activities. \nBefore surgery, dysmenorrhea intensity was classified as mild, moderate, severe, and very severe pain, \nwith one patient (2.33%) classified as mild, three patients (6.98%) as moderate, 16 patients (37.2%) as \nsevere, and 23 (53.49%) as very severe. As for pain during sexual intercourse, 13 patients (30%) reported \ndyspareunia. After surgery, 100% of the patients r eported improvement in the complaint, referring to \nmaintaining a normal routine after the VSC; of the 13 patients who did not feel that they had any \nimpairment in their daily activities before the surgery, 2 still reported feeling more lively in their rout ine \nafter having undergone surgery (P<.05). As for the intensity of dysmenorrhea after surgery, one (2.33%) \npatient classified it as moderate and 42 (97.67%) as mild (P<.05), indicating that there is a difference in \npain intensity before and after surgery.  Of the patients who previously reported dyspareunia, it was \nobserved that 100% of them reported improvement after VSC with P=.0002.  \nConclusion: CSV can improve the quality of life of patients with intestinal endometriosis.  \nKeyword: Colorectal resection in deep pelvic endometriosis ; Colorectal resection/shaving ; Colorectal \ndisc excision; Deep endometriosis; Quality of life.\nSao Luiz Jabaquara hospital, Sao Paulo, \nBrazil \n*Corresponding Author:  Demetrius \nEduardo Germini  MD, PhD, Sao Luiz \nJabaquara hospital, Sao Paulo, Brazil. \nReceiving Date: 06-20-2022 \nAccepted Date: 06-30-2022 \nPublished Date: 07-10-2022 \nCopyright© 2022 by Reina AM, et al . All \nrights reserved. This is an open access \narticle distributed under the terms of the \nCreative Commons Attribution License, \nwhich permits unrestricted use, \ndistribution, and reproduction in any \nmedium, provided the original author \nand source are credited. \n\nGermini DE | Volume 1; Issue 2 (2022) | Mapsci-ACTCR-1(2)-011 | Research Article \nCitation: Reina AM, Serigiolle LC, Nagao JM, Germini DE. Quality 0f Life After Video Laparoscopic Segmentary Colectomy for \nIntestinal Endometriosis. Arch Clin Trial & Case Rep. 2022;1(2):65-70. \nDOI: https://doi.org/10.37191/Mapsci-ACTCR-1(2)-11 \nIntroduction \nEndometriosis is a chronic disease \ndependent on the action of estrogen, in the \nendometrium stroma outside the uterine \ncavity, mainly in the pelvic peritoneum, \novaries, colon, rectum and bladder  [1]. It is \nestimated that 176 million women \nworldwide suffer f rom endometriosis  [2], \nrepresenting up to 15% of women at a \nreproductive age. Endometriosis is \nassociated with pelvic pain, dysmenorrhea, \ndyspareunia, and infertility  [3,4]; these \nsymptoms worsen the quality of life and \nwork [5,6] causing financial losses due to \nabsenteeism and decreased productivity  \n[7,8]. Intestinal endometriosis (IE) is a type \nof deep endometriosis characterized by \nendometrioma implants in the colon and \nrectum. It is estimated that 20% of women \nwith endometriosis have an intestinal form \nand 90% have colorectal involvement  \n(Figure 1). There is still no consensus on the \ntreatment option for IE  [4], in addition to \nlow recurrence rate, but a higher rate of \ncomplications is also observed in up to 18% \nof the operated patients, such as \nanastomotic dehiscence or stenosis, fistulas, \nand pelvic collections [9]. The treatment of \nIE in some cases is surgical and is associated \nwith different levels of morbidity  [10-12]. \nSeveral have shown significant results in \nsymptom resolution and improvement in \nquality of life  [13], in addition to low \nrecurrence rate. However, a higher \ncomplication rate, up to 18% of patients \noperated, has been observed in some \nstudies; complications include anastomotic \ndehiscence or stenosis, fistulas, or pelvic \ncollections [9].\n \nFigure 1: A- Surgical specimen with evidence of IE in sigmoid serosa. B- Surgical specimen with \nevidence of IE causing intestinal obliteration. C- Surgical specimen with evidence of IE affecting the \nserous and muscular layers of the rectum.\nVideo laparoscopic segmental colectomy \n(VSC) is usually indicated for larger \nendometriomas, measuring 2 cm, with \ninfiltrative capsules that go beyond the \nmuscular layer of the intestine, that go \nbeyond the main axis, or that affect more \nthan one -third of the intestinal lumen, \nwhich can lead to intestinal lumen stenosis  \n[9,14,15]. EI can worsen women’s quality of \nlife. Disabling pain leads to a reduction in \nhappiness rates , absence from daily \nactivities, and decreased performance at \nwork. The indirect costs of the most severe \ncases in terms of productivity are twice the \ncosts of treatment [16,8]. \nPurpose \nThe purpose of this study is to evaluate the \nquality of life of patients after surgical \ntreatment by video  laparoscopic segmental \n\n\nGermini DE | Volume 1; Issue 2 (2022) | Mapsci-ACTCR-1(2)-011 | Research Article \nCitation: Reina AM, Serigiolle LC, Nagao JM, Germini DE. Quality 0f Life After Video Laparoscopic Segmentary Colectomy for \nIntestinal Endometriosis. Arch Clin Trial & Case Rep. 2022;1(2):65-70. \nDOI: https://doi.org/10.37191/Mapsci-ACTCR-1(2)-11 \ncolectomy (VSC) for intestinal \nendometriosis. \nMethod \nThe study was observational, longitudinal, \nand retrospective; it was carried out at \nHospital São Luiz Jabaquara Rede D’Or (São \nPaulo, Brazil) with patients undergoing VSC \nperformed by the same surgical team \nbetween January 2016 and October 2020 and \nwas conducted from January 2016 to \nOctober 2020 in accordance with the ethical \nstandards determined by the Declaration of \nHelsinki of the World Medical Association, \nadopted in 1964 and reformulated in 1996.  \nThe patients included in the study had \nundergone VSC, had a clinical and \nradiological diagnosis of IE, and were over \n18 years of age, of reproductive age, female, \nand of various ethnicities. Al l patients \noperated on for a cause other than IE, \npatients whose medical records were not \nlocated, and all patients who refused to \nparticipate in the study were excluded from \nthis study. \nA review of the patients’ charts and a \ntelephone interview were carried out in the \nlate postoperative period, with at least 3 \nmonths between the surgery and the \ntelephone contact, for the administration of \na standardized questionnaire with the \npatient to inquire about the quality of life \nafter surgery for intestinal endometriosis. \nDescription of the cases \nTbe data of 51 patients with IE undergoing \nVSC was analyzed retrospectively . Eight \npatients were excluded due to the \nimpossibility of telephone contact, resulting \nin a total of 43 patients studied.  In these \npatients, the mean age was 36.9 years (24 to \n52 years), with symptom duration \npredominantly from 3 to 10 years in 21 \npatients (48%). Each patient in the study \nhad several complaints, among which the \nmost prevalent symptoms were pelvic pain \n(dysmenorrhea), intestinal bleed ing, \ntenesmus, dyspareunia, diarrhea, and anal \npain. Infertility was an associated condition \nin 10 patients (20.9%). As for pain \nsymptoms, the most prevalent period was \nthe perimenstrual period, and the most \nreported pain intensity was very intense in \n23 p atients (50.49%). Among the patients \nevaluated, it was possible to evaluate the \nsize of the endometrioma in 31 patients, \namong whom they ranged from 1 to 6 cm \nwith a median of 3 cm. It was possible to \ndetermine the distance from the anal edge \nin 33 patients; this distance varied between \n6 and 18 centimeters from the anal edge. It \nwas not necessary to perform protective \nostomies in any of the cases. \nAs for the quality of life of patients in the \npreoperative period, complaints were \nanalyzed regarding the impairment of daily \nactivities due to symptoms; it was found \nthat 30 (70%) of the patients involved in the \nstudy reported limitations in their daily \nactivities (home care, shopping, studying), \n27 (63%) had already been away from work \nfor a certain period, 13 ( 30%) revealed \nhaving difficulties in sexual relations, and 13 \n(30%) reported difficulties in leisure \nactivities (sports practice, travel, training). \nStatistical analysis \nFor continuous variables, the median and \ninterquartile range were calculated; when \nthere is no normal distribution and the \nmean is a confidence interval for the age \nvariable, it has a normal distribution. For \ncategorical variables, the number of \npatients in each category and their \npercentage are presented. The test applied \nto verify the ass ociation of the variables \nbefore and after the surgery was the exact \n\nGermini DE | Volume 1; Issue 2 (2022) | Mapsci-ACTCR-1(2)-011 | Research Article \nCitation: Reina AM, Serigiolle LC, Nagao JM, Germini DE. Quality 0f Life After Video Laparoscopic Segmentary Colectomy for \nIntestinal Endometriosis. Arch Clin Trial & Case Rep. 2022;1(2):65-70. \nDOI: https://doi.org/10.37191/Mapsci-ACTCR-1(2)-11 \nMcNemar test. For all analyses, the \nsignificance level considered is .05. R \nsoftware version 4.0.3 (2020-10-10) was used \nto perform the analyses. \nResults \nBefore VSC, patients classified the intensity \nof dysmenorrhea as mild, moderate, severe, \nand very severe, with one patient (2.33%) \nclassified as mild, three patients (6.98%) as \nmoderate, 16 patients (37.2%) as intense, \nand 23 (53.49%) as very intense. After VSC, \none (2.33%) patient classi fied the pain as \nmoderate and 42 (97.67%) as mild (P<.05), \nindicating that there is a difference in pain \nintensity before and after surgery. Of the 43 \npatients whose data were analyzed, 30 \n(70%) complained of having impaired daily \nactivities. Of these, 100 % reported \nimprovement in the complaint, referring to \nmaintaining a normal routine after VSC. Of \nthe 13 patients who did not feel that they \nhad any impairment in daily activities \nbefore surgery, 2 still reported feeling better \nthan before in their routine after having \nundergone surgery (P<.05).  Among the 13 \npatients who complained of having \ndifficulties in leisure activities (physical \nactivities, entertainment, travel), 12 \nreported improvements in this aspect after \nVSC, and 1 patient reported not noticing \nimprovement.  \nAmong the 29 patients who did not \ncomplain of impairment in leisure activities, \none patient with a previous complaint \nexpressed feeling better after surgery when \nperforming these activities (P<.05).  \nRegarding work performance, 27 (63%) of \nthe patients had been absent from work at \nsome point due to the intensity of the \nsymptoms; of these, 25 patients reported \nimproved performance at work on a daily \nbasis and did not suffer more absences after \nthe surgery. Of the 16 patients who did not \ncomplain of absence from work, 1 patient \nreported improved performance. In relation \nto this data, P>.05, which does not show \nstatistical significance.  Of the patients \nanalyzed, 13 (30%) reported dyspareunia; \n100% of them reported improvement after \nVSC, with P=.0002 . In relation to patients \nwho complained of infertility, the \noccurrence or nonoccurrence of pregnancy \nafter surgery was analyzed.  \nInitially, 10 patients (23.26%) reported that \ninfertility was really a problem that \ninfluenced their quality of life, with fa ilure \nafter some treatment attempts. Another two \n(4.65%) reported having undergone \ntreatment unsuccessfully, but they did not \nsee infertility as a problem in their lives. Of \nthe patients with complaints, 6 (14%) \nmanaged to conceive and four (9.3%) were \nstill unsuccessful (P>.05).  Among the 43 \npatients involved in the study, 7 (16%) \ndeveloped mild complaints in the late \npostoperative period, 4 of them due to \nchanges in usual bowel habits (constipation \nor diarrhea) but without significant impact \non quality of  life. Of the others, 1 (2.33%) \ndeveloped anastomotic stricture and \nunderwent endoscopic dilation, showing \nimprovement, and 2 other patients \ncomplained of sporadic tenesmus. \nDiscussion \nIE affects women in the most productive \nphase of their lives. The symptoms, \nespecially intense and disabling pain, \nnegatively impact the quality of life of these \npatients. The present study sought to \nanalyze the impact of VSC on the quality of \nlife of patients with IE. There are some \nlimiting factors, such as the retrosp ective \nnature of the analysis and the lack of a \nsecond group of patients undergoing a \nsurgical technique different from the one \nadopted. A comparison between surgical \n\nGermini DE | Volume 1; Issue 2 (2022) | Mapsci-ACTCR-1(2)-011 | Research Article \nCitation: Reina AM, Serigiolle LC, Nagao JM, Germini DE. Quality 0f Life After Video Laparoscopic Segmentary Colectomy for \nIntestinal Endometriosis. Arch Clin Trial & Case Rep. 2022;1(2):65-70. \nDOI: https://doi.org/10.37191/Mapsci-ACTCR-1(2)-11 \ntechniques could have broadened the \ndiscussions on the impact of surgeries in the \ntreatment of this condition. However, the \npreoperative status of each patient as a \ncontrol to measure the results was used as it \nis believed that this is also an adequate way \nto study the initial objective. Although part \nof the published studies shows a high \nnumber of postoperative complications in \nVSC, this study showed a small number of \ncomplications in the operated patients, \nmost of them mild complications such as \nchanges in bowel habits without significant \nimpact on the patients’ quality of life.  \nBassi et al [16], in a study with 151 patients of \nreproductive age with IE and symptoms of \nchronic pelvic pain, a questionnaire was \nadministered before segmental colon \nresection and 1 year after. After segmental \nintestinal resection, there was a significant \nimprovement in gastrointestinal, \ngynecological, and emotional symptoms, \nleading to an improvement in the quality of \nlife of 90% of these patients, proving its \neffectiveness. This study presented results \nin agreement with those observed by Bassi \net al. It is observed  that, of the 27 patients \n(63%) who reported absence from work due \nto the intensity of symptoms, 25 patients \nreported improvement in their daily work \nperformance and did not suffer more \nabsences after the surgery. Regarding other \nfactors that contribute to  quality of life, of \nthe total number of patients analyzed, 13 \n(30%) reported difficulty in their sexual \nrelations, and 100% of these patients \nimproved in this aspect after surgery, which \nshows a robust improvement in a quality-of-\nlife parameter.  Turco et al [17], in a study \nwith 50 patients with a mean age of 38 years \nwith symptoms of dysmenorrhea, \ndyschezia, and dyspareunia submitted to \nsegmental colon resection and filled out a \nquestionnaire assessing their quality of life \nbefore and after the operation . After \nsurgery, using the visual pain scale, pain \nimprovement was noted in 74% of patients, \nas well as greater in self -confidence and \nimprovement in interpersonal \nrelationships, sex life, and work \nperformance.  \nIn the current study, where the series was \nequivalent, with 43 patients undergoing a \nsurgical approach, the response was even \nmore impressive, showing a reduction in \nperimenstrual pain complaints to \nphysiological levels in 42 patients, more \nthan 97% of the women studied. \nIn this study, it was observed that 14% of the \npatients who had undergone surgery \nbecame pregnant in the postoperative \nperiod. This result did not reach significant \nrelevance in the comparison between pre - \nand post-operative periods. Stepniewska et \nal [18], in a study with women who \nunderwent colectomy, observed a \nspontaneous fertility rate of 35% in the \nevaluation after four years of surgery \n(P<.05). It is believed that with a longer time \nsegment, the fertility rate in the women \noperated on in the current study should still \nincrease substantially, since the interval \nbetween surgery and the interview with the \npatients was, in some cases, quite short. \nThis study, as well as others, suggests that \nthe gynecological and intestinal symptoms \nof endometriosis, especially its colorectal \ninfiltrative form, have a significant impact \non patients’ lives, affecting daily routine, \nleisure activities, employment, and even \nsexual intercourse. Although VSC is still \nconsidered an approach subject to a higher \nrate of postoperative complications, a \nsignificant improvement in the symptoms \nand in the routine of the patients involved \nafter this surgery is evident. \n\nGermini DE | Volume 1; Issue 2 (2022) | Mapsci-ACTCR-1(2)-011 | Research Article \nCitation: Reina AM, Serigiolle LC, Nagao JM, Germini DE. Quality 0f Life After Video Laparoscopic Segmentary Colectomy for \nIntestinal Endometriosis. Arch Clin Trial & Case Rep. 2022;1(2):65-70. \nDOI: https://doi.org/10.37191/Mapsci-ACTCR-1(2)-11 \nConclusion \nWithin the context in which this study was \ncarried out, one can conclude that VSC for \nthe treatment of intestinal endometriosis \ncan improve the quality of life of patients.\nReferences\n1. Milone M, Vignali A, Milone F, Pignata  G, Elmore U, Musella M, et al. Colorectal resection in deep pelvic \nendometriosis: Surgical technique and post -operative complications. World J Gastroenterol. \n2015;21(47):13345-51. 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