Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules

Jacques Donnez, Jean Squifflet, JP Squifflet
Human Reproduction · 2010 · vol. 25(8) , pp. 1949–1958 · doi:10.1093/humrep/deq135 · PMID:20547557 · W2157215492
article OA: bronze CC0 ⤵ 223 in-corpus citations
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This prospective study of 500 women found that laparoscopic shaving of deep rectovaginal endometriosis resulted in low complications, a high pregnancy rate, and a low recurrence rate, particularly in those who conceived.

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Abstract

BACKGROUND: The debate continues between advocates of the shaving technique and supporters of bowel resection in case of deep endometriosis with rectal muscularis involvement, despite little evidence for better improvement with bowel resection. METHODS: We analyzed complication, pregnancy and recurrence rates after deep endometriotic nodule excision by shaving surgery. This is a prospective analysis of 500 cases (<40 years old) of deep endometriotic nodules. RESULTS: Laparoscopic nodule resection was performed successfully in all cases. Major complications included: (i) rectal perforation in seven cases (1.4%); (ii) ureteral injury in four cases (0.8%); (iii) blood loss >300 ml in one case (0.2%); and (iv) urinary retention in four cases (0.8%). The median follow-up duration was 3.1 years (range 2-6 years). In our prospective series of 500 women, 388 wished to conceive. Of this number, 221 (57%) became pregnant naturally and 107 by means of IVF. In total, 328 women (84%) conceived. The recurrence rate was 8% among these 500 women, and it was significantly lower (P < 0.05) in women who became pregnant (3.6%) than in those who did not (15%). In women who failed to conceive, or were not interested in conceiving, severe pelvic pain recurred in 16-20% of patients. CONCLUSION: In young women, conservative surgery using the shaving technique preserves organs, nerves and the vascular blood supply, yielding a high pregnancy rate and low complication and recurrence rates. There is a need, however, for further strong and energetic debate to weigh up the benefits of shaving (debulking surgery) versus rectal resection (radical surgery).

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Postoperative Complications Rectal Diseases Vaginal Diseases Adolescent Adult Endometriosis Endometriosis Endometriosis Female Follow-Up Studies Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Laparoscopy Pregnancy Pregnancy Rate Prospective Studies Radiography Rectal Diseases

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