Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis

Horace Roman, Milles M, Mathilde Milles, Maud Vassilieff, Vassilieff M, M. Vassilieff, Resch B, B. Resch, Benoit Resch, Jean-Jacques Tuech, Jean–Jacques Tuech, Tuech JJ, Huet E, Emmanuel Huet, Darwish B, Basma Darwish, Carole Abo, Abo C
American journal of obstetrics and gynecology · 2016 · vol. 215(6) , pp. 762.e1–762.e9 · doi:10.1016/j.ajog.2016.06.055 · PMID:27393269 · W2467297075
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This study evaluated long-term functional outcomes in patients undergoing either colorectal resection or rectal shaving for the treatment of rectal endometriosis.

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Abstract

BackgroundTwo surgical approaches usually are used in the surgical management of deep infiltrating endometriosis of the rectum: the radical approach that mainly is based on colorectal resection and the conservative or symptom-guided approach that prioritizes conservation of the rectum. There are no data available that compare long-term functional digestive outcomes of 1 approach to the other.ObjectiveThe purpose of this study was to compare long-term digestive outcomes in women who were treated by either rectal shaving or colorectal resection for deep endometriosis infiltrating the rectum.Study designA retrospective comparative study was performed. All women who were treated with surgery for deep endometriosis infiltrating the rectum by either shaving or colorectal resection at the University Hospital of Rouen from January 2005 to January 2010 were enrolled. Follow-up evaluation was carried out for a minimum of 5 years. Postoperative evaluation of digestive symptoms was performed by 4 standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott-Symptom score for constipation, the Wexner score for anal continence, and the Bristol Stool Score. Symptoms that were related to endometriosis, fertility, and disease recurrence were obtained from a specific questionnaire.ResultsA total of 77 women were included. Three women were lost to follow up (3.9%), and 3 were treated by disc excision (3.9%). The mean follow-up time was 80±19 months. Forty-six women underwent conservative rectal shaving, and 25 women underwent colorectal resection. Patient characteristics and the severity of the disease were comparable in both groups. Patients who were treated by rectal shaving had significantly better Gastrointestinal Quality of Life Index values, lower Knowles-Eccersley-Scott-Symptom scores for postoperative constipation, and better anal continence. No statistically significant differences were revealed for postoperative pelvic pain. Rectal recurrence occurred in 8.7% of patients who were treated by conservative surgery: 4.3% underwent secondary colorectal resection and 4.3% were treated secondarily by rectal shaving. Consequently, avoiding a recurrence for merely 1 patient would have required 11 patients to undergo colorectal resection instead of shaving.ConclusionOur data suggest that, in patients who are treated for rectal endometriosis, colorectal resection does not improve long-term postoperative functional outcomes when compared with rectal shaving.

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Condition tags

endometriosis

MeSH descriptors

Constipation Digestive System Surgical Procedures Endometriosis Fecal Incontinence Postoperative Complications Rectal Diseases Adult Constipation Digestive System Surgical Procedures Endometriosis Endometriosis Endosonography Fecal Incontinence Female Humans Laparoscopy Laparotomy Middle Aged Postoperative Complications Rectal Diseases

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