Functional outcomes after laparoscopic colorectal resection with natural orifice specimen extraction and conventional specimen extraction for deep endometriosis: a 24-month prospective cohort study

Ezgi Darıcı, Attila Bokor, Noémi Dobó, Paweł Basta, Pawel Basta, Ewa Rabiej-Wronska, Gernot Hudelist
Ginekologia polska · 2026 · vol. 97(9) , pp. 719–727 · doi:10.5603/gpl.113139 · PMID:42742521 · W7213321572
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In women with colorectal endometriosis, laparoscopic resection improved gastrointestinal and endometriosis-related quality of life over 24 months, with pain severity being a stronger predictor of long-term outcomes than bowel dysfunction.

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This prospective cohort study evaluated bowel function, pain symptoms, and quality of life in 73 women with colorectal endometriosis undergoing laparoscopic resection via natural orifice specimen extraction or conventional abdominal extraction. Over a 24-month follow-up period, patients experienced significant improvements in gastrointestinal quality of life and endometriosis-related pain, despite a transient worsening of bowel dysfunction scores at six months that subsequently stabilized. Statistical analysis revealed that residual pain severity was a stronger predictor of long-term gastrointestinal quality of life than the degree of bowel dysfunction defined by low anterior resection syndrome scores. This paper is centrally about endometriosis — specifically assessing functional outcomes after surgical treatment of deep infiltrating lesions involving the bowel.

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Abstract

OBJECTIVES: To assess changes in bowel function, pain symptoms, and endometriosis-related quality of life over 24 months after laparoscopic colorectal resection with natural orifice specimen extraction (NOSE) and conventional abdominal specimen extraction (CASE) in patients with colorectal endometriosis. Secondary objectives were to investigate the impact of bowel dysfunction and pain severity on gastrointestinal quality of life. MATERIAL AND METHODS: This prospective cohort study included 73 women with colorectal endometriosis who underwent laparoscopic colorectal surgery with NOSE or CASE between 2019 and 2020. Outcomes were assessed preoperatively and at 6, 12, 18, and 24 months postoperatively using the low anterior resection syndrome (LARS) score, Gastrointestinal Quality of Life Index (GIQLI), Endometriosis Health Profile-30 (EHP-30), and Visual Analog Scale (VAS) pain scores. Linear regression analyses were performed to evaluate the possible interaction of bowel dysfunction and pain symptoms preoperatively and 24 months after surgery. RESULTS: A total of 73 patients were included in the analysis. Bowel function followed a characteristic temporal pattern after surgery. Mean LARS scores increased from 12.62 ± 10.72 preoperatively to 15.66 ± 13.54 at 6 months (p = 0.011), followed by significant decreases at 12 months (10.77 ± 10.61, p < 0.001) and 18 months (7.39 ± 7.61, p < 0.001), with stabilization thereafter at 24 months (7.31 ± 7.46 at 24 months, p = 0.380). Gastrointestinal quality of life improved significantly, with GIQLI scores increasing from 98.75 ± 23.68 preoperatively to 111.48 ± 17.70 at 6 months (p < 0.001) and remaining stable at 12 months (114.72 ± 18.60, p = 0.059), 18 months (114.38 ± 18.13, p = 0.443), and 24 months (112.81 ± 18.81, p = 0.181). Mean EHP-30 pain scores decreased markedly from 12.04 ± 12.40 preoperatively to 0.33 ± 0.85 at 6 months (p < 0.001). Although a modest increase was observed between 6 and 12 months (2.82 ± 6.00, p < 0.001), pain scores remained substantially lower than baseline at 24 months (2.40 ± 5.61, p = 0.074). Linear regression analysis demonstrated significant associations between both pain severity and bowel dysfunction with GIQLI. EHP-30 pain scores explained a greater proportion of GIQLI variance than LARS scores both preoperatively (adjusted R² = 0.63 vs 0.046) and at 24 months (adjusted R² = 0.275 vs 0.182). CONCLUSIONS: Laparoscopic colorectal resection for deep endometriosis was associated with favorable 24-month outcomes, including improved gastrointestinal quality of life, endometriosis-related quality of life, and pain symptoms, with bowel function recovering after transient early postoperative deterioration. Long-term GIQLI was more strongly associated with residual pain than with LARS-defined bowel dysfunction, emphasizing pain control as a key determinant of patient-reported outcomes after colorectal surgery for endometriosis.
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Abstract

Objectives: To assess changes in bowel function, pain symptoms, and endometriosis-related quality of life over 24 months after laparoscopic colorectal resection with natural orifice specimen extraction (NOSE) and conventional abdominal specimen extraction (CASE) in patients with colorectal endometriosis. Secondary objectives were to investigate the impact of bowel dysfunction and pain severity on gastrointestinal quality of life.

Material and methods

This prospective cohort study included 73 women with colorectal endometriosis who underwent laparoscopic colorectal surgery with NOSE or CASE between 2019 and 2020. Outcomes were assessed preoperatively and at 6, 12, 18, and 24 months postoperatively using the low anterior resection syndrome (LARS) score, Gastrointestinal Quality of Life Index (GIQLI), Endometriosis Health Profile-30 (EHP-30), and Visual Analog Scale (VAS) pain scores. Linear regression analyses were performed to evaluate the possible interaction of bowel dysfunction and pain symptoms preoperatively and 24 months after surgery.

Results

A total of 73 patients were included in the analysis. Bowel function followed a characteristic temporal pattern after surgery. Mean LARS scores increased from 12.62 ± 10.72 preoperatively to 15.66 ± 13.54 at 6 months (p = 0.011), followed by significant decreases at 12 months (10.77 ± 10.61, p < 0.001) and 18 months (7.39 ± 7.61, p < 0.001), with stabilization thereafter at 24 months (7.31 ± 7.46 at 24 months, p = 0.380). Gastrointestinal quality of life improved significantly, with GIQLI scores increasing from 98.75 ± 23.68 preoperatively to 111.48 ± 17.70 at 6 months (p < 0.001) and remaining stable at 12 months (114.72 ± 18.60, p = 0.059), 18 months (114.38 ± 18.13, p = 0.443), and 24 months (112.81 ± 18.81, p = 0.181). Mean EHP-30 pain scores decreased markedly from 12.04 ± 12.40 preoperatively to 0.33 ± 0.85 at 6 months (p < 0.001). Although a modest increase was observed between 6 and 12 months (2.82 ± 6.00, p < 0.001), pain scores remained substantially lower than baseline at 24 months (2.40 ± 5.61, p = 0.074). Linear regression analysis demonstrated significant associations between both pain severity and bowel dysfunction with GIQLI. EHP-30 pain scores explained a greater proportion of GIQLI variance than LARS scores both preoperatively (adjusted R² = 0.63 vs 0.046) and at 24 months (adjusted R² = 0.275 vs 0.182).

Conclusions

Laparoscopic colorectal resection for deep endometriosis was associated with favorable 24-month outcomes, including improved gastrointestinal quality of life, endometriosis-related quality of life, and pain symptoms, with bowel function recovering after transient early postoperative deterioration. Long-term GIQLI was more strongly associated with residual pain than with LARS-defined bowel dysfunction, emphasizing pain control as a key determinant of patient-reported outcomes after colorectal surgery for endometriosis.

Keywords

bowel endometriosisNOSEnatural orifice specimen extractionLARSGIQLIquality of lifeminimally invasive surgery

References

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MeSH descriptors

Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases Colonic Diseases

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