Bowel resection for intestinal endometriosis

PURPOSE: The study contained herein was undertaken to evaluate which factors predict a good outcome following intestinal resection for endometriosis. METHODS: A retrospective analysis of all patients undergoing bowel resection for severe (American Fertility Society Stage IV) endometriosis at one institution between the years 1992 and 1996 was conducted using systematic chart review and follow-up by telephone interview. RESULTS: Twenty-nine patients were identified within the study period. The most frequent symptoms were pelvic pain, abdominal pain, rectal pain, and dysmenorrhea. Nearly all patients (93 percent) underwent low anterior resection of the rectum and distal sigmoid. Other intestinal procedures were appendectomy, terminal ileal resection, cecectomy, and sigmoid resection. Thirty-four percent of patients had simultaneous total abdominal hysterectomy and bilateral salpingooophorectomy. Complete follow-up was obtained on 26 patients (90 percent; mean follow-up 22.6 (range, 8-63) months). All patients (100 percent) reported subjective improvement. Forty-six percent of patients were "cured" according to the prospectively applied definition (resolution of symptoms without need for further medical or surgical therapy). The only variable analyzed that was associated with "cure" was concomitant total abdominal hysterectomy and bilateral salpingooophorectomy (odds ratio, 12; 95 percent confidence interval, 1.8-81.7). This association remained significant after correcting for age and the presence of gastrointestinal symptoms. CONCLUSION: Intestinal resection can be performed safely in most women with severe endometriosis and bowel involvement, although many of these patients experience persistent or recurrent symptoms. Total abdominal hysterectomy and bilateral salpingooophorectomy at the time of bowel resection correlates with improved outcome.