Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis

Meuleman C, C Meuleman, Christel Meuleman, Carla Tomassetti, C Tomassetti, A. D’Hoore, A D'hoore, D'Hoore A, Buyens A, Ann Buyens, A. Buyens, Van Cleynenbreugel B, B Van Cleynenbreugel, Ben Van Cleynenbreugel, Fieuws S, S Fieuws, Steffen Fieuws, Freddy Penninckx, F Penninckx, Penninckx F, I. Vergote, Vergote I, Ignace Vergote, Thomas D'Hooghe, Thomas D’Hooghe, D'Hooghe T, T. D'Hooghe
Human Reproduction · 2011 · vol. 26(9) , pp. 2336–2343 · doi:10.1093/humrep/der231 · PMID:21771772 · W2170511329
article OA: bronze CC0 ⤵ 50 in-corpus citations
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CO2 laser laparoscopic radical excision of endometriosis with colorectal invasion and bowel resection improved pain, sexual function, and quality of life with low complication and recurrence rates and good fertility outcomes.

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Abstract

BACKGROUND: Laparoscopic segmental bowel resection and reanastomosis for endometriosis with colorectal wall invasion can be associated with high complication rates. This study was performed to test the hypothesis that this high complication rate can be prevented and combined with a good clinical outcome, following a multidisciplinary surgical approach. METHODS: A retrospective cohort study of all patients with deep endometriosis and colorectal invasion treated by CO₂ laser laparoscopic radical excision between September 2004 and September 2006 (n = 45) to document the clinical outcome: complications, recurrence and fertility (life table analysis), pain, quality of life (QOL) and sexual function. RESULTS: No immediate major post-operative complications requiring surgical reintervention were recorded. Gynaecological pain (P < 0.0001), sexual function (P < 0.03) and QOL (P< 0.0001), improved significantly after a median follow-up period of 27 (range: 16-40) months. Although five patients (11%) had a surgical reintervention, histologically proven recurrent endometriosis was observed in only two (4%), with a cumulative endometriosis recurrence rate of 2.2 and 4.4% after 1 and 3 years, respectively. Thirteen of 28 patients who wanted to become pregnant conceived after surgery. One patient delivered twice. These 14 pregnancies were achieved spontaneously (n = 9) or after IVF (n = 5). The cumulative pregnancy rate was 47% after 3 years. CONCLUSION: Pain, sexual function and QOL improved significantly and were associated with a good fertility rate and a low complication and recurrence rate after a CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis.

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Lasers, Gas Rectal Diseases Adult Anastomosis, Surgical Cohort Studies Colonic Diseases Endometriosis Female Humans Laparoscopy Lasers, Gas Pain Pain Postoperative Complications Pregnancy Pregnancy Rate Quality of Life Rectal Diseases

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