Gastrointestinal function and pain outcomes following segmental resection or discoid resection for low rectal endometriosis

This study aims to examine the effect of full thickness discoid resection (FTDR) and modified, limited nerve-vessel sparing segmental bowel resection (NVSSR) in symptomatic patients with low rectal deep endometriosis (DE) within 7 cm from the anal verge. Presurgical and postsurgical evaluation of gastrointestinal (GI) function reflected by low anterior resection syndrome (LARS) and gastrointestinal function-related quality of life index (GIQLI) scores, complication rates, pain scores/visual analog scale (VAS) and endometriosis health profile (EHP-30) was performed.

In this prospective multicenter cohort study, 63 premenopausal patients with symptomatic low (within 7 cm from the anal verge) colorectal endometriosis, undergoing low modified limited nerve vessel sparing rectal segmental bowel resection (NVSSR) and full thickness discoid resection (FTDR) were evaluated. Presurgery and postsurgery lower anterior resection syndrome (LARS) scores, gastrointestinal function-related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP-30) parameters compared between two groups.

Out of 63 women, 49 (77.8%) underwent NVSSR while 14 (22.2%) underwent FTDR. LARS-like symptoms were observed presurgically in 24/63 (38.1%) patients. Postsurgical LARS was observed in 14/63 (22.2%) of the patients (10/49, 20.4% in NVSSR vs. 4/14, 28.5% in the FTDR group). The LARS-like symptoms significantly decreased following surgery in the FTDR group (p = 0.049) and showed a trend for decrease in the NVSSR group (p = 0.077). Postsurgical de novo LARS was only observed in 5/63 (8%) of the patients (NVSSR 4/49, 8.1%, FTDR 1/14, 7.1%). Postsurgical GIQLI scores improved in both groups (p < 0.001) with comparable changes in the NVSSR and FTDR cohorts (p = 0.490). Postoperative grade III complication rates between NVSSR and FTDR did not vary significantly (6/49, 12.2% vs. 3/14, 21.4% p = 0.26). Pain/VAS scores and EHP-30 scores significantly decreased after a mean follow-up of 29.6 ± 11 months and 30.6 ± 11 months in the NVSSR and FTDR groups, respectively (EHP-30; p < 0.001; dysmenorrhea, dyspareunia, dyschezia all p < 0.05 for both cohorts).

When comparing low colorectal surgery by either NVSSR or FTDR in a high-risk group for surgical complications, both techniques confer improvement of GI function reflected by LARS and GIQLI with non-significant differences in major complication rates, reduced pain and EHP-30 scores. Similar content being viewed by others Data availability The data that support the findings of this study are available from the corresponding author

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Hudelist, D.Pashkunova, A. Rath, D. Miklos, A. Bokor; statistical analysis: E. Darici; manuscript writing: G. Hudelist, A. Bokor, E. Darici. All authors commented on the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest E. Darici, A. Bokor, D. Miklos, D. Pashkunova, A. Rath and G. Hudelist declare that they have no competing interests. Ethical standards All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Data number of IRB: Ethikkomission Krankenhaus der Barmherzigen Brüder Wien; BHB2_2018 and Institutional Ethical and Review Board of Semmelweis University: 58723-4/2016/EKU. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The authors E. Darici and A. Bokor contributed equally to the manuscript. Rights and permissions About this article Cite this article Darici, E., Bokor, A., Miklos, D. et al. Gastrointestinal function and pain outcomes following segmental resection or discoid resection for low rectal endometriosis. Wien Klin Wochenschr 137, 495–503 (2025). https://doi.org/10.1007/s00508-024-02448-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00508-024-02448-9