Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis

Lyons SD, Stephen D Lyons, Simon S B Chew, Chew SS, Thomson AJ, Angus J M Thomson, Lenart M, Meegan Lenart, Michał Lenart, C. Camaris, Catherine Camaris, Camaris C, Vancaillie TG, Thierry G Vancaillie, Abbott JA, Jason A Abbott, Jason Abbott
Journal of Minimally Invasive Gynecology · 2006 · vol. 13(5) , pp. 436–441 · doi:10.1016/j.jmig.2006.05.009 · PMID:16962528 · W2166847183
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This study assessed clinical and quality-of-life outcomes in patients undergoing fertility-sparing laparoscopic surgery that included bowel resection for severe endometriosis.

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Abstract

Study objectiveTo describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality-of-life outcomes.DesignProspective observational cohort study (Canadian Task Force classification II-2).SettingAustralian tertiary referral center for the surgical treatment of endometriosis.PatientsSeven consecutive patients with known endometriosis involving the bowel.InterventionLaparoscopic resection of all endometriosis, including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy.Measurements and main resultsPreoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and dyschezia. Validated research tools (SF12, EuroQOL, and Sexual Activity Questionnaire) also assessed quality of life. Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 (interquartile range 43-85) versus 5 (0-10); p=.028, nonmenstrual pelvic pain 74 (48-85) versus 11 (0-18); p=.046, dyspareunia 66 (0-98) versus 5 (0-8); p=.080, and dyschezia 48 (20-64) versus 20 (0-40); p=.173. All measures of quality of life were improved at 12 months after surgery, although not reaching statistical significance because of the small sample size. All three women wishing to conceive after operation have been successful, resulting in three live births at term. There were few complications associated with this surgery.ConclusionFertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life. Results appear to parallel published data for conservative resection of endometriosis not involving bowel. For women with severe endometriosis involving bowel, this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Intestinal Diseases Laparoscopy Quality of Life Adult Endometriosis Female Follow-Up Studies Humans Ileostomy Intestinal Diseases Pilot Projects Prospective Studies Rectum Rectum Treatment Outcome

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