P18.08: Bowel resection for DIE: 2D and 3D transvaginal sonographic evaluation of residual disease and associated symptoms

To evaluate the presence or absence of residual posterior disease and adhesions by 2D and 3D transvaginal sonography in patients who underwent segmental bowel resection for Deep infiltrating endometriosis (DIE). Furthermore the presence or absence of residual pelvic endometriosis, adhesions and adenomyosis were correlated to specific symptoms and infertility. This retrospective observational study included 50 premenopausal patients (mean age 37.4±5.2 yrs) with bowel DIE who underwent segmental bowel resection. All patients underwent also an accurate 2D, 3D and power Doppler TVS examination and mapping of pelvic disease before and after surgery. All patients are assessed for pelvic pain by visual analog scale (VAS). The sonographic features of adenomyosis, adhesions, presence of ovarian, peritoneal and deep endometriosis were evaluated. A previous published mapping system to evaluate pelvic endometriosis was always performed. At the TVS scan performed within 6 month after surgery we found in our study population 14 patients (28%) with residual DIE, 38 patients (76%) with adhesions in the posterior compartment, 32 patients (64%) with sonographic features of adenomyosis. No patients showed ovarian endometriosis. In 25 patients who did not have medical therapy after surgery because of the desire of pregnancy 21 patients (84%) had severe dysmenorrhea (vas >5) and 13 (52%) had dyspareunia (vas >5), 19 patients have resorted to ART. DIE is a chronic disease that is not completely eradicable. After surgery painful symptomatology could be correlated to residual posterior disease and mostly to adhesions and adenomyosis that very often coexist with DIE. However surgery, when indicated, allows an improvement in painful symptomatology and quality of life. The spontaneous pregnancy rate in our study is not improved by surgery.