Radical excision of rectovaginal endometriosis results in high rate of pain relief – results of a long‐term follow‐up study

Satu Tarjanne, Jari Sjöberg, Oskari Heikinheimo
Acta obstetricia et gynecologica Scandinavica · 2009 · vol. 89(1) , pp. 71–77 · doi:10.3109/00016340903362558 · PMID:20021267 · W2130457920
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Radical excision of rectovaginal endometriosis provided long-term pain relief for patients, with bowel resection associated with a lower recurrence risk.

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Abstract

OBJECTIVE: To evaluate the long-term results of radical excision for rectovaginal endometriosis (RVE) with special emphasis on current symptoms and risk factors as regards recurrence. METHODS: A total of 116 patients operated upon because of RVE were offered a clinical follow-up evaluation visit; 60 (52%) consented. The time (mean +/- SD) from the index surgery to the follow-up visit was 4.0 +/- 0.5 years. MAIN OUTCOME MEASURES: Daily symptoms using a visual analogue scale for 30 consecutive days prior to clinical assessment; the amount of uterine bleeding was also assessed. Endometriosis recurrence was evaluated via clinical and ultrasonographic examination. RESULTS: The symptom sum scores (maximum 300) were low with median scores (range) of 3 (0-32) for dysmenorrhea and 9 (0-72) for pelvic pain. Evidence of RVE recurrence was found or suspected in 29 (48%) of the 60 women assessed. Clinical recurrence was not associated with pain symptoms. In univariable analysis, amenorrhea at the time of clinical assessment was associated with a lower risk of recurrence (odds ratio; OR 0.13; 95% CI (confidence interval) 0.02-0.65, p = 0.01); the effect of bowel resection was not significant (OR 0.37: 95% CI 0.13-1.07, p = 0.07). In multivariable analysis, the protective effect of bowel resection on recurrence was significant (OR 0.23; 95% CI 0.06-0.89, p = 0.03). CONCLUSIONS: Radical surgery may result in long-term pain relief in cases of RVE. Bowel resection is associated with a lower risk of RVE recurrence. Therapy that induces amenorrhea may be effective in preventing recurrence following surgical treatment of RVE.

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Condition tags

mesh:D004412mesh:D004715endometriosisbowel_endometriosisdysmenorrhea

MeSH descriptors

Endometriosis Rectal Diseases Vaginal Diseases Dysmenorrhea Dysmenorrhea Endometriosis Female Follow-Up Studies Gynecologic Surgical Procedures Humans Odds Ratio Pain Measurement Rectal Diseases Risk Factors Treatment Outcome Uterine Hemorrhage Uterine Hemorrhage Vaginal Diseases

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