Pain recurrence after shaving of rectovaginal endometriosis

Background: Surgical treatment of rectovaginal endometriosis varies from shaving of the nodule off the rectal wall without perforation, over discoid excision to routine rectal resection. Of these methods, shaving involves the lowest rate of serious complications but leaves endometriosis tissue on the bowel with risk of recurrence. This could motivate a change into more radical surgery. In the present study we therefore assessed recurrence of pain after shaving of rectovaginal endometriosis performed 2001-2009. Methods: Retrospective follow-up study. Questionnaires were sent to 212 women of whom 174 women (82%) responded. Outcomes were correlated to the involvement of the anterior rectal wall and postoperative hormonal treatment. Results: Recurrence (pain unchanged or worse) of menstrual pain was found in 26 %, intermenstrual pain in 29 %, dyspareunia in 42 % and dyschezia in 41 %. Postoperative OCs and gestagen IUD showed a trend towards a protective effect against menstrual pain (p=0.06). There was found no significant association between recurrence of pain and anterior rectal wall involvement. Conclusion: Shaving of rectovaginal endometriosis shows a high risk of postoperative pain recurrence, especially for dyspareunia and dyschezia. Routine postoperative hormonal treatment seems of value. Research into new surgical methods is motivated.