Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: giving patients an informed choice

Roman H, Horace Roman, Loisel C, Cecile Loisel, C. Loisel, B. Resch, Resch B, Benoit Resch, Tuech JJ, Jean Jacques Tuech, J.‐J. Tuech, Hochain P, Patrick Hochain, Anne Marie Leroi, Leroi AM, Anne‐Marie Leroi, Loic Marpeau, L. Marpeau, Marpeau L
Human Reproduction · 2010 · vol. 25(4) , pp. 890–899 · doi:10.1093/humrep/dep407 · PMID:20106836 · W2137544525
article OA: bronze CC0 ⤵ 75 in-corpus citations
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Colorectal segmental resection for rectal endometriosis was associated with increased stool frequency compared to nodule excision, with no significant difference in pain recurrence between the procedures.

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Abstract

BACKGROUND: The aim of this study was to compare delayed functional digestive and urinary outcomes following two different surgical procedures used in the management of rectal endometriosis. METHODS: Women who had undergone surgical management of rectal endometriosis with at least 1 year of post-operative follow-up were included in a retrospective study. Post-operative symptoms were evaluated using specific questionnaires which focused on pelvic pain and functional outcomes. RESULTS: There were 41 women who underwent surgical treatment of symptomatic rectal endometriosis. Post-operative follow-up was completed over 26 +/- 13 months (range 12-53). Colorectal segmental resection was performed in 25 women (61%) and nodule excision in 16 (39%). An increase in the number of daily stools > or =3 was observed in 13 (52%) and 3 (19%) patients managed, respectively, by segmental resection and nodule excision (P = 0.02). Severe constipation (<1 stool/5 days) was recorded in three women having undergone segmental resection. The probabilities of being free of dysmenorrhea, dyspareunia and non-cyclic pain at 24 months in women managed by segmental resection and nodule excision were, respectively, 80% (95% CI: 55-92%), 65% (95% CI: 42-81%), 43% (95% CI: 23-62%) and 62% (95% CI: 34-81%), 81% (95% CI: 52-94), 69% (95% CI: 40-86%). When pain recurrences occurred, a significantly lower post-operative score for pain was observed in both groups. No significant difference in pain improvement was found between surgical procedures. CONCLUSION: Colorectal segmental resection appears to be associated with several unpleasant functional symptoms when compared with nodule excision. Information about functional outcomes should be provided to patients managed for rectal endometriosis, and should be considered when deciding on the most appropriate treatment of this disease.

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Condition tags

dysmenorrheadyspareuniaendometriosisbowel_endometriosis

MeSH descriptors

Endometriosis Rectal Diseases Vaginal Diseases Adult Digestive System Surgical Procedures Digestive System Surgical Procedures Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Endometriosis Endometriosis Female Gynecologic Surgical Procedures Gynecologic Surgical Procedures Humans Pain Pain Rectal Diseases Rectal Diseases

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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