Objective: To assess the impact of type of surgery for colorectal endometriosisrectal shaving, discoid or colorectal segmental resection-on complications and surgical outcomes.Data Sources: We performed a systematic review of all English and French language fulltext articles addressing surgical management of colorectal endometriosis and compared the postoperative complications according to surgical technique by meta-analysis. The PubMed, Clinical Trials.gov Cochrane Library and Web of Science databases were searched for relevant studies published before March 27, 2020. The search strategy used the following MeSH terms: ("bowel endometriosis" or "colorectal endometriosis") AND ("surgery for endometriosis" or "conservative management" or "radical management" or "colorectal resection" or "shaving" or "full thickness resection" or "disc excision") AND ("treatment", "outcomes", "long term results" and "complications"). Methods of Study Selection:Two authors conducted the literature search and independently screened abstracts for inclusion, with resolution of any difference by three other authors. Studies were included when data on surgical management (shaving, disc excision and/ or segmental resection) were provided and when postoperative outcomes were detailed with at least the number of complications. The risk of bias was assessed according to the Cochrane recommendations. Tabulation, Integration, and Results: Of the168 full-text articles assessed for eligibility, 60 were included in the qualitative synthesis. Seventeen of these were included in the metaanalysis on rectovaginal fistula, 10 on anastomotic leakage, five on anastomotic stenosis, and nine on voiding dysfunction <30 days. The mean complication rate according to shaving, discoid excision and segmental resection were 2.2%, 9.7% and 9.9%, respectively. Rectal shaving was less associated with rectovaginal fistula than discoid excision (OR=0.19; 95% CI [0.10-0.36], p<0.00001, I 2 =33%) and segmental colorectal resection (OR=0.26, 95% IC [0.15-0.44], p<0.00001, I 2 =0%). No difference was found in the occurrence of rectovaginal fistula between discoid excision and segmental colorectal resection (OR=1.07, 95%CI [0.70-1.63], p=0.76, I 2 =0%). Rectal shaving was less associated with leakage than disc occurrence of voiding dysfunction <30 days between segmental resection and rectal shaving (OR=3.05, 95% IC [0.55-16.87], p=0.20, I 2 =0%) or between segmental colorectal and discoid resection (OR=0.99, 95% IC [0.54-1.85], p=0.99, I 2 =71%). Conclusion:Colorectal surgery for endometriosis exposes patients to a risk of severe complications such as rectovaginal fistula, anastomotic leakage, anastomotic stenosis and voiding dysfunction. Rectal shaving appears to be less associated with postoperative complications than disc excision and segmental colorectal resection. However, this technique is not suitable in all patients with large bowel infiltration. Compared to segmental colorectal resection, disc excision has several advantages including shorter operating time, short...

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Objectives. To examine the association between phthalates exposure and two measures of uterine fibroid burden: diameter of largest fibroid and uterine volume. Design: Pilot, cross-sectional study Setting: Academic medical center Patient(s): Fifty-seven pre-menopausal women undergoing either hysterectomy or myomectomy for fibroids. Intervention: None Main Outcome Measures: Diameter of the largest fibroid and uterine dimensions were abstracted from medical records. Spot urine samples were analyzed for 14 phthalate biomarkers using mass spectrometry. We estimated associations between fibroid outcomes and individual phthalate metabolites, sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP), and a weighted sum of anti-androgenic phthalate metabolites (∑AA Phthalates) using linear regression, adjusting for age, race/ethnicity, and BMI. Fibroid outcomes were also examined dichotomously (divided at the median) using logistic regression. Results. Most women were Black, overweight or obese, and college-educated. In multivariable models, higher levels of mono-hydroxyisobutyl phthalate, monocarboxyoctyl phthalate,monocarboxynonyl phthalate, mono(2-ethylhexyl) phthalate, mono(2-ethyl-5-hydroxyhexyl phthalate) (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), ∑DEHP and ∑AA Phthalates were positively associated with uterine volume. Associations were most pronounced for individual DEHP metabolites(MEHHP, MEOHP, MECPP), ∑DEHP and ∑AA Phthalates. For example, a doubling in ∑DEHP and ∑AA Phthalates was associated with 33.19% (95% CI 6.59, 66.43) and 26.81% (95% CI 2.19, 57.37) increase in uterine volume, respectively. There were few associations between phthalate biomarkers and fibroid size. Conclusions. Exposure to some phthalate biomarkers was positively associated with uterine volume, which further supports the hypothesis that phthalates exposures may be associated with fibroid outcomes. Additional studies are needed to confirm these relationships.