Fertility and clinical outcome after bowel resection in infertile women with endometriosis

Abstract

Bowel resection for endometriosis improves pain symptoms and quality of life in symptomatic women. However, little is known about fertility after surgery, particularly after such treatment in women suffering from infertility. The aim of the present study was to evaluate post-operative fertility and long-term clinical outcome after laparoscopic colorectal resection for endometriosis in infertile women. This study reports clinical outcomes in 62 infertile women who underwent laparoscopic excision of endometriosis with segmental bowel resection performed for severe intestinal symptoms. Among women younger than 30 years trying to conceive spontaneously, the cumulative pregnancy rate was 58% and the cumulative pregnancy rate was 45% in those aged 30-34 years. The total pain recurrence was 9.7% (six cases) and endometriosis recurrence was diagnosed by ultrasound in 14.5% (nine cases) during the follow-up period. Four of these patients needed further surgery because of severe symptoms. The surgical treatment of bowel endometriosis seems to improve pain symptoms and patients' satisfaction rates, and it could also be indicated in infertile women.

Comparison of Complete and Incomplete Excision of Deep Infiltrating Endometriosis

“…In our study, the complication rate in the complete excision group was 9.1% (5/55), and 0% (0/38) in the incomplete excision group. The complication rates in the complete excision group in our study were consistent with those described in the literature [12][13][14]. The morbidity remains low for such complex procedures.…”

“…Recent studies suggest that complete excision of DIE lesions leads to a reliable and per-sistent relief of pain symptoms, improvement of quality of life and acceptable postoperative fertility rates [12][13][14]. However radical surgical excision of deep endometriosis increases the risks of complications and is associated with severe morbidity.…”

Surgical treatment of rectovaginal endometriosis with rectal involvement

“…There were also five nonsystematic revisions published [3,28,[32][33][34]. In some of the studies, a radical treatment was assessed [5,13,15,[25][26][27][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56], while others assessed a conservative one [57][58][59][60][61][62][63]. There were six nonrandomized papers in which groups of patients with different therapeutic options were compared [30,[35][36][37][38][39].…”

“…Moreover, it is not specified in each series if the gestations were achieved spontaneously or after reproductive assistance treatment, making the interpretation of the results difficult. What does appear uniform between the papers is the conclusion that improvement of reproductive function after surgery for RVE is greater the younger the patient and the earlier the intervention is made [44,45,55].…”

“…Initially, the majority of papers defended a conservative surgical approach directed toward the extirpation or ablation of the endometriosic lesions with minimal excisional surgery of the rectum [6,12,[65][66][67][68]. However, in the last decade, multiple authors have proposed more aggressive techniques including intestinal resection, especially in those cases with an affected muscularis propia of the rectum but also in those having an intact mucosa [5,13,15,[25][26][27][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. The argument used for the practice of this radical surgery is that of achieving the greatest resection possible of the endometriosic lesions, diminishing the postoperative symptomatology and avoiding any early relapse of the disease [41,42].…”