Outcomes after rectosigmoid resection for endometriosis: a systematic literature review

Balla, Andrea; Quaresima, Silvia; Subiela, José Daniel; Shalaby, Mostafa; Petrella, Giuseppe; Sileri, Pierpaolo

doi:10.1007/s00384-018-3082-y

Cited by 50 publications

(36 citation statements)

References 65 publications

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“…For this reason, it should be considered the first-line investigation in patients with suspicion of deep endometriosis [5]. Surgical management of rectosigmoid endometriosis (shaving excision, discoid resection, or segmental bowel resection) leads to a significant improvement of pain and intestinal complains [6,7]. Overall, these procedures may carry a not-negligible risk of complications such as ureteral damages, damages to the pelvic nerves, and dehiscence of the suture in cases of bowel resection.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Barra

Scala

Maggiore

et al. 2020

JCM

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Background: Rectosigmoid endometriosis is a severe form of deep endometriosis, which may be responsible for pain symptoms and a wide range of intestinal complains such as diarrhea, constipation, and abdominal cramping. The primary objective of this study was to evaluate the efficacy of long-term therapy with dienogest (DNG), a fourth-generation progestin, for ameliorating quality of life, pain, and intestinal symptoms of patients affected by rectosigmoid endometriosis. Methods: A retrospective analysis of a prospectively collected database was done on patients with endometriotic nodules infiltrating at least the muscular layer of the rectosigmoid wall with an estimated colorectal stenosis <60%. The diagnosis of rectosigmoid endometriosis was based on transvaginal ultrasonography. Patients accepting to participate in the study received continuous oral treatment with DNG at the dose of 2 mg/day. Results: At the end of the first year of treatment, a significant decrease in dysmenorrhea (P < 0.001), chronic pelvic pain (P < 0.001), dyspareunia (P < 0.001), dyschezia (P < 0.001), and in intestinal symptoms (P < 0.001) was observed. A progressive increase of the Endometriosis Health Profile-30 (EHP-30) and Gastrointestinal Quality of Life Index (GIQLI) scores was observed in the first two years of therapy (P < 0.001 and P < 0.001, respectively). Improvements of patients’ symptoms and quality of life were maintained until the end of the study. The regimen was well tolerated, and the frequency and amount of irregular bleeding decreased as treatment progressed. Conclusion: The current study confirms the efficacy of long-term therapy with DNG for treating symptoms caused by rectosigmoid endometriosis.

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Section: Introductionmentioning

confidence: 99%

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Barra

Scala

Maggiore

et al. 2020

JCM

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“…Pelvic pain, infertility, dysmenorrhea and dyspareunia are the most common symptoms of endometriosis [ 3 , [9] , [10] , [11] ]. The incidence rate of gastrointestinal endometriosis is 3%–37% of all cases, and rectum and sigmoid colon are the most common sites of it, accounting for 50%–70%.…”

Section: Discussionmentioning

confidence: 99%

“…Operation should be designed according to the location, extent and the purpose of the surgery. For intestinal endometriosis, recto-vaginal fistula and anastomotic dehiscence/leak are the most serious postoperative complications, and being less than 10 cm away from the anal verge is an independent risk factor for this [ 1 , 3 , 9 , 11 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

A case report: Rectal endometriosis mimicking rectal cancer

Zhao

Wang

Zhang

2018

International Journal of Surgery Case Reports

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“…Of note, 95 out of these 123 women were described in a single study [34]. Excluding this outlier, the probability of undergoing surgery Vercellini et al,9 despite medical therapy was 8% (28/350; persistence or worsening of pain symptoms, n=11;…”

Section: Endometriosis Of the Proximal Rectum And Distal Sigmoid (Recmentioning

confidence: 98%

“…However, in many women, bowel endometriosis does not cause overt obstruction to faecal transit. Thus, when conception is not an issue, medical treatment might constitute a therapeutic alternative, especially considering that resection of endometriotic lesions with opening of the intestinal lumen may be followed by complications such as suture leakage, rectovaginal fistula formation, anastomosis stenosis, atonic bladder, and de novo bowel dysfunction [7][8][9][10]. The magnitude of the risk is associated also with the distance between the endometriotic lesion and the anal verge and with the coexistence of multiple lesions requiring more than one excision or segmental resection of a long intestinal tract [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Advances in the medical management of bowel endometriosis

Vercellini

Sergenti

Buggio

et al. 2021

Best Practice & Research Clinical Obstetrics & Gynaecol

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Endometriosis infiltrating the bowel can be treated medically in accurately selected women not seeking conception and without overt obstructive symptomatology. When the rectosigmoid junction is involved, the probabilities of intestinal symptoms relief, undergoing surgery after treatment failure, and developing bowel obstruction during hormonal treatment are around 70%, 10%, and 1-2%, respectively. When the lesion infiltrates exclusively the mid-rectum, thus in cases of true rectovaginal endometriosis, the probabilities of intestinal symptoms relief and undergoing surgery are about 80% and 3%, respectively. Endometriotic obstructions of the rectal ampulla have not been reported. A recto-sigmoidoscopy or colonoscopy should be performed systematically before starting medical therapies, also to rule out malignant tumours arising from the intestinal mucosa. Progestogens are safe, generally effective, well tolerated, inexpensive, and should be considered as first-line medications for bowel endometriosis. Independently of symptom relief, intestinal lesions should be checked periodically to exclude nodule progression during hormonal treatment.

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Outcomes after rectosigmoid resection for endometriosis: a systematic literature review

Abstract: Despite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.

Cited by 50 publications

References 65 publications

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

Long-Term Administration of Dienogest for the Treatment of Pain and Intestinal Symptoms in Patients with Rectosigmoid Endometriosis

A case report: Rectal endometriosis mimicking rectal cancer

Advances in the medical management of bowel endometriosis

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