Surgical outcome and long‐term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis

Abstract

The aim of this study was to assess the long-term outcome of treating severely symptomatic women with deep infiltrating intestinal endometriosis by laparoscopic segmental rectosigmoid resection. Detailed intraoperative and postoperative records and questionnaires (preoperatively, 1 month postoperatively and every 6 months for 3 years) were collected from 22 women. The estimated blood loss during surgery was 290 ± 162 ml (range 180-600), and average hospital stay was 8 days (range 6-19). One woman required blood transfusion after surgery. Two cases were converted to laparotomy. One woman had early dehiscence of the anastomosis. Six months after surgery, there was a significant reduction of symptom scores (greater than 50% for most types of pain) related to intestinal localisation of endometriosis (P < 0.05). Score improvements were maintained during the whole period of follow up. Noncyclic pelvic pain scores showed significant reductions (P < 0.05) after 6 and 12 months, but there was a high recurrence rate later. Dysmenorrhoea and dyspareunia improved in 18/21 and 14/18 women with preoperative symptoms, respectively. Constipation, diarrhoea and rectal bleeding improved in all affected women for the whole period of follow up. Laparoscopic segmental rectosigmoid resection seems safe and effective in women with deep infiltrating colorectal endometriosis resulting in significant reductions in painful and dysfunctional symptoms associated with deep bowel involvement.

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].…”

“…This improvement is greater during the first year after the intervention, although it can stay above 70% of the patients after 3 and 5 years, especially for those specific intestinal symptoms such as dyschezia [46,51].…”

“…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].…”

“…In this publication, 357 cases were followed up for 20 months showing a recurrence rate of symptomatology of 6.3% and a recurrence rate of endometriosic nodules in 3.5% of the patients [27]. When they compared these results to those obtained after laparotomic colorectal resection, they found a similar rate of complications [51]. Keckstein and Weisinger [25] found a 7.4% complications rate and Daraï et al [26] reported a 10% complications rate, with 6% being rectovaginal fistulas.…”

Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study

“…The treatment for severe endometriosis, particularly in patients with DIE involving the bowel, is often complex and may require a multidisciplinary surgical approach for symptomatic patients who do not improve with medical treatment [16][17][18]. Several case series involving segmental bowel resection for DIE have been reported in the literature, but these have been limited owing to a lack of validated questionnaires, small sample size, or absence of a control group that did not undergo bowel surgery [10,[19][20][21][22][23][24][25][26][27][28]. Moreover, some studies have lacked longterm follow-up [23,28].…”