The surgical management of rectovaginal endometriosis: plus ça change?

Wright, Jeremy; Ballard, Karen

doi:10.1111/j.1471-0528.2010.02818.x

Cited by 4 publications

(8 citation statements)

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“…Our conclusion is similar to the comment of Wright and Ballard, ie, “although the surgical treatment of bowel endometriosis appears to have become an established practice, it is worth bearing in mind that its efficacy may be lower than that of medical treatment”1 and that HBSO alone with or without subsequent hormone replacement therapy may be a good treatment option. Only randomized studies of medical versus surgical treatments and/or conservative surgery or HBSO alone versus addition of bowel resection performed in centers serving a large number of women with deep infiltrating endometriosis (or multicenter studies) will allow us to determine which option provides the most patient satisfaction.…”

Section: Discussionsupporting

confidence: 83%

“…Despite the relatively high rate of morbidity, surgical excision of deep infiltrating bowel endometriosis (disc and segmental bowel resection) has become a popular treatment modality due to improved operative laparoscopy techniques 1. An increasing number of studies have reported numerous cases in which laparoscopic segmental bowel resection has been performed,2 but the clinical reason or indication is often poorly documented.…”

Section: Introductionmentioning

confidence: 99%

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Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement?

Acién¹,

Núñez²,

Quereda³

et al. 2013

IJWH

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BackgroundThe purpose of this paper is to report the long-term results of surgery without bowel resection in patients suffering from deep infiltrating endometriosis with rectovaginal or colorectal involvement.MethodsThis retrospective observational study identified 42 patients suffering with deep infiltrating endometriosis who underwent surgery. Conservative surgery was performed in 23 women (only one of them with bowel resection), and 19 women underwent a hysterectomy and bilateral salpingo-oophorectomy (HBSO). In the conservative surgery group, a later HBSO was performed in eight patients as a second operation. Pregnancies, recurrences, reoperations, use of hormone replacement therapy, and outcomes during long-term follow-up were analyzed.ResultsThe average follow-up duration was 7 ± 5.7 years in conservative surgery cases. Only one patient was treated with sigmoid bowel resection in 1997 and had complications. In this conservative surgery group, 13 patients (56%) received medical treatment after surgery, 10 patients wanted to get pregnant (of whom seven [70%] were successful), and eight patients underwent a subsequent HBSO because of recurrent symptoms and/or endometrioma. Therefore, HBSO was performed in 27 patients, of whom 14 (51.8%) used hormone replacement therapy for 5.6 ± 3.6 years. No recurrences or complications were observed in patients after HBSO with or without hormone replacement therapy.ConclusionGood clinical results can be obtained by performing only conservative surgery and/or HBSO without bowel resection, an alternative that could reduce the number of colorectal resections that are performed very frequently nowadays. After HBSO, patients may use hormone replacement therapy for several years with total satisfaction and well-being.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement?

Acién¹,

Núñez²,

Quereda³

et al. 2013

IJWH

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“…It is not clear if the medical management approach prevents disease progression, especially in more severe cases of endometriosis with colorectal extension. In addition, discontinuation of this therapy commonly results in recurrence [18].…”

Section: Sites Of Endometriosis Affecting the Bowelmentioning

confidence: 99%

Systematic review of the outcome associated with the different surgical treatment of bowel and rectovaginal endometriosis

Moustafa

Elnasharty

2013

Gynecol Surg

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Background: Treatment of deep endometriosis involving the bowel is controversial. There is limitation of medical treatment. Several surgical techniques are used. All of them are associated with potential intraoperative complications and long-term hazards for the bladder, bowel and sexual function. Objectives: This study seeks to review systematically different types of surgical treatment of bowel endometriosis which include mucosal skinning (shaving), disc excision, and segmental resection. The review includes the number of participants, histology, symptomatology, preoperative assessment, types and access of surgery, complications, hospital stay, length and way of follow up, symptom improvement, recurrence, and effects on fertility. Study strategy: All published articles on surgical treatment of endometriosis (shaving, rectovaginal endometriosis, disc excision, and segmental resection), identified through MEDLINE, EMBASE, CINAHL, and Cochran library during 1970-2011. Grey literatures were searched as well. Selection criteria: The terms 'endometriosis', 'bowel', surgical, and complications were used. Articles describing 50 patients or more who had bowel surgery for endometriosis were only included. Data collection and analysis: Data did not permit a meaningful meta-analysis. Main results: We analyzed 36 articles after thorough literature search. It described 2,414 of mucosal skinning/rectovaginal endometriosis, 381 of disc excision, and 2,728 of bowel resection for deep endometriosis involving the bowel. The indication for surgery was stated in most of the studies. Histology was confirmed in the majority; however, completeness of the excision was stated in few articles. There is significant improvement of symptoms with all types of surgery. Complications were higher in segmental resection than conservative surgery (shaving and disc excision) especially leakage and fistula formation. The duration of surgery and hospital stay was shorter in conservative surgery unless there were complications or if associated with other surgeries. Fertility outcome was favourable in all. The recurrence and reoperation rate was higher in one study only in the shaving group, but otherwise was comparable to the resection group. Conclusion: There was no difference in the outcome between different types of surgery which indicates that we should adopt the conservative surgery if possible. The heterogeneity of the studies makes it difficult to do any valuable statistical analysis. There should be standardization in clinical trials evaluating bowel surgery for endometriosis.

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“…2 We presume that Kondo et al 1 meant skinning of the lesions when they used the terminology 'shaving', but once again it is not clear whether they were carrying this out at the mucosal or serosal surface of the bowel.…”

Section: Referencesmentioning

confidence: 99%

“…4 We agree that the common practice is to start with McRoberts' manoeuvre, as performed in 97% of our cohort. 2 The experience and judgment of the accoucheur at that juncture could have influenced the choice of manoeuvre, as posterior arm delivery was performed as the primary manoeuvre in one of 205 cases and as the secondary manoeuvre in 22 of 147 cases, and the experience of the accoucheur is certainly an important factor affecting the success and complication rate of different manoeuvres. However, as it was a retrospective review, it is difficult to take experience into account.…”

mentioning

confidence: 99%

Complications after surgery for deeply infiltrating pelvic endometriosis

Padavala

Navaneetham

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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delivery or when the HBDI is more than 1 minute, as recommended by Spong et al.,3 who have shown in their prospective study on 250 vaginal deliveries that 60 sec represented the mean + 2SDs of the HBDI. We agree with Spong et al. that 1 minute is a reasonable cut-off point, and by adopting this criterion, we would avoid over-diagnosis on the one hand and missing the diagnosis on the other; moreover, our statistics can also be compared with international figures. We also believe that setting a time limit would avoid delay in the diagnosis and improve perinatal outcome, as HBDI also has a strong impact on neonatal outcome. 4 We agree that the common practice is to start with McRoberts' manoeuvre, as performed in 97% of our cohort. 2 The experience and judgment of the accoucheur at that juncture could have influenced the choice of manoeuvre, as posterior arm delivery was performed as the primary manoeuvre in one of 205 cases and as the secondary manoeuvre in 22 of 147 cases, and the experience of the accoucheur is certainly an important factor affecting the success and complication rate of different manoeuvres. However, as it was a retrospective review, it is difficult to take experience into account. j References

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The surgical management of rectovaginal endometriosis: plus ça change?

Abstract: Please cite this paper as: Wright J, Ballard K. The surgical management of rectovaginal endometriosis: plus ça change? BJOG 2011;118:274–277.

Cited by 4 publications

References 10 publications

Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement?

Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement?

Systematic review of the outcome associated with the different surgical treatment of bowel and rectovaginal endometriosis

Complications after surgery for deeply infiltrating pelvic endometriosis

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