Long-term follow-up after conservative surgery for rectovaginal endometriosis.
OBJECTIVE
The purpose of this study was to evaluate long-term results in patients who received conservative surgical treatment for rectovaginal endometriosis.


METHODS
We analyzed the follow-up data for 83 women who underwent surgery for rectovaginal endometriosis. The inclusion criteria were age 20 to 42 years, moderate-to-severe pain symptoms, conservative treatment with retention of the uterus, and at least 1 ovary; the follow-up period was > or =12 months. Kaplan-Meier analysis and Cox regression were used to calculate recurrence rates.


RESULTS
The cumulative rates of pain recurrence, clinical or sonographic recurrence, and new treatment were 28%, 34%, and 27%, respectively. The younger patients had the higher risk of recurrence. Pregnancy had protective effects against the recurrence of symptoms and a need for a new treatment. Patients who underwent bowel resection had fewer recurrences.


CONCLUSIONS
Segmental resection and anastomosis of the bowel, when necessary, improves the outcome without affecting chances of conception. Higher recurrence rates in younger patients seems to justify a more radical treatment in this group of women.
Fedele
Luigi
L
Clinica Ostetrico-Ginecologica dell' Università di Milano, Ospedale San Paolo, Milan, Italy. luigi.fedele@unimi.it
Bianchi
Stefano
S
Zanconato
Giovanni
G
Bettoni
Gaia
G
Gotsch
Francesca
F
D000328:Adult; D000367:Age Factors; D018572:Disease-Free Survival; D004715:Endometriosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007558:Italy / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012002:Rectal Diseases / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017741:Survivors; D014623:Vaginal Diseases / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*