title: Radical resection of invasive endometriosis with bowel or bladder involvement--long-term results.
abstract: OBJECTIVE
  With the present study we wanted to evaluate the effect of a radical resection of bowel and bladder endometriosis with respect to relief of pain symptoms and long-term effects.
  
  
  METHODS
  Retrospectively we analyzed 23 patients undergoing bowel or bladder resection for infiltrating endometriosis between 1995 and 2004. Chart review was performed and data were analyzed with respect to pain symptoms, fertility, type of surgery, operative morbidity and mortality. At 1, 3 and 5 years of follow-up patients were asked to evaluate their symptoms based on a visual analogue pain scale (0: no pain, 10: most severe pain). Results were compared using the Student's t-test.
  
  
  RESULTS
  Leading symptoms were chronic pelvic pain (17/23, 73.9%), dysmenorrhea (11/23, 47.8%), dyspareunia (6/23, 26.1%), infertility (4/23, 17.4%) and dyschezia (4/23, 17.4%). Three patients (13%) had abdominal hysterectomy, 5 (21.7%) LSO (n = 2) or BSO (n = 3), 18 (78.3%) anterior rectal resection, 4 (17.4%) sigmoid resection, 2 (8.6%) segmental bladder resection and one patient (4.3%) cecal resection. Major complications requiring re-operation occurred in three patients (2x postoperative bleeding, 1x anastomosis break-down). During follow-up (mean 40.5 months) 21 of the 23 patients (91.3%) had a persistent improvement of symptoms, 8 of the 23 (34.8%) had recurrent symptoms with a mean symptom-free interval of 40.4 months after surgery (24-60 months). No patient developed dyspareunia or dyschezia during follow-up. Overall cure rate was 73.9%. Four patients became pregnant (23%). Average pain scores increased during follow-up period but still remained significantly below the initial score (p < 0.001).
  
  
  CONCLUSIONS
  Radical surgery for deep endometriosis with bowel or bladder involvement leads to a reliable and persistent relief of pain symptoms. Especially deep dyspareunia and dyschezia might be eliminated by this procedure.
authors.affiliation: Department of Obstetrics and Gynecology, Heinrich-Heine-University, Moorenstr. 5, D-40225 Duesseldorf, Germany. fleisch@med.uni-duesseldorf.de
authors.forename: Markus C
authors.initials: MC
authors.lastname: Fleisch
authors.forename: Dimitris
authors.initials: D
authors.lastname: Xafis
authors.forename: Filip
authors.initials: F
authors.lastname: De Bruyne
authors.forename: Juergen
authors.initials: J
authors.lastname: Hucke
authors.forename: Hans Georg
authors.initials: HG
authors.lastname: Bender
authors.forename: Peter
authors.initials: P
authors.lastname: Dall
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000209:etiology / Q000601:surgery*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000601:surgery*