Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis.
OBJECTIVE
To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality-of-life outcomes.


METHODS
Prospective observational cohort study (Canadian Task Force classification II-2).


METHODS
Australian tertiary referral center for the surgical treatment of endometriosis.


METHODS
Seven consecutive patients with known endometriosis involving the bowel.


METHODS
Laparoscopic resection of all endometriosis, including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy.


RESULTS
Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and dyschezia. Validated research tools (SF12, EuroQOL, and Sexual Activity Questionnaire) also assessed quality of life. Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 (interquartile range 43-85) versus 5 (0-10); p=.028, nonmenstrual pelvic pain 74 (48-85) versus 11 (0-18); p=.046, dyspareunia 66 (0-98) versus 5 (0-8); p=.080, and dyschezia 48 (20-64) versus 20 (0-40); p=.173. All measures of quality of life were improved at 12 months after surgery, although not reaching statistical significance because of the small sample size. All three women wishing to conceive after operation have been successful, resulting in three live births at term. There were few complications associated with this surgery.


CONCLUSIONS
Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life. Results appear to parallel published data for conservative resection of endometriosis not involving bowel. For women with severe endometriosis involving bowel, this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility.
Lyons
Stephen D
SD
Department of Endo-Gynaecology, Royal Hospital for Women, Sydney, Australia. stephen.lyons@sesiahs.health.nsw.gov.au
Chew
Simon S B
SS
Thomson
Angus J M
AJ
Lenart
Meegan
M
Camaris
Catherine
C
Vancaillie
Thierry G
TG
Abbott
Jason A
JA
D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000601:surgery*; D010535:Laparoscopy; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D012007:Rectum / Q000601:surgery; D016896:Treatment Outcome