Rectal endometriosis: results of radical excision and review of published work.
BACKGROUND
The aim of this paper is to review the results of surgical excision of rectal endometriosis and review the published work on this challenging condition.


METHODS
All cases of endometriosis involving the rectum treated by a single colorectal surgeon were identified from a prospective database and the results reviewed.


RESULTS
Between 1995 and 2005, 213 rectal procedures were carried out on 203 patients together with an endogynaecologist. Eighteen cases involved dissection of endometriosis off the rectal wall, 58 involved full-thickness excision of the anterior rectal wall and 137 segmental excisions of the rectum were carried out. A loop ileostomy was required in 7 (5%) of the segmental resections. Seventy-five per cent of the cases were either laparoscopic or laparoscopically assisted. Infertility was significantly more common in the group requiring a segmental resection (P=0.026) and a history of rectal pain during defecation more common in patients having dissection of endometriosis off the rectal wall (P=0.031). There were no other significant differences between the different types of rectal surgery. The morbidity for all rectal procedures was 7% and there was one anastomotic leak in the segmental resection group. The actuarial rectal recurrence rate of endometriosis was 22.2% 95% confidence interval (CI) (2.5, 42.0) for dissection off the rectal wall and this was significantly different from the recurrence of 5.17% 95%CI (0.0, 10.9) for anterior rectal wall excision and 2.19% 95%CI (0.0, 4.6) for segmental rectal resection (P=0.007). The overall rectal recurrence for all cases was 4.69% 95%CI (1.8, 7.5).


CONCLUSIONS
Endometriosis of the rectum can be successfully treated with low morbidity and low recurrence rates by excising the disease as completely as possible using full-thickness excision of the anterior rectal wall or segmental resection of the rectum.
Brouwer
Richard
R
Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Woods
Rodney J
RJ
D000328:Adult; D000465:Algorithms; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004715:Endometriosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D012002:Rectal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies