title: Radical excision of rectovaginal endometriosis results in high rate of pain relief - results of a long-term follow-up study.
abstract: OBJECTIVE
  To evaluate the long-term results of radical excision for rectovaginal endometriosis (RVE) with special emphasis on current symptoms and risk factors as regards recurrence.
  
  
  METHODS
  A total of 116 patients operated upon because of RVE were offered a clinical follow-up evaluation visit; 60 (52%) consented. The time (mean +/- SD) from the index surgery to the follow-up visit was 4.0 +/- 0.5 years.
  
  
  METHODS
  Daily symptoms using a visual analogue scale for 30 consecutive days prior to clinical assessment; the amount of uterine bleeding was also assessed. Endometriosis recurrence was evaluated via clinical and ultrasonographic examination.
  
  
  RESULTS
  The symptom sum scores (maximum 300) were low with median scores (range) of 3 (0-32) for dysmenorrhea and 9 (0-72) for pelvic pain. Evidence of RVE recurrence was found or suspected in 29 (48%) of the 60 women assessed. Clinical recurrence was not associated with pain symptoms. In univariable analysis, amenorrhea at the time of clinical assessment was associated with a lower risk of recurrence (odds ratio; OR 0.13; 95% CI (confidence interval) 0.02-0.65, p = 0.01); the effect of bowel resection was not significant (OR 0.37: 95% CI 0.13-1.07, p = 0.07). In multivariable analysis, the protective effect of bowel resection on recurrence was significant (OR 0.23; 95% CI 0.06-0.89, p = 0.03).
  
  
  CONCLUSIONS
  Radical surgery may result in long-term pain relief in cases of RVE. Bowel resection is associated with a lower risk of RVE recurrence. Therapy that induces amenorrhea may be effective in preventing recurrence following surgical treatment of RVE.
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Tarjanne
authors.forename: Jari
authors.initials: J
authors.lastname: Sjöberg
authors.forename: Oskari
authors.initials: O
authors.lastname: Heikinheimo
mesh_terms: D004412:Dysmenorrhea / Q000453:epidemiology; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D016017:Odds Ratio; D010147:Pain Measurement; D012002:Rectal Diseases / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000453:epidemiology; D014623:Vaginal Diseases / Q000453:epidemiology*