Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: giving patients an informed choice.
BACKGROUND
The aim of this study was to compare delayed functional digestive and urinary outcomes following two different surgical procedures used in the management of rectal endometriosis.


METHODS
Women who had undergone surgical management of rectal endometriosis with at least 1 year of post-operative follow-up were included in a retrospective study. Post-operative symptoms were evaluated using specific questionnaires which focused on pelvic pain and functional outcomes.


RESULTS
There were 41 women who underwent surgical treatment of symptomatic rectal endometriosis. Post-operative follow-up was completed over 26 +/- 13 months (range 12-53). Colorectal segmental resection was performed in 25 women (61%) and nodule excision in 16 (39%). An increase in the number of daily stools > or =3 was observed in 13 (52%) and 3 (19%) patients managed, respectively, by segmental resection and nodule excision (P = 0.02). Severe constipation (<1 stool/5 days) was recorded in three women having undergone segmental resection. The probabilities of being free of dysmenorrhea, dyspareunia and non-cyclic pain at 24 months in women managed by segmental resection and nodule excision were, respectively, 80% (95% CI: 55-92%), 65% (95% CI: 42-81%), 43% (95% CI: 23-62%) and 62% (95% CI: 34-81%), 81% (95% CI: 52-94), 69% (95% CI: 40-86%). When pain recurrences occurred, a significantly lower post-operative score for pain was observed in both groups. No significant difference in pain improvement was found between surgical procedures.


CONCLUSIONS
Colorectal segmental resection appears to be associated with several unpleasant functional symptoms when compared with nodule excision. Information about functional outcomes should be provided to patients managed for rectal endometriosis, and should be considered when deciding on the most appropriate treatment of this disease.
Roman
Horace
H
Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France. horace.roman@gmail.com
Loisel
Cecile
C
Resch
Benoit
B
Tuech
Jean Jacques
JJ
Hochain
Patrick
P
Leroi
Anne Marie
AM
Marpeau
Loic
L
D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods; D004412:Dysmenorrhea / Q000503:physiopathology; D004414:Dyspareunia / Q000503:physiopathology; D004715:Endometriosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010146:Pain / Q000503:physiopathology; D012002:Rectal Diseases / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000503:physiopathology / Q000601:surgery*