title: Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility.
abstract: OBJECTIVE
  We report the first randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis focusing on perioperative complications, improvement in symptoms, quality of life, and fertility.
  
  
  BACKGROUND
  Bowel endometriosis is one of the most severe forms of endometriosis. Although laparoscopically assisted surgery is a validated technique for colorectal cancer, there are serious concerns about its appropriateness for endometriosis in young women wishing to conceive because it is almost invariably a traumatic procedure.
  
  
  METHODS
  We conducted a noninferiority trial and randomly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection. The median follow-up was 19 months. The primary end point was improvement in dyschesia.
  
  
  RESULTS
  Overall, a significant improvement in digestive symptoms (dyschesia P < 0.0001, diarrhea P < 0.01, and bowel pain and cramping P < 0.0001), gynecologic symptoms (dysmenorrhea P < 0.0001 and dyspareunia P < 0.0001), and general symptoms (back pain P = 0.001 and asthenia P = 0.0001) was observed. No difference in the symptom delta values and quality of life was noted between the groups. Median blood loss was lower in the laparoscopic group (P < 0.05). Total number of complications was higher in the open surgery group (P = 0.04), especially grade 3 (P = 0.03). Pregnancy rate was higher in the laparoscopic group (P = 0.006), and the cumulative pregnancy rate was 60%.
  
  
  CONCLUSIONS
  Our findings support that laparoscopy is a safe option for women requiring colorectal resection for endometriosis. Moreover, laparoscopy offers a higher pregnancy rate than open surgery with similar improvements in symptoms and in quality of life.
authors.affiliation: Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie Paris 6, France. emile.darai@tnn.aphp.fr
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.forename: Gil
authors.initials: G
authors.lastname: Dubernard
authors.forename: Charles
authors.initials: C
authors.lastname: Coutant
authors.forename: Catherine
authors.initials: C
authors.lastname: Frey
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D010535:Laparoscopy; D011183:Postoperative Complications; D011247:Pregnancy; D011788:Quality of Life; D012002:Rectal Diseases / Q000601:surgery*