Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis.
BACKGROUND
Radical en bloc hysterectomy and colorectal resection (REHCR) is the ultimate and radical surgery for extensive pelvic endometriosis. Our aims were to evaluate feasibility, quality of life, and urinary function after REHCR by laparoscopy compared with laparotomy.


METHODS
Single-center, retrospective study of 29 endometriosis patients having undergone REHCR (16 by laparoscopy, 13 by laparotomy). Gynecologic and digestive symptoms, quality of life [Short-Form (SF)-36 health status], and urinary function [International Prostate Score Symptoms (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS)] were evaluated using validated questionnaires.


RESULTS
Except for mean age, no difference in epidemiologic characteristics was found between groups. Mean follow-up was 14 months (range 1-78 months). Four of the 16 patients (25%) of the laparoscopic group required laparoconversion. Consumption of analgesic drugs was lower in the laparoscopic group, and diarrhea (P < 0.001) and lower back pain (P < 0.001) improved. Improvement in dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), asthenia (P < 0.001), and quality of life was observed without difference between groups. Urinary function was not altered and did not differ between groups.


CONCLUSIONS
Our data support the feasibility of REHCR by laparoscopy with less analgesic consumption. Efficacy in terms of symptoms and improvement in quality of life were similar between groups, suggesting that laparoscopy should be offered to patients requiring REHCR.
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
Emile
E
Daraï
Marcos
M
Ballester
Elisabeth
E
Chereau
Charles
C
Coutant
Roman
R
Rouzier
Estelle
E
Wafo
D000328:Adult; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies