title: Surgical treatment of deeply infiltrating endometriosis with colorectal involvement.
abstract: BACKGROUND
  Treatment of colorectal endometriosis is difficult and challenging. We reviewed the clinical outcome of surgical treatment of deeply infiltrating endometriosis (DIE) with colorectal involvement.
  
  
  METHODS
  Review was based upon a literature search using following search terms: (1) 'surgery' and 'colorectal endometriosis', (2) 'bowel' and 'endometriosis' and 'surgery'.
  
  
  METHODS
  clear explanation of surgical technique and follow-up data on at least one of the following items: complications, pain, quality of life (QOL), fertility and recurrence.
  
  
  RESULTS
  Most of the 49 studies included complications (94%) and pain (67%); few studies reported recurrence (41%), fertility (37%) and QOL (10%); only 29% reported (loss of) follow-up. Out of 3894 patients, 71% received bowel resection anastomosis, 10% received full-thickness disc excision and 17% were treated with superficial surgery. Comparison of clinical outcome between different surgical techniques was not possible. Post-operative complications were present in 0-3% of the patients. Although pain improvement was reported in most studies, pain evaluation was patient-based in <50% (Visual Analogue Scale in only 18%). While QOL was improved in most studies, prospective data were only available for 149 patients. Pregnancy rates were 23-57% with a cumulative pregnancy rate of 58-70% within 4 years. The overall endometriosis recurrence rate in studies (>2 years follow-up) was 5-25% with most of the studies reporting 10%. Owing to highly variable study design and data collection, a CONSORT-inspired checklist was developed for future studies.
  
  
  CONCLUSIONS
  Prospective studies reporting standardized and well-defined clinical outcome after surgical treatment of DIE with colorectal involvement with long-term follow-up are needed.
authors.affiliation: Leuven University Fertility Centre, Department of Obstetrics and Gynecology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
authors.forename: Christel
authors.initials: C
authors.lastname: Meuleman
authors.forename: Carla
authors.initials: C
authors.lastname: Tomassetti
authors.forename: André
authors.initials: A
authors.lastname: D'Hoore
authors.forename: Ben
authors.initials: B
authors.lastname: Van Cleynenbreugel
authors.forename: Freddy
authors.initials: F
authors.lastname: Penninckx
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Hooghe
mesh_terms: D001723:Birth Rate; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005298:Fertility; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D018873:Pregnancy Rate; D011788:Quality of Life; D012002:Rectal Diseases / Q000601:surgery*; D012008:Recurrence; D012810:Sigmoid Diseases / Q000601:surgery*; D016896:Treatment Outcome