title: Clinical outcome after CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis.
abstract: BACKGROUND
  Laparoscopic segmental bowel resection and reanastomosis for endometriosis with colorectal wall invasion can be associated with high complication rates. This study was performed to test the hypothesis that this high complication rate can be prevented and combined with a good clinical outcome, following a multidisciplinary surgical approach.
  
  
  METHODS
  A retrospective cohort study of all patients with deep endometriosis and colorectal invasion treated by CO₂ laser laparoscopic radical excision between September 2004 and September 2006 (n = 45) to document the clinical outcome: complications, recurrence and fertility (life table analysis), pain, quality of life (QOL) and sexual function.
  
  
  RESULTS
  No immediate major post-operative complications requiring surgical reintervention were recorded. Gynaecological pain (P < 0.0001), sexual function (P < 0.03) and QOL (P< 0.0001), improved significantly after a median follow-up period of 27 (range: 16-40) months. Although five patients (11%) had a surgical reintervention, histologically proven recurrent endometriosis was observed in only two (4%), with a cumulative endometriosis recurrence rate of 2.2 and 4.4% after 1 and 3 years, respectively. Thirteen of 28 patients who wanted to become pregnant conceived after surgery. One patient delivered twice. These 14 pregnancies were achieved spontaneously (n = 9) or after IVF (n = 5). The cumulative pregnancy rate was 47% after 3 years.
  
  
  CONCLUSIONS
  Pain, sexual function and QOL improved significantly and were associated with a good fertility rate and a low complication and recurrence rate after a CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis.
authors.affiliation: Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Meuleman
authors.forename: C
authors.initials: C
authors.lastname: Tomassetti
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
authors.forename: A
authors.initials: A
authors.lastname: Buyens
authors.forename: B
authors.initials: B
authors.lastname: Van Cleynenbreugel
authors.forename: S
authors.initials: S
authors.lastname: Fieuws
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.forename: I
authors.initials: I
authors.lastname: Vergote
authors.forename: T
authors.initials: T
authors.lastname: D'Hooghe
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D054020:Lasers, Gas / Q000627:therapeutic use*; D010146:Pain / Q000601:surgery; D011183:Postoperative Complications; D011247:Pregnancy; D018873:Pregnancy Rate; D011788:Quality of Life; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome