title: Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum.
abstract: OBJECTIVE
  To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision.
  
  
  METHODS
  "Before and after" comparative retrospective study.
  
  
  METHODS
  University tertiary referral center.
  
  
  METHODS
  Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum.
  
  
  METHODS
  Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted.
  
  
  METHODS
  Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score.
  
  
  RESULTS
  Preoperative patient characteristics, rectal nodule features, and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life Score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency.
  
  
  CONCLUSIONS
  It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection.
authors: Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France. horace.roman@gmail.com
authors: Horace
authors: H
authors: Roman
authors: Maud
authors: M
authors: Vassilieff
authors: Jean Jacques
authors: JJ
authors: Tuech
authors: Emmanuel
authors: E
authors: Huet
authors: Guillaume
authors: G
authors: Savoye
authors: Loïc
authors: L
authors: Marpeau
authors: Lucian
authors: L
authors: Puscasiu
mesh_terms: D000328:Adult; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000379:methods; D004715:Endometriosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010686:Philosophy, Medical; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D011788:Quality of Life; D012007:Rectum / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome