title: Clinical outcome after radical excision of moderate-severe endometriosis with or without bowel resection and reanastomosis: a prospective cohort study.
abstract: OBJECTIVE
  To assess the clinical outcome of women requiring laparoscopic excision of moderate-severe endometriosis in women with and without bowel resection and reanastomosis.
  
  
  METHODS
  Two hundred three patients with laparoscopically excised moderate (n = 67) or severe (n = 136) endometriosis (rAFS: revised endometriosis classification of the American Fertility Society) were prospectively followed during a median of 20 months (1-45 months) using a CONSORT-inspired checklist. Patients completed the EHP30 Quality-of-Life Questionnaire and visual analogue scales (VAS) for dysmenorrhea, chronic pelvic pain, and deep dyspareunia and answered questions about postoperative complications, reinterventions/recurrences, and fertility outcome 1 month before and 6, 12, 18, and 24 months after surgery. Clinical outcome was compared between women with deeply infiltrative endometriosis undergoing CO2 laser ablative surgery with bowel resection (study group, 76/203; 37%) and without bowel resection (control group, 127/203; 63%).
  
  
  RESULTS
  Both groups were similar with respect to population characteristics and clinical outcome, except for mean rAFS score [higher in study group (73 ± 31) than in control group (48 ± 26)] and minor complication rate [higher in study group (11%) than in control group (1%)]. In both groups, mean VAS and EHP30 scores improved significantly and remained stable for 24 months after surgery, with a pregnancy rate of 51%. Within 1, 2, and 3 years follow-up, the cumulative reintervention rate was 1%, 7%, and 10%, respectively, and the cumulative endometriosis recurrence rate was 1%, 6%, and 8%, respectively.
  
  
  CONCLUSIONS
  Clinical outcome after CO2 laser laparoscopic excision of moderate-severe endometriosis was comparable in women with or without bowel resection and reanastomosis, except for a higher minor complication rate occurring in women with bowel resection and reanastomosis (NCT00463398).
authors.affiliation: *Leuven University Fertility Center, Department of Obstetrics and Gynaecology †Department of Obstetrics and Gynaecology ‡Department of Abdominal Surgery §Department of Urology, University Hospital Leuven, Herestraat, Leuven, Belgium; and ¶Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium and University Hasselt, Belgium.
authors.forename: Christel
authors.initials: C
authors.lastname: Meuleman
authors.forename: Carl
authors.initials: C
authors.lastname: Tomassetti
authors.forename: Albert
authors.initials: A
authors.lastname: Wolthuis
authors.forename: Ben
authors.initials: B
authors.lastname: Van Cleynenbreugel
authors.forename: Annouschka
authors.initials: A
authors.lastname: Laenen
authors.forename: Freddy
authors.initials: F
authors.lastname: Penninckx
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: André
authors.initials: A
authors.lastname: DʼHoore
authors.forename: Thomas
authors.initials: T
authors.lastname: DʼHooghe
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome