title: Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years' experience from a tertiary referral unit.
abstract: BACKGROUND
  The management of symptomatic rectal endometriosis is a challenging condition that may necessitate limited stripping or limited segmental anterior rectal resection (LSARR) depending upon the extent and severity of the disease.
  
  
  OBJECTIVE
  To report the efficacy of LSARR in terms of pain, quality of life and short- and long-term complications-in particular, those pertaining to bowel function.
  
  
  METHODS
  The case notes of all patients undergoing LSARR were reviewed. The analysed variables included surgical complications, overall symptomatic improvement rate, dysmenorrhoea, dyspareunia, and dyschezia. Chronic pain was measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Bowel symptoms were assessed using the Memorial Sloan Kettering Cancer Centre (MSKCC) questionnaire.
  
  
  RESULTS
  Seventy-four women who underwent LSARR by both open and laparoscopic approaches were included in this study. Sixty-nine (93.2%) women reported improvement in pain and the same percentage would recommend the similar procedure to a friend with the same problem. Approximately 42% of women who wished to conceive had at least one baby. The higher frequency of defecation was a problem in the early post-operative period but this settled in later stages without influencing the quality of life score. Post-operative complications were recorded in 14.9% of cases.
  
  
  CONCLUSIONS
  LSARR for rectal endometriosis is associated with a high degree of symptomatic relief. Pain relief achieved following LSARR does not appear to degrade with time. As anticipated, some rectal symptoms persist in few patients after long-term follow-up but LSARR is nonetheless still associated with a very high degree of patient satisfaction.
authors.affiliation: Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: James
authors.initials: J
authors.lastname: English
authors.affiliation: Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria surgeon1wrh@hotmail.com.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Jenney
authors.initials: J
authors.lastname: Lo
authors.affiliation: Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Guy
authors.initials: G
authors.lastname: Hudelist
authors.affiliation: Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Mirza K
authors.initials: MK
authors.lastname: Baig
authors.affiliation: Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, 177 Preston Road Brighton, BN1 AG, UK, Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK, Department of Obstetrics and Gynaecology, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK and Department of Obstetrics and Gynaecology, Wilhelminen Hospital, Vienna, Austria.
authors.forename: William A
authors.initials: WA
authors.lastname: Miles
keywords: limited segmental anterior rectal resection; long-term outcomes; quality of life; rectal endometriosis