title: Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study.
abstract: To assess long-term bowel symptoms in women who underwent segmental bowel resection for deep-infiltrating endometriosis (DIE) compared with women who underwent resection of severe endometriosis without bowel resection.
  
  
  
  Cohort study with matched controls (Canadian Task Force classification II-2).
  
  
  
  Cleveland Clinic.
  
  
  
  71 patients (36 cases and 35 controls).
  
  
  
  Patients who were at least 4 years out from undergoing segmental bowel resection due to DIE were matched with patients who had undergone resection of stage III/IV endometriosis without bowel resection. The patients completed validated questionnaires, and data were analyzed using the Wilcoxon rank-sum, χ(2), and Fisher exact tests.
  
  
  
  The Bristol Stool Form Scale, Patient Assessment of Constipation Symptoms Questionnaire (PAC-SYM), and St Mark's Vaizey Fecal Incontinence Grading System were used to elicit information. The median duration of follow-up was 10.1 years (range, 4-18 years). The mean patient age and body mass index were comparable in the cases and the controls. A larger proportion of cases than controls reported new bowel symptoms (58% [21 of 36] vs 14% [5 of 35]; p = .001), as well as abdominal pain, incomplete bowel movements, and false alarms on the PAC-SYM questionnaire; however, total PAC-SYM and Vaizey Fecal Incontinence Grading System scores were similar in the 2 groups (median, 8 [interquartile range, 8-10] vs 8 [8-10]; p = .86). Similarly, the proportion of patients with normal stool consistency (Bristol Stool Form Scale score 2-6) was similar in the 2 groups (80.6% [29 of 36] vs 94.3% [33 of 35]; p = .59).
  
  
  
  Segmental bowel resection for DIE may be associated with a higher incidence of new bowel symptoms (possibly due to abdominal pain, incomplete bowel movements, and/or false alarms), but not with worse constipation or fecal incontinence, compared with surgery without bowel resection.
authors.affiliation: Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH; South Florida Institute for Reproductive Medicine, Miami, FL; Department of Obstetrics and Gynecology, Herbert Wertheim College of Medicine at Florida International University, Miami, FL.
authors.forename: Enrique
authors.initials: E
authors.lastname: Soto
authors.affiliation: Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH; Advanced Fertility Center of Chicago, Chicago, IL.
authors.forename: Michelle
authors.initials: M
authors.lastname: Catenacci
authors.affiliation: Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH; Fertility Center of Las Vegas, Las Vegas, NV; Department of Obstetrics and Gynecology, University of Nevada School of Medicine, Las Vegas, NV.
authors.forename: Carrie
authors.initials: C
authors.lastname: Bedient
authors.affiliation: Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: J Eric
authors.initials: JE
authors.lastname: Jelovsek
authors.affiliation: Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH. Electronic address: falcont@ccf.org.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D003248:Constipation / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D013505:Digestive System Surgical Procedures; D004412:Dysmenorrhea / Q000209:etiology / Q000503:physiopathology; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000503:physiopathology; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Constipation; Deep infiltrating endometriosis; Fecal incontinence; Segmental bowel resection; Severe endometriosis