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Choi JDW, Hu H, Cao A, Pathma-Nathan N, Toh JWT. Unresolved debate on surgery for deep infiltrating endometriosis of the rectum: bowel resection or a more conservative approach? ANZ J Surg 2024. [PMID: 38873963 DOI: 10.1111/ans.19134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/09/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Joseph Do Woong Choi
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hillary Hu
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Amy Cao
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Nimalan Pathma-Nathan
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James Wei Tatt Toh
- Department of Colorectal Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Villa NAC, Benetti-Pinto CL, Yela DA. Evaluation of Bowel Function of Women with Colorectal Endometriosis: a Cross-Sectional Study. Reprod Sci 2023; 30:3590-3596. [PMID: 37607988 DOI: 10.1007/s43032-023-01324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
The objective was to evaluate bowel function in women with colorectal endometriosis according to treatment type. Cross-sectional study, carried out with 141 women with endometriosis, followed by the University of Campinas from May 2020 to April 2021. Women were divided into 3 groups according to the kind of treatment: 16 women with conservative surgery, 35 women with radical surgery treatment, and 90 women with clinical treatment. The clinical and sociodemographic characteristics of these women were evaluated. To access bowel outcome, we used the following questionnaires: the Bristol Stool Scale, the Bowel Function in the Community, the Gastrointestinal Quality of Life Index (GIQLI), and the Pelvic Floor Distress Inventory (PFDI-20). The mean treatment time was 32.24 ± 29.37 months. The women of the three groups had similar gastrointestinal quality of life index scores (p = 0.27) and pelvic floor distress inventory scores (p = 0.23). Women in the radical surgery group had a higher frequency of evacuatory effort and change in posture to evacuate (p = 0.01 and 0.009, respectively) than did those in the other groups. Women with constipation had worse quality of life and more pain than those without constipation. In conclusion, women with endometriosis treated with radical surgery (segmental resection) had a higher frequency of constipation. In addition, women with endometriosis and constipation had a worse quality of life and higher pain scores compared to those without constipation.
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Affiliation(s)
- Nara Abe Cairo Villa
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Alexander Fleming Street 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Cristina Laguna Benetti-Pinto
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Alexander Fleming Street 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil
| | - Daniela Angerame Yela
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Alexander Fleming Street 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil.
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Raos M, Mathiasen M, Seyer-Hansen M. Impact of surgery on fertility among patients with deep infiltrating endometriosis. Eur J Obstet Gynecol Reprod Biol 2023; 280:174-178. [PMID: 36508855 DOI: 10.1016/j.ejogrb.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the study was to investigate pregnancy and live birth rate after surgical resection of rectosigmoid deep infiltrating endometriosis (DIE), and study if complications affect these rates. STUDY DESIGN Historical case series. 193 patients with rectosigmoid DIE and pregnancy intention undergoing a rectosigmoid resection for DIE from January 2009 to May 2019. All operations were performed at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark. Surgical and fertility outcome data were obtained through patient files. Anonymized data was analyzed statistically. Normally distributed continuous variables are stated as means, categorical data as percentages and time to pregnancy as Kaplan-Meier failure function. Live birth rates stratified on complications were tested with chi2 test. RESULTS 117 patients became pregnant postoperatively with a pregnancy and live birth rate of 60.6% and 53.9%, respectively. 39 patients (20.2%) became pregnant spontaneously and 78 patients (40.4%) by intrauterine insemination or assisted reproductive technologies. Median time to pregnancy after surgery was 12.4 months (range: 0.4-58). Clavien-Dindo complication grade III (none grade IV) was registered among 16.6%. These patients had pregnancy and live birth rates of 50%, not statistically significantly different from those without complications. CONCLUSIONS Postoperative pregnancy and live birth rates after resection of rectosigmoid endometriosis in this study are in line with conservative treatment, when comparing with the literature. Interestingly, complications (Clavien-Dindo grade III) did not affect live birth rate or time to pregnancy.
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Affiliation(s)
- Maja Raos
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Mie Mathiasen
- Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Parra RS, Valério FP, Zanardi JVC, Feitosa MR, Camargo HP, Féres O. Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1040-1046. [PMID: 36138537 PMCID: PMC9800063 DOI: 10.1055/s-0042-1756212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose was to assess the rates of postoperative complications and the need of temporary stoma of laparoscopic surgical treatment for bowel endometriosis in a referral center. METHODS The surgical indication, type of operation, operative time, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, postoperative complications were evaluated. RESULTS One-hundred and fifty patients were included. The average duration of surgery was significantly longer for segmental resection (151 minutes) than for disc excision (111.5 minutes, p < 0.001) and shaving (96.8 minutes, p < 0.001). Patients with segmental resection had longer postoperative lengths of hospital stay (1.87 days) compared with patients with disc excision (1.43 days, p < 0.001) and shaving (1.03 days, p < 0.001). A temporary stoma was performed in 2.7% of patients. Grade II and III postoperative complications occurred in 6.7% and 4.7% patients, respectively. CONCLUSION Laparoscopic intestinal resection has an acceptable postoperative complication rate and a low need for a temporary stoma.
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Affiliation(s)
- Rogério Serafim Parra
- School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil,Address for correspondence Rogério Serafim Parra, MD, PhD Av. Bandeirantes, 3900, 14048-900, Ribeirão Preto, SPBrazil
| | | | | | - Marley Ribeiro Feitosa
- School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Hugo Parra Camargo
- School of Medicine of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Gabriel I, Vitonis AF, Missmer SA, Fadayomi A, DiVasta AD, Terry KL, Minassian VA. Association between endometriosis and lower urinary tract symptoms. Fertil Steril 2022; 117:822-830. [PMID: 35109981 DOI: 10.1016/j.fertnstert.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine if women with endometriosis experience lower urinary tract symptoms (LUTSs) more often than those without. DESIGN Cross-sectional analysis at enrollment in a longitudinal cohort. SETTING Enrollment at 2 academic hospitals and from the local community. PATIENT(S) This analysis included 1,161 women with (n = 520) and without (n = 641) surgically confirmed endometriosis who were enrolled in the Women's Health Study: from Adolescence to Adulthood between 2012 and 2018. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Prevalence of LUTSs, including stress incontinence, urgency and frequency, straining with urination, incomplete bladder emptying, hematuria, dysuria, and bladder pain using standardized questionnaires. RESULT(S) The primary outcomes were that women with endometriosis reported the following more often than those without: difficulty passing urine (7.9% vs. 2%; crude odds ratio [OR], 4.14 [95% confidence interval {CI}, 2.19-7.80]; adjusted OR [aOR], 4.31 [95% CI, 2.07-8.95]); still feeling full after urination (18.8% vs. 4.7%; crude OR, 4.73 [95% CI, 3.08-7.25]; aOR, 4.67 [95% CI, 2.88-7.56]); having to urinate again within minutes of urinating (33.1% vs. 17.0%; crude OR, 2.41 [95% CI, 1.83-3.18]; aOR, 2.49 [95% CI, 1.81-3.43]), dysuria (11.7% vs. 4.9%; crude OR, 2.55 [95% CI, 1.62-4.01]; aOR, 2.38 [95% CI, 1.40-4.02]); and pain when the bladder is full (23.0% vs. 4.9%; crude OR, 5.79 [95% CI, 3.82-8.78]; aOR, 6.04 [95% CI, 3.74-9.76]). For the secondary outcomes, among female participants with endometriosis, we observed that the odds of LUTS did not differ by the revised American Society for Reproductive Medicine stage (I/II vs. III/IV) or duration of endometriosis-associated symptoms. CONCLUSION(S) Women with surgically confirmed endometriosis were more likely to report LUTS than those without.
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Affiliation(s)
- Iwona Gabriel
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Gynecology, Obstetrics and Oncological Gynecology, Medical University of Silesia, Bytom, Poland.
| | - Allison F Vitonis
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | - Stacey A Missmer
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Ayòtúndé Fadayomi
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
| | - Amy D DiVasta
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts; Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Vatche A Minassian
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
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Farella M, Tuech JJ, Bridoux V, Coget J, Chati R, Resch B, Marpeau L, Roman H. Surgical Management by Disk Excision or Rectal Resection of Low Rectal Endometriosis and Risk of Low Anterior Resection Syndrome: A Retrospective Comparative Study. J Minim Invasive Gynecol 2021; 28:2013-2024. [PMID: 34020051 DOI: 10.1016/j.jmig.2021.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To assess the risk of low anterior resection syndrome (LARS) between women managed by either disk excision or rectal resection for low rectal endometriosis. DESIGN Retrospective study of a prospective database. SETTING University hospital. PATIENTS One hundred seventy-two patients managed by disk excision or rectal resection for deep endometriosis infiltrating the rectum <7 cm from the anal verge. INTERVENTIONS Rectal disk excision and/or segmental resection using transanal staplers. MEASUREMENTS AND MAIN RESULTS One hundred eight patients (62.8%) were treated by disk excision (group D) and 64 (37.2%) by rectal resection (group R). All patients answered the LARS score questionnaire. Follow-up was 33.3 ± 22 months for group D (range 12-108 months) and 37.3 ± 22.1 months (range 12-96 months) for group R (p = .25). The rates of rectovaginal fistula and pelvis abscess requiring radiologic drainage and surgery in the D and R groups were, respectively, 7.4% and 8.3% vs 7.8% and 9.3%. The rate of women with normal bowel movements postoperatively was higher in group D (61.1% vs 42.8%, p = .05). Women enrolled in group R reported higher frequency of stools (p <.001), clustering of stools (p = .02), and fecal urgency (p = .05). Regression logistic model revealed 2 independent risk factors for minor/major LARS: performing low rectal resection (adjusted odds ratio 2.28; 95% confidence interval, 1.1-4.7) and presenting with bladder atony requiring self-catheterization beyond postoperative day 7 (adjusted odds ratio 2.52; 95% confidence interval, 1.1-5.8). CONCLUSION The probability of normal bowel movements is higher after disk excision than after low rectal resection in women with deep endometriosis infiltrating the low rectum.
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Affiliation(s)
- Marilena Farella
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux (Drs. Farella and Roman); Rouen University Hospital, Rouen, France. Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Dr. Farella)
| | | | - Valérie Bridoux
- Department of Surgery (Drs. Tuech, Bridoux, Coget, and Chati)
| | - Julien Coget
- Department of Surgery (Drs. Tuech, Bridoux, Coget, and Chati)
| | - Rachid Chati
- Department of Surgery (Drs. Tuech, Bridoux, Coget, and Chati)
| | - Benoit Resch
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Resch and Marpeau)
| | - Loïc Marpeau
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Resch and Marpeau)
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux (Drs. Farella and Roman); Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark (Dr. Roman).
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Vesale E, Roman H, Moawad G, Benoit L, Touboul C, Darai E, Bendifallah S. Voiding Dysfunction after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:1490-1502.e3. [PMID: 32730989 DOI: 10.1016/j.jmig.2020.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Surgical management of deep endometriosis is associated with a high incidence of lower urinary tract dysfunction. The aim of the current systematic review and meta-analysis was to assess the rates of voiding dysfunction according to colorectal shaving, discoid excision, and segmental resection for deep endometriosis. DATA SOURCES We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. Medical Subject Headings terms for colorectal endometriosis and voiding dysfunction were combined and restricted to the French and English languages. The final search was performed on August 28, 2019. The outcome measured was the occurrence of postoperative voiding dysfunction. METHODS OF STUDY SELECTION Study Quality Assessment Tools were used to assess the quality of included studies. Studies rated as good and fair were included. Two reviewers independently assessed the quality of each included study, discrepancies were discussed; if consensus was not reached, a third reviewer was consulted. TABULATION, INTEGRATION AND RESULTS Out of 201 relevant published reports, 51 studies were ultimately reviewed systematically and 13 were included in the meta-analysis. Rectal shaving was statistically less associated with postoperative voiding dysfunction than segmental colorectal resection (Odds ratio [OR] 0.34; 95% confidence intervals [CI], 0.18-0.63; I2 = 0%; p <.001) or discoid excision (OR 0.22; 95% CI, 0.09-0.51; I2 = 0%; p <.001). No significant difference was noted when comparing discoid excision and segmental colorectal resection (OR 0.74; 95% CI, 0.32-1.69; I2 = 29%; p = .47). Similarly, rectal shaving was associated with a lower risk of self-catheterization >1 month than segmental colorectal resection (OR 0.3; 95% CI, 0.14-0.66; I2 = 0%; p = .003). This outcome was no longer significant when comparing discoid excision and segmental colorectal resection (OR 0.72; 95% CI, 0.4-1.31; I2 = 63%; p = .28). CONCLUSION Colorectal surgery for endometriosis has a significant impact on urinary function regardless of the technique. However, rectal shaving causes less postoperative voiding dysfunction than discoid excision or segmental resection.
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Affiliation(s)
- Elie Vesale
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); Department of Gynecology and Obstetrics, Medical Center of the Sud-Francilien, (Dr Vesale), Corbeil-Essonne, France
| | - Horace Roman
- Clinique Tivoli-Ducos, Bordeaux (Dr. Roman), France
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, (Dr. Moawad), Washington, District of Columbia
| | - Louise Benoit
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris.
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
| | - Emile Darai
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Vesale, Benoit, Touboul, Darai, and Bendifallah); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E) (Drs. Vesale, Touboul, Darai, and Bendifallah); UMR_S938, Sorbonne University, (Drs. Benoit, Touboul, Darai, and Bendifallah), Paris
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Roman H, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Collinet P, Daraï E, Tuech JJ. Baseline severe constipation negatively impacts functional outcomes of surgery for deep endometriosis infiltrating the rectum: Results of the ENDORE randomized trial. J Gynecol Obstet Hum Reprod 2019; 48:625-629. [PMID: 30902761 DOI: 10.1016/j.jogoh.2019.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/16/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predictive factors of functional outcomes after the surgery of rectal endometriosis are not well identified. Our recent randomized trial did not find significant differences between functional outcomes in patients managed by radical or conservative rectal surgery. OBJECTIVE To identify preoperative factors which determine functional outcomes of surgery in patients with rectal endometriosis. STUDY DESIGN We performed a cohort study on the population of a 2-arm randomised trial, from March 2011 to August 2013. Patients were enrolled in three French university hospitals and had either conservative surgery by shaving or disc excision, or radical rectal surgery by segmental resection. The primary endpoint was the proportion of patients experiencing one of the following symptoms: constipation, frequent bowel movements, anal incontinence, dysuria or bladder atony requiring self-catheterisation 24 months postoperatively. Secondary endpoints were the values of the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS), the Gastrointestinal Quality of Life Index (GIQLI), the Wexner scale, the Urinary Symptom Profile (USP) and the Short Form 36 Health Survey (SF36). A logistic regression model based on backward selection was used to screen for baseline factors that could impact the primary endpoint. A generalized estimating equations model for repeated measures was used to assess whether a trend could be observed over the follow-up period as regards gastrointestinal and quality of life scores. RESULTS 60 patients with deep endometriosis infiltrating the rectum were managed by conservative surgery (27 cases) and segmental colorectal resection (33 cases). The primary endpoint was recorded in 26 patients (48.1% for conservative surgery vs. 39.4% for radical surgery, OR = 0.70, 95% CI 0.22-2.21). There was a significant improvement in values of all gastrointestinal, quality of life and urinary scores after surgery. Comparing patients with KESS scores < 10 (reference) to those with scores between 10 and 17 (OR = 2.1, 95%CI 0.4-12.2), as well as those with scores >17 (OR = 11.1, 95%CI 2.2-20.5), revealed that the odds to record the primary endpoint are significantly higher in the latter group. Trend analyses suggest that the odds of an elevated KESS score are significantly higher at baseline than at 6 months, but significantly lower after 12 months. CONCLUSIONS Patients with severe preoperative constipation are less likely to achieve normal bowel movements after surgery for rectal endometriosis, using either radical or conservative rectal procedures.
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Affiliation(s)
- Horace Roman
- Center of Endometriosis, Clinique Tivoli-Ducos, 33000, Bordeaux, France.
| | - Michael Bubenheim
- Department of Biostatistics, Rouen University Hospital, 76031 Rouen, France
| | - Emmanuel Huet
- Department of Surgery, Rouen University Hospital, 76031 Rouen, France
| | - Valérie Bridoux
- Department of Surgery, Rouen University Hospital, 76031 Rouen, France
| | - Chrysoula Zacharopoulou
- Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, 75020 Paris, France
| | - Pierre Collinet
- Gynaecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - Emile Daraï
- Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, 75020 Paris, France
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Surgery using plasma energy for deep endometriosis: A quality of life assessment. J Gynecol Obstet Hum Reprod 2018; 47:359-364. [DOI: 10.1016/j.jogoh.2018.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 11/19/2022]
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Arcoverde FVL, Andres MDP, Borrelli GM, Barbosa PDA, Abrão MS, Kho RM. Surgery for Endometriosis Improves Major Domains of Quality of Life: A Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2018; 26:266-278. [PMID: 30244153 DOI: 10.1016/j.jmig.2018.09.774] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/14/2018] [Accepted: 09/15/2018] [Indexed: 11/27/2022]
Abstract
Because surgery for endometriosis can involve severe complications, it is important to determine if the patient's quality of life (QOL) is indeed improved after surgery. A systematic review and meta-analysis, when appropriate, was conducted and included 38 studies that assessed the QOL using validated questionnaires administered before and after surgery. Results were grouped according to the type of endometriosis reported: all types endometriosis, deep infiltrative endometriosis (DIE), and bowel endometriosis. Quantitative analysis was performed on 17 homogeneous studies. Pooled response mean differences between the 36-Item and 12-Item Short Form Survey (SF-36 and SF-12) showed significant improvement in Mental Component Score (MCS) after surgery for all types of endometriosis (.21; 95% confidence interval [CI], .04-.38); significant improvement after surgical treatment for DIE in Vitality (.67; 95% CI, .41-.94), Social Functioning (.59; 95% CI, .18-.99), Role Emotional .49; 95% CI, .02-.97), Mental Health (.39; 95% CI, .03-.74), Physical Functioning (.93; 95% CI, .49-1.38), Bodily Pain (1.23; 95% CI, .47-1.99), General Health (.57; 95% CI, .02-1.12), MCS (.55; 95% CI, .10-1.00), and Physical Component Score (PCS; .73; 95% CI, .27-1.18); and significant improvement after surgery for bowel endometriosis for all 8 domains (Vitality [1.00; 95% CI, .56-1.43], Social Functioning [.97; 95% CI, .57-1.37], Role Emotional [1.17; 95% CI, .7-1.63], Mental Health [.94; 95% CI, .5-1.38], Physical Functioning [.74; 95% CI, .3-1.18], Role Physical [1.25; 95% CI, .75-1.76], Bodily Pain [1.39; 95% CI, .79-1.98], General Health [.84; 95% CI, 1.46-1.22]), MCS (.93; 95% CI, .47-1.40), PCS (.82; 95% CI, .40-1.23), and total score (1.15; 95% CI, .48-1.83). Only 1 study assessed patients with minimal disease and showed significant improvement in PCS (p = .002) and MCS (p <.001). This systematic review reveals that surgery for endometriosis resulted in overall improvement in most health domains of health-related QOL, with the greatest improvement found in the Bodily Pain domain.
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Affiliation(s)
- Fernanda Vieira Lins Arcoverde
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina de Paula Andres
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Giuliano Moysés Borrelli
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila de Almeida Barbosa
- Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and
| | - Mauricio Simões Abrão
- Endometriosis Section, Gynecologic Division (Drs. Vieira Lins Arcoverde, de Paula Andres, Moysés Borrelli, and Simões Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. de Paula Andres, de Almeida Barbosa, and Simões Abrão), BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil, and.
| | - Rosanne Marie Kho
- Benign Gynecology Surgery Section (Dr. Kho), Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
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Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril 2017; 108:931-942. [PMID: 29202966 DOI: 10.1016/j.fertnstert.2017.09.006] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/03/2017] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Abstract
Deep endometriosis (DE) remains the most difficult endometriotic entity to treat. Medical treatment for DE can reduce symptoms but does not cure the disease, and surgical removal of the lesion is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Although several surgical techniques such as laparoscopic bowel resection, disc excision, and rectal shaving have been described, there is no consensus regarding the choice of technique or the timing of surgery. Our review of publications reporting results and complications of surgery for rectovaginal DE reveals a relatively higher complication rate after bowel resection compared with shaving and disc excision, especially for rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization. Data show that shaving is feasible even in advanced disease. The risk of immediate complications after shaving and disc excision is probably lower than after colorectal resection, allowing for better functional outcomes. The presumed higher risk of recurrence related to shaving has not been demonstrated. For these reasons, surgeons should consider rectal shaving as a first-line surgical treatment of rectovaginal DE, regardless of nodule size or association with other digestive localizations. When the result of rectal shaving is unsatisfactory (rare cases), disc excision may be performed either exclusively by laparoscopy or by using transanal staplers. Segmental resection may ultimately be reserved for advanced lesions responsible for major stenosis or for several cases of multiple nodules infiltrating the rectosigmoid junction or sigmoid colon.
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Affiliation(s)
- Olivier Donnez
- Institut du sein et de Chirurgie gynécologique d'Avignon, Polyclinique Urbain V (Elsan Group), Avignon, France, and Pôle de recherche en gynécologie, IREC institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
| | - Horace Roman
- Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics and Research Group EA 4308 Spermatogenesis and Male Gamete Quality, Rouen University Hospital, Rouen, France
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