Effects of Surgical Excision of Endometriosis regarding Quality of Life and Psychological Well-Being: A Review

Functional Outcomes After Rectal Resection for Deep Infiltrating Pelvic Endometriosis: Long-term Results

BACKGROUND

Curative management of deep infiltrating endometriosis requires complete removal of all endometriotic implants. Surgical approach to rectal involvement has become a topic of debate given potential postoperative bowel dysfunction and complications.

OBJECTIVE

This study aims to assess long-term postoperative evacuation and incontinence outcomes after laparoscopic segmental rectal resection for deep infiltrating endometriosis involving the rectal wall.

DESIGN

This is a retrospective study of prospectively collected data.

SETTINGS

This single-center study was conducted at the University Hospital of Bern, Switzerland.

PATIENTS

Patients with deep infiltrating endometriosis involving the rectum undergoing rectal resection from June 2002 to May 2011 with at least 24 months follow-up were included.

MAIN OUTCOME MEASURES

Aside from endometriosis-related symptoms, detailed symptoms on evacuation (points: 0 (best) to 21 (worst)) and incontinence (0-24) were evaluated by using a standardized questionnaire before and at least 24 months after surgery.

RESULTS

Of 66 women who underwent rectal resection, 51 were available for analyses with a median follow-up period of 86 months (range: 26-168). Forty-eight patients (94%) underwent laparoscopic resection (4% converted, 2% primary open), with end-to-end anastomosis in 41 patients (82%). Two patients (4%) had an anastomotic insufficiency; 1 case was complicated by rectovaginal fistula. Dysmenorrhea, nonmenstrual pain, and dyspareunia substantially improved (p < 0.001 for all comparisons). Overall evacuation score increased from a median of 0 (range: 0-11) to 2 points (0-15), p = 0.002. Overall incontinence also increased from 0 (range: 0-9) to 2 points (0-9), p = 0.003.

LIMITATIONS

This study was limited by its retrospective nature and moderate number of patients.

CONCLUSIONS

Laparoscopic segmental rectal resection for the treatment of deep infiltrating endometriosis including the rectal wall is associated with good results in endometriotic-related symptoms, although patients should be informed about possible postoperative impairments in evacuation and incontinence. However, its clinical impact does not outweigh the benefit that can be achieved through this approach. See Video Abstract at http://links.lww.com/DCR/A547.

Endometriosis Psychological Aspects: A Literature Review

Introduction

Current evidence suggests that endometriosis imposes a considerable psychological burden on the affected women. This study was aimed to review this evidence.

Methods

A comprehensive electronic search was performed in Science direct, Medline/ PubMed, PsychINFO, Embase, CINAHL, Cochrane Clinical Trials, Scopus, Google scholar, Magiran and SID (Scientific Information Database) up to December, 15, 2016. Methodological quality of retrieved studies was assessed using a valid checklist. The main findings with regard to the objective of this review are extracted and summarized in tables.

Results

A total of 24 studies were included in the review from which, 23 used quantitative method and 1 used qualitative. Key findings of all studies showed that endometriosis reduces various aspects of psychological well-being.

Conclusions

Psychological interventions ranging from screening, providing consultation to psychiatric treatment prescriptions as same as the social supports such as work incentives should be integrated to endometriosis management protocols.

Salient aspects of quality of life among women diagnosed with endometriosis: A qualitative study

This study examined health-related quality of life among a sample of South African women diagnosed with endometriosis. Semistructured interviews were conducted with 25 participants in South Africa. Participants discussed the ways in which endometriosis affected their health-related quality of life. A total of 10 categories emerged from the data, namely, (1) medical factors, (2) physical functioning, (3) psychological functioning, (4) sexual functioning, (5) reproductive functioning, (6) interpersonal functioning, (7) occupational functioning, (8) information and knowledge, (9) healthcare and medical treatment and (10) financial impact and considerations. Each category was described and compared with findings from other health-related quality of life research in women with endometriosis.

Surgical Therapy of Endometriosis: Challenges and Controversies

Endometriosis is one of the most common disorders encountered in surgical gynaecology. The laparoscopic technique, the planning of the surgical intervention, the extent of information provided to patients and the interdisciplinary coordination make it a challenging intervention. Complete resection of all visible foci of disease offers the best control of symptoms. However, the possibility of achieving this goal is limited by the difficulty of detecting all foci and the risks associated with radical surgical strategies. Thus, the excision of ovarian endometrioma can result in a significant impairment of ovarian function, while damage to nerve structures during resection of the uterosacral ligaments, the parametrium, the rectovaginal septum or the vaginal cuff to treat deep infiltrating endometriosis can lead to serious functional impairments such as voiding disorders. A detailed risk-benefit analysis is therefore necessary, and patients must be treated using an individual approach.