Reduced pain and increased fertiliy rates after surgery for colorectal endometriosis


Reduced pain and increased fertiliy rates after surgery for colorectal endometriosis

Conservative laparoscopic surgery with full thickness disk resection and nerve-vessel sparing segmental resection for women with DIE.

Key Points

Highlights: 

  • Two different types of laparoscopic surgery, namely SR (segmental bowel resection) and DR (disc resection) were applied to the patients with colorectal endometriosis.

Importance:

  • The optimal resection of bowel endometriosis has not been solved yet. The technique used by the authors includes both conservative and radical, improves the pain, QuOL, and furthermore, fertility results are good. 
What's done here:
  • Authors aimed to evaluate surgical outcomes of SR and DR regarding fertility and pain symptoms and the QuOL score of women with colorectal deep infiltrating endometriosis.

Key results:

  • Short-term results: Minor complication rate is more in the SR group than in the DR group of patients.   
  • Long-term results were complications as hemoperitoneum, the leak of bowel anastomosis and rectovaginal fistulas which have seemed to occur more in the SR group of endometriotic patients whose ENZIAN score was grade III. 
  • Increased fertility rate and relief of pelvic pain observed in both segmental bowel resection (SR) and disc resection (DR) groups.

Limitations:

  •  To perform these laparoscopic bowel operations, a well-trained and experienced OB/GYN surgeon team is needed.

Lay Summary

This prospective cohort study which recently published in AOGS by Hudelist et al. from Oslo University, Norway is about their one hundred thirty-four laparoscopic operations of DIE cases performed between 2011 and  2016, in a tertiary center in Oslo. The cases with the diagnosis of severe DIE before surgery complained some degrees of pelvic pain and infertility, were referred to this tertiary hospital in Oslo.

Authors performed two types of laparoscopic surgery techniques namely segmental bowel resection (SR) and full thickness disc resection (DR) regarding the spread of deep infiltrating endometriotic lesions. Their conservative laparoscopic surgery technique was thoroughly described in this abstract which consists paying attention to remove the limited segment of affected bowels and approaching to spare the nerves of hypogastric plexus and mesorectum arteries during the operation.

Their statistical analyses between SR and DR groups contain demographic data and characteristics of patients including symptoms, intraoperative findings, as well as long-term outcomes of pain reliefs and fertility after surgery. 

After two months of surgery, while SR and DR groups represent almost equal morbitidy, all cases showed a statistically important pain relief what made their life quality higher.

Another success of the authors is the same rise of fertility rate in both operated groups. 

The results of the present analysis reflect the benefits of both techniques for deeply infiltrating endometriosis in the improvement of pain and fertility. The decision to favor one of the techniques are based on evidence and made by the interdisciplinary surgical team, and necessitates experience.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30080244


Deep infiltrated endometriosis colorectal resection pain conservative surgery infertility nerve sparing laparoscopic surgery morbidity full-thickness disc resection segmental bowel resection.

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