Clinical outcome after CO2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis

Abstract

background: Laparoscopic segmental bowel resection and reanastomosis for endometriosis with colorectal wall invasion can be associated with high complication rates. This study was performed to test the hypothesis that this high complication rate can be prevented and combined with a good clinical outcome, following a multidisciplinary surgical approach. results: No immediate major post-operative complications requiring surgical reintervention were recorded. Gynaecological pain (P , 0.0001), sexual function (P , 0.03) and QOL (P , 0.0001), improved significantly after a median follow-up period of 27 (range: 16-40) months. Although five patients (11%) had a surgical reintervention, histologically proven recurrent endometriosis was observed in only two (4%), with a cumulative endometriosis recurrence rate of 2.2 and 4.4% after 1 and 3 years, respectively. Thirteen of 28 patients who wanted to become pregnant conceived after surgery. One patient delivered twice. These 14 pregnancies were achieved spontaneously (n ¼ 9) or after IVF (n ¼ 5). The cumulative pregnancy rate was 47% after 3 years.conclusion: Pain, sexual function and QOL improved significantly and were associated with a good fertility rate and a low complication and recurrence rate after a CO 2 laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis.

Research Priorities for Endometriosis: Recommendations From a Global Consortium of Investigators in Endometriosis

“…[178][179][180] 54. Recommendation (new): To stratify reproductive outcome in women with endometriosis-associated infertility according to their current reproductive status and plans.…”

Kakovost življenja pred in po laparoskopski resekciji črevesa zaradi globoke infiltrativne endometrioze

“…V drugem sklopu smo oblikovali vprašanja za subjektivno oceno kakovosti življe-nja pred operacijo z naslednjimi danimi možnostmi: zelo slaba, slabša, zmanjša-na in bolezen ni pomembno vplivala na kakovost življenja ter vprašanje za oceno kakovosti življenja po operaciji z naslednjimi danimi možnostmi: slabša, nespremenjena, boljša in bistveno boljša. Ker je bila raziskava retrospektivna in je od operacije pogosto preteklo več let, nismo uporabili lestvice VAS za oceno jakosti bolečine, temveč smo ocenili simptome in kakovosti življenja po vzoru avtorjev, ki obravnavajo podobno problematiko (12). Glavni namen retrospektivne raziskave je bil ugotoviti kakovost življenja bolnic z endometriozo črevesa pred in po laparoskopski resekciji.…”

“…Boljšo kakovost življenja je v naši raziskavi navedlo 28,9 % bolnic, bistveno boljšo pa 55,3 %. Podobne rezultate navajajo tudi številni drugi avtorji (12,36,37,38).…”

Disfunção sexual em endometriose: uma revisão sistemática

“…31 Treze estudos investigaram a contribuição do tratamento na DSF sendo que nove avaliaram o efeito da cirurgia, 17,18,19,21,22,25,29,30,33 um o papel do medicamento 24 e três a combinação de ambos os tratamentos. 23,27,32 A análise da contribuição do medicamento para a função sexual ficou restrita.…”

“…9,11,20,26,28,31,34 Ainda, a avaliação da função sexual foi o objeto principal de estudo em 14 artigos científicos 9,11,20,22,23,[26][27][28][29][30][31][32][33][34] e em seis deles, foi investigada secundariamente à QV e dor. 17,18,19,21,24,25 Um achado que despertou a atenção foi que apenas quatro 20,26,28,34 dos sete estudos que não investigaram o efeito do tratamento na DSF, utilizaram grupo controle, ou seja, compararam a função sexual nas mulheres com e sem endometriose. Ainda, um desses estudos destacou como limitação a ausência de grupo controle.…”