Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: giving patients an informed choice

Abstract

Colorectal segmental resection appears to be associated with several unpleasant functional symptoms when compared with nodule excision. Information about functional outcomes should be provided to patients managed for rectal endometriosis, and should be considered when deciding on the most appropriate treatment of this disease.

Surgical treatment of rectovaginal endometriosis with rectal involvement

“…In some of the studies, a radical treatment was assessed [5,13,15,[25][26][27][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56], while others assessed a conservative one [57][58][59][60][61][62][63]. There were six nonrandomized papers in which groups of patients with different therapeutic options were compared [30,[35][36][37][38][39]. The follow-up time was not uniform within studies, neither were the criteria used to establish the diagnosis, the extent of the RVE, or the result variables.…”

“…The results for discoidal resection analyzed in comparative studies (Table 3) show that the rate of severe complications remains low, the symptomatic improvement stands around 90%, and the rate of relapse between 5% and 14% [30,35,37,39]. Gestation rates, though low as they are, are still higher than those obtained with radical treatments [37,39].…”

“…All of them are observational studies in which the treatment option was not decided randomly; rather, it was made in terms of clinical criteria or in consensus with the patients [30,[35][36][37][38][39].…”

“…In four of these studies [30,35,37,39], they compared the postoperative results between different techniques used for RVE. Although some of the outcomes and the way they were assessed are not directly comparable between papers, one can see a tendency that points to a similar symptomatic improvement among the different techniques and a greater rate of surgical complications among the most radical approaches.…”

“…On the other hand, other groups prefer the excision of the endometriosic nodule to colorectal resection, since the rate of morbidity is lower and the recurrence of pain is similar [3,[28][29][30].…”