Evaluation of Bowel Function After Surgical Treatment for Intestinal Endometriosis: A Prospective Study

Abstract

BACKGROUND: Defecation symptoms related to intestinal deep infiltrative endometriosis are caused by anatomical and functional disorders and are probably linked to the course of the disease and surgical treatment. OBJECTIVE: The primary aim of this study was to assess bowel function before and after intestinal deep infiltrative endometriosis surgery. Secondarily, we sought to correlate defecatory symptoms with preoperative risk factors. DESIGN/SETTINGS: This is a single-center prospective cohort study, using the low anterior resection syndrome score to evaluate bowel function 4 weeks before, as well as at 6 months and 1 year after surgery. The Wilcoxon signed-rank test and logistic multiple regression analyses were performed to compare preoperative and postoperative scores. The level of significance was set at <0.05 for all comparisons. PATIENTS: Thirty-seven adult female patients who underwent intestinal resection for deep infiltrative endometriosis between 2015 and 2017 were included. MAIN OUTCOME MEASURES: The primary outcome was bowel function appraisement in deep infiltrative endometriosis intestinal surgery. RESULTS: During the preoperative evaluation, 48.6% of patients reported low anterior resection syndrome score ≥21. This group presented a mean score of 17.9 ± 13.7, with a median of 20 and a range of 5 to 30. After 1 year, the mean score was decreased to 9.6 ± 11.1, with a median of 4 and a range of 0 to 22. A significant difference was detected when comparing the post- and preoperative scores (p = 0.0006). Improvements in defecatory symptoms such as reduced fecal incontinence for flatus (p = 0.004) and liquid stools (p = 0.014) were also reported. The clustering of stools (p = 0.005) and fecal urgency (p = 0.001) also improved 1 year after surgery. The preoperative multiple logistic regression showed that dyschezia was the only independent variable associated with bowel symptoms. LIMITATIONS: This is a well-documented prospective study, but the data presented have a relatively small population. CONCLUSIONS: This study provides evidence that intestinal deep infiltrative endometriosis surgery improves bowel function and has a positive impact on evacuation symptoms. See Video Abstract at http://links.lww.com/DCR/B534. EVALUACIÓN DE LA FUNCIÓN INTESTINAL DESPUÉS DEL TRATAMIENTO QUIRÚRGICO PARA LA ENDOMETRIOSIS INTESTINAL: UN ESTUDIO PROSPECTIVO ANTECEDENTES: Se considera que los síntomas defecatorios relacionados con la endometriosis intestinal infiltrativa profunda, son causados por trastornos anatómicos y funcionales, y probablemente estén relacionados con el curso de la enfermedad y tratamiento quirúrgico. OBJETIVO: El objetivo principal fue evaluar la función intestinal antes y después de la cirugía por endometriosis intestinal infiltrativa profunda. En segundo lugar, correlacionar los síntomas defecatorios con los factores de riesgo preoperatorios. DISEÑO / AJUSTES: Es un estudio de cohorte prospectivo de un solo centro, utilizando la puntuación del síndrome de resección anterior baja (LARS Score) para evaluar la función intestinal 4 semanas antes, 6 meses y un año después de la cirugía. Se realizaron pruebas de rango firmado de Wilcoxon y análisis de regresión logística múltiple para comparar puntuaciones preoperatorias y postoperatorias. Para todas las comparaciones, el nivel de significancia se estableció en <0.05. ENTORNO CLINICO: Se incluyeron 37 mujeres adultas sometidas a resección intestinal por endometriosis infiltrativa profunda entre 2015 y 2017. PRINCIPALES MEDIDAS DE VALORACION: El resultado principal, fue la evaluación de la función intestinal en cirugía de endometriosis infiltrativa profunda intestinal. RESULTADOS: Durante la evaluación preoperatoria, el 48,6% de los pacientes reportaron Síndrome de Resección Anterior Baja ≥ 21. Este grupo presentó una puntuación media de 17,9 ± 13,7, con una mediana de 20 y un rango de 5 a 30. Después de un año, la puntuación media se redujo a 9,6 ± 11,1, con una mediana de 4 y un rango de 0 a 22 Se detectó una diferencia significativa al comparar las puntuaciones postoperatorias y preoperatorias (p = 0,0006). Se informó de mejoras en los síntomas defecatorios como la reducción de la incontinencia fecal por flatos (p = 0,004) y heces líquidas (p = 0,014). La agrupación de heces (p = 0,005) y la urgencia fecal (p = 0,001) presentaron mejoría a un año después de la cirugía. La regresión logística múltiple preoperatoria mostró que la disquecia fue la única variable independiente asociada con los síntomas intestinales. LIMITACIONES: A pesar de que es un estudio prospectivo bien documentado, los datos presentados son de una población relativamente pequeña. CONCLUSIONES: El estudio proporciona evidencia de que la cirugía intestinal por endometriosis infiltrativa profunda, mejora la función intestinal y tiene un impacto positivo en los síntomas de evacuación. Consulte Video Resumen en http://links.lww.com/DCR/B534.

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain

“…These data confirm the efficacy of surgery for deep endometriosis in reducing pelvic pain and improving sexual function (FSFI-19) and quality of life (EHP-30) [15][16][17][18][19][20][21][22][23][24][25]. Restricted segmental bowel resections and linear excisions have a comparable effect on sex- Considering the strong correlation of FSFI (p = 0.0166) and EHP30 (p = 0.0009) before and after surgery, a specific effect of bowel resections on sexuality after surgery needed to be corrected by FSFI and EHP-30 before surgery.…”

“…These data confirm the efficacy of surgery for deep endometriosis in reducing pelvic pain and improving sexual function (FSFI-19) and quality of life (EHP-30) [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Restricted segmental bowel resections and linear excisions have a comparable effect on sexual function, suggesting that the decreased sexual function after segmental rectum resections for diseases other than endometriosis (mostly cancers) cannot be extrapolated to endometriosis.…”

“…Deep and cystic ovarian endometriosis are associated with severe pain [ 2 ] and sexual dysfunction [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Surgical excision of deep endometriosis improves pain and quality of life [ 15 ], bowel function [ 16 ], and sexual function [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. The improved sexual function is explained by the decrease in pain since chronic pelvic pain [ 26 , 27 , 28 , 29 ], especially deep dyspareunia [ 22 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ] and even dysmenorrhoea [ 14 ], are strong inhibitors of sexual function.…”

Endometriosis Surgery during the First Wave of the COVID-19 Pandemic: A Brazilian Single Institution Experience

“…Despite the evidences that deep infiltrative endometriosis surgery improves pain [ 15 ] and has a positive impact on evacuation symptoms and bowel function [ 16 ], the treatment of endometriosis and infertility prompt complex clinical questions without simple answers. It is important to acknowledge that for many women, life goes on and the burden of chronic disease still needs to be managed, even if resources are being diverted to other areas in the midst of a global focus on COVID-19 [ 17 ].…”

Laparoscopic Low Anterior Resection for Severe Deep Pelvic Endometriosis (Stage IV) With Hybrid Notes Technique for Specimen Extraction and Anvil Insertion

“…Hybrid NOTES (natural orifice surgery accompanied by transabdominal access) 1,2 combines the advantages of transabdominal laparoscopic surgery while limiting surgical trauma to the abdominal wall. Among various routes of intra-abdominal access, the transvaginal method is the most appealing one because of its utility and safety.…”