Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study

Abstract

ObjectiveTo estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.DesignA multicentre, prospective cohort study.Setting51 hospitals accredited as specialist endometriosis centres.Participants5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.InterventionsLaparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.Main outcome measuresStandardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded.ResultsAt 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures.ConclusionLaparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

“…A consensus of expert reported >85% pain relief after complete resection of DE nodule by the shaving technique [ 60 ], confirming that surgery for DE significantly decreases pain symptoms [ 15 , 35 , 82 , 83 ]. This was also reported in a large series of 4721 patients undergoing excisional surgery for DE [ 91 ]. Complete surgery for DE improves sexual quality of life and health-related quality of life, and this improvement remains stable six months after surgery [ 45 ].…”

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

“…A consensus of expert reported >85% pain relief after complete resection of DE nodule by the shaving technique [ 60 ], confirming that surgery for DE significantly decreases pain symptoms [ 15 , 35 , 82 , 83 ]. This was also reported in a large series of 4721 patients undergoing excisional surgery for DE [ 91 ]. Complete surgery for DE improves sexual quality of life and health-related quality of life, and this improvement remains stable six months after surgery [ 45 ].…”

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

“…In another review, in 2036 women undergoing surgery for DIE, complications were distributed as follows: 2.7% of fistula, 1.5% colostomy, and 0.3% of infection, 13 complications also similar to a third literature review including 1799 women 15 . A recent cohort of 4721 women showed a lower rate of complications (6.8%) with a predominance of gastrointestinal complications such as fistula and colostomy 16 . All of these results underscore the need for preoperative guidance, and performing surgeries in specialized centers.…”

Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis

“…Maintaining long-term follow-up is a challenge, particularly in this relatively young and mobile patient group. However, the follow-up data in our cohort was considerably more complete than the average follow-up rates of 50%, 38% and 27% at 6-, 12- and 24-months post-op respectively for the BSGE database overall ( Byrne et al, 2018 ).…”

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

“…A consensus of expert reported >85% pain relief after complete resection of DE nodule by the shaving technique [ 60 ], confirming that surgery for DE significantly decreases pain symptoms [ 15 , 35 , 82 , 83 ]. This was also reported in a large series of 4721 patients undergoing excisional surgery for DE [ 91 ]. Complete surgery for DE improves sexual quality of life and health-related quality of life, and this improvement remains stable six months after surgery [ 45 ].…”

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

“…In another review, in 2036 women undergoing surgery for DIE, complications were distributed as follows: 2.7% of fistula, 1.5% colostomy, and 0.3% of infection, 13 complications also similar to a third literature review including 1799 women 15 . A recent cohort of 4721 women showed a lower rate of complications (6.8%) with a predominance of gastrointestinal complications such as fistula and colostomy 16 . All of these results underscore the need for preoperative guidance, and performing surgeries in specialized centers.…”

Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis

“…Maintaining long-term follow-up is a challenge, particularly in this relatively young and mobile patient group. However, the follow-up data in our cohort was considerably more complete than the average follow-up rates of 50%, 38% and 27% at 6-, 12- and 24-months post-op respectively for the BSGE database overall ( Byrne et al, 2018 ).…”

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

“…A consensus of expert reported >85% pain relief after complete resection of DE nodule by the shaving technique [ 60 ], confirming that surgery for DE significantly decreases pain symptoms [ 15 , 35 , 82 , 83 ]. This was also reported in a large series of 4721 patients undergoing excisional surgery for DE [ 91 ]. Complete surgery for DE improves sexual quality of life and health-related quality of life, and this improvement remains stable six months after surgery [ 45 ].…”

Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment

“…In another review, in 2036 women undergoing surgery for DIE, complications were distributed as follows: 2.7% of fistula, 1.5% colostomy, and 0.3% of infection, 13 complications also similar to a third literature review including 1799 women 15 . A recent cohort of 4721 women showed a lower rate of complications (6.8%) with a predominance of gastrointestinal complications such as fistula and colostomy 16 . All of these results underscore the need for preoperative guidance, and performing surgeries in specialized centers.…”

Excisional endometriosis surgery with hysterectomy and bilateral salpingo-oophorectomy versus excisional endometriosis surgery alone for pelvic pain associated with deep endometriosis

“…Maintaining long-term follow-up is a challenge, particularly in this relatively young and mobile patient group. However, the follow-up data in our cohort was considerably more complete than the average follow-up rates of 50%, 38% and 27% at 6-, 12- and 24-months post-op respectively for the BSGE database overall ( Byrne et al, 2018 ).…”