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.

Endometriosis and the Ureter

“…Recent data from the British Society for Gynecological Endoscopy endometriosis centres found a 0.5% ureteric complication rate for cases of rectovaginal endometriosis. 6 This suggests improvement in the risk from a previous report published in 2012, in which Park et al documented an overall 1.1% risk of ureteric injury in laparoscopic cases and 1.2% in laparotomy cases based on a retrospective review of 2,927 patients. 7 Importantly in this study, patients with risk factors (endometriosis, pelvic infl ammatory disease, previous pelvic surgery, a prior history of pelvic radiation and patients with congenital anomalies) had a 2.7 % risk of ureteric injury compared to a risk of 0.9% in those without these risk factors.…”

Manejo de la endometriosis rectovaginal: revisión de la literatura

“…Se caracterizan por tener un elevado riesgo de complicaciones hasta del 53% 28,29 . En un estudio multicéntrico en centros de experiencia con manejo multidisciplinario de este tipo de pacientes, donde se realizó escisión quirúrgica de endometriosis rectovaginal para manejo de dolor pélvico crónico y síntomas gastrointestinales, con seguimiento de la mejoría de la calidad de vida a 6 meses y a 2 años, encontraron que este tipo de manejo es efectivo, con presentación de complicaciones generales de 6.8%, con complicaciones gastrointestinales del 1,1%, y del tracto urinario del 1% 30 .…”

The role of Endometriosis Clinical Nurse Specialists in British Society for Gynaecological Endoscopy registered centres: A UK survey of practice

“…Rectovaginal endometriosis is endometriosis that involves the rectovaginal septum area (rectovaginal septum; vagina; utero‐sacral ligaments; rectum) (NHS England, 2013). Removing the endometriosis in these cases involves complex surgery and can be associated with high rates of serious complications (Byrne et al., 2018). National BSGE criteria (see http://www.bsge.org.uk) now exist which set out the standards of service and workload required to undertake surgical excision of advanced endometriosis.…”

“…National BSGE criteria (see http://www.bsge.org.uk) now exist which set out the standards of service and workload required to undertake surgical excision of advanced endometriosis. To retain accreditation as a BSGE Endocentre, all consenting patients who undergo surgery for deep rectovaginal endometriosis that includes dissection of the pararectal space in an Endocentre must have their data entered on to the BSGE national endometriosis database (Byrne et al., 2018). This increasing caseload is driving the establishment of endometriosis centres where such work can be undertaken by specialist multidisciplinary teams (MDT).…”