Long‐term surgical outcomes of nerve‐sparing discoid and segmental resection for deep endometriosis

Abstract

Introduction The aim of this study was to investigate long‐term outcomes in terms of pain, quality of life (QoL), and gastrointestinal symptoms in women following colorectal surgery for deep endometriosis. Material and methods In this historical cohort, women who underwent surgical treatment for deep endometriosis by either nerve‐sparing full‐thickness discoid resection (DR) or colorectal segmental resection (SR) between March 2011 and August 2016 were re‐evaluated through telephone interviews about their long‐term pain symptoms, subjective overall QoL as rated using a score from 0 (worst) to 10 (optimal), and gastrointestinal outcomes reflected by lower anterior resection syndrome (LARS) following a first postsurgical evaluation (visit 1) published previously and a long‐term follow‐up evaluation (visit 2). Results The median long‐term follow‐up time was 35.4 months at visit 1 and 86 months at visit 2. Of 134 patients, 77 were eligible for final analysis and 57 were lost to follow‐up. Compared with presurgical values, QoL scores were significantly increased at both postsurgical evaluation visits in both the SR cohort (scores of 3, 8.5, and 10 at the presurgical visit, visit 1, and visit 2, respectively; p < 0.001) and the DR cohort (scores of 3, 9, and 10, respectively; p < 0.001). Pain scores for dysmenorrhea (SR group scores of 8, 2, and 2, respectively; p < 0.001; DR group scores of 9, 2, and 1, respectively; p < 0.001), dyspareunia (SR group scores of 4, 0, and 0, respectively; p < 0.001; DR group scores of 5, 0, and 1, respectively; p = 0.003), and dyschezia (SR group scores of 8, 2, and 2, respectively; p < 0.001; DR group scores of 9, 2, and 1, respectively; p < 0.001) significantly decreased after surgery and remained stable in both cohorts over the follow‐up period. Minor and major LARS, reflecting gastrointestinal function, was observed in 6.5% and 8.1% of the SR group and in 13.3% and 6.7% of the DR group, respectively, at visit 1 and in 3.2% and 3.2% of the SR group and 0% and 0% of the DR group, respectively, at visit 2, without significant differences between the SR and DR groups. Conclusions Colorectal surgery for deep endometriosis, either by DR or SR, provides stable and long‐term pain relief with low rates of permanent gastrointestinal function impairment.

Vascular‐ and nerve‐sparing bowel resection for deep endometriosis: A retrospective single‐center study

“…Although surgery was generally associated with an improvement in dyspareunia, as already reported by several authors, 34–36 we observed an overall worsening of sexual function, even though it was not statistically significant. This finding might depend on the high number of posterolateral parametrectomies performed in association with segmental bowel resection (78.7% of patients) and on the median distance of resection from the anal margin (6 cm).…”

“…31,32 In addition, in a recent study on discoid resection for bowel DE, Roman et al reported a significant improvement in gastrointestinal function only regarding the GIQLI but not with all validated questionnaires used before and after surgery (KESS, Wexner score, and Bristol scale), though their findings are not reliably comparable due to the absence of segmental resections in his series. 33 Although surgery was generally associated with an improvement in dyspareunia, as already reported by several authors, [34][35][36] we ob- median distance of resection from the anal margin (6 cm). Both of these factors can lead to the lesion of a number of autonomic nerves responsible for decreasing blood flow to the vagina and aiding lubrication, as previously reported.…”

Pain, gastrointestinal function and fertility outcomes of modified nerve‐vessel sparing segmental and full thickness discoid resection for deep colorectal endometriosis – A prospective cohort study

“…Colorectal deep endometriosis (DE) is commonly associated with more pain and adverse gastrointestinal (GI) outcomes 2,3 . Although a large percentage of women with colorectal DE can be managed conservatively, 4 several studies have demonstrated a significant short‐ but also long‐term decrease in pain symptoms following surgical resection of colorectal DE 5–8 …”

“…2,3 Although a large percentage of women with colorectal DE can be managed conservatively, 4 several studies have demonstrated a significant short-but also long-term decrease in pain symptoms following surgical resection of colorectal DE. [5][6][7][8] There is, so far, no real consensus on how to optimally treat colorectal endometriosis surgically, since the application of the main three techniques, namely, segmental colorectal resection, full thickness discoid resection (FTDR) and so-called shaving, depends on various factors which may differ from unit to unit and surgeon to surgeon. 9,10 These include infiltration length and depth of DE, presence of multifocal disease and surgical experience and personal preference.…”

“… 2 , 3 Although a large percentage of women with colorectal DE can be managed conservatively , 4 several studies have demonstrated a significant short‐ but also long‐term decrease in pain symptoms following surgical resection of colorectal DE. 5 , 6 , 7 , 8 …”