Pain, quality of life and complications following the radical resection of rectovaginal endometriosis

Abstract

Objective To determine the long term response, quality of life and levels of pain following the radical excision of rectovaginal endometriosis. Design A cohort study.Setting A tertiary referral centre for the management of advanced endometriosis.Sample All patients who had undergone radical resection.Methods Case note review and patient questionnaire.Main outcome measures Surgical complications. Overall improvement. Dysmenorrhoea, dyspareunia, dyschezia and chronic pain were measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire. Results Twelve radical resections were performed by laparotomy, 48 by laparoscopy. Ten patients had a hysterectomy. Forty-eight patients underwent shaving of the pre-rectal fascia, two had a disc resection of the rectum, 10 had an anterior rectal resection. Two patients required a colostomy and two needed subsequent dilation of a stenosed anastomosis. Forty-four of the first 46 patients replied. The median follow up period was 12 months (range 2 to 22 months) and 86% (38/44) reported an improvement or whom 27 (61%) had a good response (pain completely gone or greatly improved). Patients having a hysterectomy or a disc or segmental resection of the rectum reported a good response and had a normal quality of life. Quality of life scores in the study group overall were lower than the background population. Conclusions Radical resection is an effective treatment for rectovaginal endometriosis. Hysterectomy and rectal resection were associated with a better response and quality of life.

Centres of excellence for the management of advanced endometriosis: where are they and what do they do?

“…The Royal College of Obstetricians and Gynaecologists has emphasised the importance of involving patients in the establishment of services [3], and it would be essential to maintain input from individual patients and their support groups during the development of any network. There is evidence that surgical excision of advanced endometriosis improves pain and quality of life [1,4]. In our own practice, women having excisional surgery show an 86% improvement, with those having a disc or segmental resection of the rectum having significantly better pain scores and quality of life than those having shaving of the prerectal fascia [4].…”

“…There is evidence that surgical excision of advanced endometriosis improves pain and quality of life [1,4]. In our own practice, women having excisional surgery show an 86% improvement, with those having a disc or segmental resection of the rectum having significantly better pain scores and quality of life than those having shaving of the prerectal fascia [4]. The method and the extent of resection required is still a matter of debate [5].…”

Surgical treatment of rectovaginal endometriosis with rectal involvement

“…There were also five nonsystematic revisions published [3,28,[32][33][34]. 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 Diagnosis and Management of Severe Endometriosis

“…Medical treatment has been found to be largely inadequate for rectal disease. 30,31 Surgical treatment and the complete excision of endometriosis appears to offer good long term symptomatic relief, [32][33][34] however this may involve significant bowel surgery and the potential for major complications. Conversely less invasive surgery is associated with fewer complications, but incomplete resection carries a higher risk of disease recurrence and generally does not confer the long-term symptomatic benefits seen with complete resection.…”

“…Over the past 10 years, a large number of studies have shown significant improvements in pain and overall quality of life following radical surgery. [32][33][34] However it can be associated with significant complications. Both minor and major complications have been reported following radical surgery including fistula formation (0-14%), 27,32 anastomotic leaks (2.2-8%)hemorrhage (1-11%), 38 infection (1-3%), 38 ureteric injury (4.1%) 32 and long term bladder (1-71%) and bowel dysfunction (1-15%).…”