Elsevier

Journal of Minimally Invasive Gynecology

Volume 13, Issue 5, September–October 2006, Pages 436-441
Journal of Minimally Invasive Gynecology

Original article
Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis

Presented at the XVth Annual Scientific Meeting of the Australian Gynaecological Endoscopy Society, Perth, Australia, May 4–6 2005; the combined New South Wales/Queensland Annual Scientific Meeting of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Sydney, Australia, June 11–12, 2005 (winner of the Crown Street Medal for best registrar presentation); and the 33rd Annual Meeting of the AAGL, November 9–12, 2005, Chicago, Illinois.
https://doi.org/10.1016/j.jmig.2006.05.009Get rights and content

Abstract

Study objective

To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality-of-life outcomes.

Design

Prospective observational cohort study (Canadian Task Force classification II-2).

Setting

Australian tertiary referral center for the surgical treatment of endometriosis.

Patients

Seven consecutive patients with known endometriosis involving the bowel.

Intervention

Laparoscopic resection of all endometriosis, including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy.

Measurements and main results

Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and dyschezia. Validated research tools (SF12, EuroQOL, and Sexual Activity Questionnaire) also assessed quality of life. Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 (interquartile range 43–85) versus 5 (0–10); p = .028, nonmenstrual pelvic pain 74 (48–85) versus 11 (0–18); p = .046, dyspareunia 66 (0–98) versus 5 (0–8); p = .080, and dyschezia 48 (20–64) versus 20 (0–40); p = .173. All measures of quality of life were improved at 12 months after surgery, although not reaching statistical significance because of the small sample size. All three women wishing to conceive after operation have been successful, resulting in three live births at term. There were few complications associated with this surgery.

Conclusion

Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life. Results appear to parallel published data for conservative resection of endometriosis not involving bowel. For women with severe endometriosis involving bowel, this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility.

Section snippets

Materials and methods

The institutional human ethics committee granted approval for this study. All patients signed an informed consent for participation in the study. Between March and November 2003, seven consecutive patients undergoing laparoscopic colorectal surgery for intestinal endometriosis were recruited to this pilot study. Demographic data were collected before operation for presenting symptoms, menstrual history, reproductive history, and previous medical and surgical treatment for endometriosis. A team

Results

The study population consisted of seven patients with a median age of 30 years (range, 23–43 years) at the time of surgery (Table 1). All women were nulliparous, and four had primary infertility, defined as more than 12 months of regular, unprotected sexual intercourse without pregnancy. All patients had previously been diagnosed with histologically confirmed endometriosis requiring ablation or excision. Three patients had previously undergone laparoscopic surgery in this unit for primary

Discussion

The pain and quality of life outcomes of this study parallel the results of long-term studies of laparoscopic resection of endometriosis not involving bowel.9 Statistically significant improvements in dysmenorrhea and nonmenstrual pelvic pain, and reductions in dyspareunia and dyschezia, which were not statistically significant, confirm the effectiveness of laparoscopic resection of endometriosis involving bowel recently reported by others.10, 11 To date there has been no prospective study on

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