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Acta Obstet Gynecol Scand. 2018 Feb;97(2):158-167. doi: 10.1111/aogs.13260. Epub 2017 Dec 20.

Long-term evaluation of painful symptoms and fertility after surgery for large rectovaginal endometriosis nodule: a retrospective study.

Author information

1
Gynecological Surgery Service, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France.
2
Service of Hepato Gastro Enterology, CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France.
3
Biostatistics Units (DRCI), CHU University Hospital Clermont-Ferrand, Clermont-Ferrand, France.

Abstract

INTRODUCTION:

Optimal surgical treatment of rectovaginal endometriosis remains a controversial topic. The objective of this study was to evaluate long-term postoperative outcomes after rectal shaving or colorectal resection for rectovaginal endometriosis.

MATERIAL AND METHODS:

195 patients underwent surgery (172 managed by shaving, 23 by colorectal resection) between January 2000 and June 2013 for rectovaginal endometriosis (>2 cm) involving at least the serosa of the rectum. Primary outcome measures were pain and fertility. Secondary outcome measures were complications, recurrence rates and quality of life.

RESULTS:

Mean follow-up was 60 ± 42 months in the shaving group and 67 ± 47 months in the resection group. The mean VAS score for pelvic pain between the pre and postoperative period decreased from 5.5 ± 3.5 (shaving group) and 7.3 ± 2.9 (resection group) to 2.3 ± 2.4 (p < 0.001) and 2.0 ± 1.8 (p < 0.001), respectively. For dysmenorrhea, the mean baseline VAS score fell postoperatively from 7.7 ± 2.8 (shaving group) and 8.2 ± 2.6 (resection group) to 3.3 ± 2.9 (p < 0.001) and 2.7 ± 2.7 (p < 0.001), respectively. Pregnancy rates were 73% for shaving and 69% for resection. Major complications occurred in 4% of patients in the shaving group and in 26% in the resection group (p = 0.001). Thirteen patients (7.6%) from the shaving group and none from the resection group were reoperated for suspicion of endometriosis recurrence (p = 0.37). Postoperative quality of life scores revealed no differences between the two groups.

CONCLUSION:

Our study demonstrates that rectal shaving, when feasible for rectovaginal nodule (>2 cm) infiltrating the digestive serosa, has equal impact on pain and pregnancy rates compared with colorectal resection at long-term follow-up, with low complication and favorable pregnancy rates.

KEYWORDS:

Endometriosis; colorectal resection; infertility; pain; rectal shaving; rectovaginal endometriosis

PMID:
29143306
DOI:
10.1111/aogs.13260
[Indexed for MEDLINE]

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