Quality of life after laparoscopic colorectal resection for endometriosis

TLDR

Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The study aims to evaluate the efficacy of laparoscopic segmental colorectal resection for endometriosis on quality of life, gynaecologic and digestive symptoms, and complications. The study enrolled 58 symptomatic women undergoing laparoscopic segmental colorectal resection, assessed pre‑ and post‑operative gynaecologic and digestive symptoms with questionnaires and SF‑36, recorded perioperative complications, and followed patients for a median of 22.5 months. Laparoscopic segmental colorectal resection improved dysmenorrhoea, dyspareunia, bowel pain, defecation pain, diarrhoea, lower back pain, asthaenia, and all SF‑36 domains, but did not improve tenesmus, rectorrhagia, or constipation, with a 15.5% complication rate including 10.3% rectovaginal fistulae.

Abstract

Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. Therefore, the aims of the current study were to evaluate the efficacy of laparoscopic segmental colorectal resection for endometriosis on quality of life and gynaecologic and digestive symptoms, and its complications.After magnetic resonance imaging and rectal endoscopic sonographic evaluation of symptomatic colorectal endometriosis, 58 consecutive women requiring colorectal resection were included in this study. Symptom questionnaires and the short-form (SF)-36 Health Status and the quality of life score were completed. Linear intensity scores for several gynaecologic and digestive symptoms and perioperative complications were also recorded.Fifty-one women (88%) underwent laparoscopic segmental colorectal resection and seven required laparoconversion. Major complications occurred in nine cases (15.5%), including six rectovaginal fistulae (10.3%), and the three remaining complications corresponded to a haemoperitoneum, a uroperitoneum and a pelvic abscess. Median follow-up after colorectal resection was 22.5 months (2-55 months). A significant improvement in dysmenorrhoea (P < 0.0001), dysparaeunia (P < 0.0001), bowel movement pain or cramping (P < 0.0001), pain on defecation (P < 0.0001), diarrhoea (P < 0.016), lower back pain (P < 0.0001) and asthaenia (P < 0.0002) was observed. Tenesmus, rectorrhagia and constipation were not improved. All the items of the SF-36 Health Status and the quality of life score were improved after colorectal resection for endometriosis.Laparoscopic segmental colorectal resection for endometriosis significantly improves quality of life and gynaecologic and digestive symptoms. However, women have to be informed on the risk of complications including rectovaginal fistula.