Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum

Capsule:
Women managed in accordance with a conservative surgical philosophy for rectal endometriosis seem to have better digestive outcomes when compared with those managed by the radical approach.

Authors:
Horace Roman, M.D., Ph.D., Maud Vassilieff, M.D., Jean Jacques Tuech, M.D., Ph.D., Emmanuel Huet, M.D., Guillaume Savoye, M.D., Ph.D., Loïc Marpeau, M.D., Lucian Puscasiu, M.D., Ph.D.

Volume 99, Issue 6, Pages 1695-1704.e6, May 2013

Abstract:

Objective:
To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision.

Design:
“Before and after” comparative retrospective study.

Setting:
Universitary tertiary referral centre.

Patients:
Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum.

Interventions:
Twenty-four women were managed during a period when surgeons pursued a radical philosophy towards treatment, and 51 women were managed during a period when a conservative philosophy was adopted.

Main Outcomes Measures:
Standardized gastro-intestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI), the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS), the Bristol Stool Score and the Fecal Incontinence Quality of Life Score (FIQL).

Results:
Preoperative patient characteristics, rectal nodule features and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, while during the second period only 20% of women underwent colorectal resection (P<0.001). Women managed according to the conservative philosophy had a significantly improved KESS, GIQLI and depression/self-perception FIQL score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency.

Conclusions:
It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection.

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