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

作者：Roman Horace^*; Vassilieff Maud; Tuech Jean Jacques; Huet Emmanuel; Savoye Guillaume; Marpeau Loic; Puscasiu Lucian

来源：Fertility and Sterility, 2013, 99(6): 1695-+.

DOI：10.1016/j.fertnstert.2013.01.131

• Rectal endometriosis
• colorectal resection
• shaving
• excision

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. %26lt;br%26gt;Design: %26quot;Before and after%26quot; comparative retrospective study. %26lt;br%26gt;Setting: University tertiary referral center. %26lt;br%26gt;Patient(s): Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum. %26lt;br%26gt;Intervention(s): Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted. %26lt;br%26gt;Main Outcomes Measure(s): Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score. %26lt;br%26gt;Result(s): 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, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life 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. %26lt;br%26gt;Conclusion(s): 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.

• 出版日期2013-5