Abstract
Background
The purpose of this paper is to report the long-term results of surgery without bowel resection in patients suffering from deep infiltrating endometriosis with rectovaginal or colorectal involvement.
Methods
This retrospective observational study identified 42 patients suffering with deep infiltrating endometriosis who underwent surgery. Conservative surgery was performed in 23 women (only one of them with bowel resection), and 19 women underwent a hysterectomy and bilateral salpingo-oophorectomy (HBSO). In the conservative surgery group, a later HBSO was performed in eight patients as a second operation. Pregnancies, recurrences, reoperations, use of hormone replacement therapy, and outcomes during long-term follow-up were analyzed.
Results
The average follow-up duration was 7 ± 5.7 years in conservative surgery cases. Only one patient was treated with sigmoid bowel resection in 1997 and had complications. In this conservative surgery group, 13 patients (56%) received medical treatment after surgery, 10 patients wanted to get pregnant (of whom seven [70%] were successful), and eight patients underwent a subsequent HBSO because of recurrent symptoms and/or endometrioma. Therefore, HBSO was performed in 27 patients, of whom 14 (51.8%) used hormone replacement therapy for 5.6 ± 3.6 years. No recurrences or complications were observed in patients after HBSO with or without hormone replacement therapy.
Conclusion
Good clinical results can be obtained by performing only conservative surgery and/or HBSO without bowel resection, an alternative that could reduce the number of colorectal resections that are performed very frequently nowadays. After HBSO, patients may use hormone replacement therapy for several years with total satisfaction and well-being.
Acknowledgments
This study was supported by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, and FEDER, Madrid, Spain (PI07/0417, PI10/01815) within the Plan Nacional de I + D + I 2008–2011. The authors acknowledge American Journal Experts for editing the manuscript for English language.
Author contributions
PA conceived and designed the study, analyzed the data, interpreted the results, and wrote the manuscript. CN and FQ collaborated in the study design and together with MV, contributed in the acquisition, analysis and interpretation of data and revised critically the intellectual content of the manuscript. IV and VV helped with the bibliographic search, contributed with the analysis and the interpretation of the data and the critical revision of the manuscript. All authors approved the final version of the manuscript to be published. PA had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of data analysis.
Disclosure
The authors report no conflicts of interest in this work.