Abstract
Objective. To evaluate the long-term results of radical excision for rectovaginal endometriosis (RVE) with special emphasis on current symptoms and risk factors as regards recurrence. Methods. A total of 116 patients operated upon because of RVE were offered a clinical follow-up evaluation visit; 60 (52%) consented. The time (mean ± SD) from the index surgery to the follow-up visit was 4.0 ± 0.5 years. Main outcome measures. Daily symptoms using a visual analogue scale for 30 consecutive days prior to clinical assessment; the amount of uterine bleeding was also assessed. Endometriosis recurrence was evaluated via clinical and ultrasonographic examination. Results. The symptom sum scores (maximum 300) were low with median scores (range) of 3 (0–32) for dysmenorrhea and 9 (0–72) for pelvic pain. Evidence of RVE recurrence was found or suspected in 29 (48%) of the 60 women assessed. Clinical recurrence was not associated with pain symptoms. In univariable analysis, amenorrhea at the time of clinical assessment was associated with a lower risk of recurrence (odds ratio; OR 0.13; 95% CI (confidence interval) 0.02–0.65, p = 0.01); the effect of bowel resection was not significant (OR 0.37: 95% CI 0.13–1.07, p = 0.07). In multivariable analysis, the protective effect of bowel resection on recurrence was significant (OR 0.23; 95% CI 0.06–0.89, p = 0.03). Conclusions. Radical surgery may result in long-term pain relief in cases of RVE. Bowel resection is associated with a lower risk of RVE recurrence. Therapy that induces amenorrhea may be effective in preventing recurrence following surgical treatment of RVE.
Acknowledgements
We wish to thank Ms Marjatta Tevilin for her professional help in data management and Ms Nina Hedkrok for her excellent editorial assistance. Dr Pasi Korhonen of StatFinn Oy (Espoo, Finland) is thanked for expert help with the statistical analysis. Financial support from University Central Hospital Research Funds is gratefully acknowledged.
Disclosure of interest: Dr Heikinheimo has been a paid consultant and lecturer for Bayer Schering Pharma AG, Novo-Nordisk and Schering-Plough. Drs Sjöberg and Tarjanne have no conflicts of interest to declare.