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Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis

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Abstract

Background

Radical en bloc hysterectomy and colorectal resection (REHCR) is the ultimate and radical surgery for extensive pelvic endometriosis. Our aims were to evaluate feasibility, quality of life, and urinary function after REHCR by laparoscopy compared with laparotomy.

Methods

Single-center, retrospective study of 29 endometriosis patients having undergone REHCR (16 by laparoscopy, 13 by laparotomy). Gynecologic and digestive symptoms, quality of life [Short-Form (SF)-36 health status], and urinary function [International Prostate Score Symptoms (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS)] were evaluated using validated questionnaires.

Results

Except for mean age, no difference in epidemiologic characteristics was found between groups. Mean follow-up was 14 months (range 1–78 months). Four of the 16 patients (25%) of the laparoscopic group required laparoconversion. Consumption of analgesic drugs was lower in the laparoscopic group, and diarrhea (P < 0.001) and lower back pain (P < 0.001) improved. Improvement in dysmenorrhea (P < 0.001), dyspareunia (P < 0.001), asthenia (P < 0.001), and quality of life was observed without difference between groups. Urinary function was not altered and did not differ between groups.

Conclusion

Our data support the feasibility of REHCR by laparoscopy with less analgesic consumption. Efficacy in terms of symptoms and improvement in quality of life were similar between groups, suggesting that laparoscopy should be offered to patients requiring REHCR.

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References

  1. Vercellini P, Vendola N, Bocciolone L, Rognoni MT, Carinelli SG, Candiani GB (1991) Reliability of the visual diagnosis of ovarian endometriosis. Fertil Steril 56:1198–1200

    CAS  PubMed  Google Scholar 

  2. Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55:759–765

    CAS  PubMed  Google Scholar 

  3. Minh HN, Smadja A, Orcel L (1986) An integrated histogenetic concept of internal and external endometriosis. J Gynecol Obstet Biol Reprod (Paris) 15:29–35

    CAS  Google Scholar 

  4. Brosens IA (1997) Endometriosis—a disease because it is characterized by bleeding. Am J Obstet Gynecol 176:263–267

    Article  CAS  PubMed  Google Scholar 

  5. Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (2005) On behalf of the ESHRE special interest group for endometriosis and endometrium guideline development group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704

    Article  PubMed  Google Scholar 

  6. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy JN (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389

    Article  PubMed  Google Scholar 

  7. Chapron C, Dubuisson JB, Chopin N, Foulot H, Jacob S, Vieira M, Barakat H, Fauconnier A (2003) Deep pelvic endometriosis: management and proposal for a “surgical classification”. Gynecol Obstet Fertil 31:197–206

    Article  CAS  PubMed  Google Scholar 

  8. Weed JC, Ray JE (1987) Endometriosis of the bowel. Obstet Gynecol 69:727–730

    CAS  PubMed  Google Scholar 

  9. Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76:358–365

    Article  CAS  PubMed  Google Scholar 

  10. Mc Afee CH, Greer HL (1960) A report of 29 cases and a survey of the literature. Intestinal endometriosis. J Obstet Gynaecol Br Emp 67:539–555

    Google Scholar 

  11. Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1:217–220

    CAS  PubMed  Google Scholar 

  12. Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13:1125–1128

    Article  CAS  PubMed  Google Scholar 

  13. Possover M, Diebolder H, Plaul K, Schneider A (2000) Laparascopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol 96:304–307

    Article  CAS  PubMed  Google Scholar 

  14. Duepree HJ, Senagore AJ, Delaney CP, Marcello PW, Brady KM, Falcone T (2002) Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg 195:754–758

    Article  PubMed  Google Scholar 

  15. Nezhat C, Nezhat F, Pennington E (1992) Laparoscopic treatment of infiltrative rectosigmoid colon and rectovaginal septum endometriosis by the technique of video laparoscopy and the CO2 laser. Br J Obstet Gynaecol 99(8):664–667

    CAS  PubMed  Google Scholar 

  16. Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192:394–400

    Article  PubMed  Google Scholar 

  17. Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG 107:44–54

    Article  CAS  PubMed  Google Scholar 

  18. Abbott J, Hawe J, Hunter D, Holmes M, Finn P, Garry R (2004) Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril 82:878–884

    Article  PubMed  Google Scholar 

  19. Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F (2004) Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol 190:1020–1024

    Article  PubMed  Google Scholar 

  20. Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M (2005) Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 12:508–513

    Article  PubMed  Google Scholar 

  21. Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E (2006) Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 21:1243–1247

    Article  PubMed  Google Scholar 

  22. Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg Endosc 21:1572–1577

    Article  CAS  PubMed  Google Scholar 

  23. Pomel C, Atallah D, Le Bouedec G, Rouzier R, Morice P, Castaigne D, Dauplat J (2003) Laparoscopic radical hysterectomy for invasive cervical cancer: 8-year experience of a pilot study. Gynecol Oncol 91:534–539

    Article  PubMed  Google Scholar 

  24. Ford J, English J, Miles WF, Giannopoulos T (2005) A new technique for laparoscopic anterior resection for rectal endometriosis. JSLS 9:73–77

    PubMed  Google Scholar 

  25. Marcelli F, Collinet P, Vinatier D, Robert Y, Triboulet JP, Biserte J, Villers A (2006) Ureteric and bladder involvement of deep pelvic endometriosis. Value of multidisciplinary surgical management. Prog Urol 16:588–593

    PubMed  Google Scholar 

  26. Wood C, Maher P, Woods R (2000) Laparoscopic surgical techniques for endometriosis and adenomyosis. Diagn Ther Endosc 6:153–168

    Article  CAS  PubMed  Google Scholar 

  27. Roseau G, Dumontier I, Palazzo L, Chapron C, Dousset B, Chaussade S, Dubuisson JB, Couturier D (2000) Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications. Endoscopy 32:525–530

    Article  CAS  PubMed  Google Scholar 

  28. Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan S (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16:2427–2433

    CAS  PubMed  Google Scholar 

  29. Bazot M, Detchev R, Cortez A, Amouyal P, Uzan S, Daraï E (2003) Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison. Hum Reprod 18:1686–1692

    Article  PubMed  Google Scholar 

  30. Balleyguier C, Chapron C, Dubuisson JB, Kinkel K, Fauconnier A, Vieira M, Hélénon O, Menu Y (2002) Comparison of magnetic resonance imaging and transvaginal ultrasonography in diagnosing bladder endometriosis. J Am Assoc Gynecol Laparosc 9:15–23

    Article  CAS  PubMed  Google Scholar 

  31. Sutton C, David Adamson G, Jones K (2006) Modern management of endometriosis. CRC, Boca Raton, p 130

    Google Scholar 

  32. Ware JE Jr, Sherboune CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  33. Leplège A, Ecosse E, Verdier A, Perneger TV (1998) The french SF-36 health survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51:1013–1023

    Article  PubMed  Google Scholar 

  34. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148:1549–1557

    CAS  PubMed  Google Scholar 

  35. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing. Br J Urol 77:805–812

    CAS  PubMed  Google Scholar 

  36. Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Darai E (2008) Use of the SF-36 questionnaire to predict quality-of-life improvement after laparoscopic colorectal resection for endometriosis. Hum Reprod 23:846–851

    Article  CAS  PubMed  Google Scholar 

  37. Pomel C, Castaigne D (2004) Laparoscopic hand-assisted Miami Pouch following laparoscopic anterior pelvic exenteration. Gynecol Oncol 93:543–545

    Article  CAS  PubMed  Google Scholar 

  38. Fedele L, Bianchi S, Zanconato G, Raffaelli R, Berlanda N (2004) Is rectovaginal endometriosis a progressive disease? Am J Obstet Gynecol 191:1539

    Article  PubMed  Google Scholar 

  39. Emmanuel KR, Davis C (2005) Outcomes and treatment options in rectovaginal endometriosis. Curr Opin Obstet Gynecol 17:399–402

    Article  PubMed  Google Scholar 

  40. Koninckx PR, Timmermans B, Meuleman C, Penninckx F (1996) Complications of CO2-laser endoscopic excision of deep endometriosis. Hum Reprod 11:2263–2268

    CAS  PubMed  Google Scholar 

  41. Ford J, English J, Miles WA, Giannopoulos T (2004) Pain, quality of life and complications following the radical resection of rectovaginal endometriosis. BJOG 111:353–356

    Article  PubMed  Google Scholar 

  42. Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G (2007) Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol 19:308–313

    Article  PubMed  Google Scholar 

  43. Ribeiro PA, Rodrigues FC, Kehdi IP, Rossini L, Abdalla HS, Donadio N, Aoki T (2006) Laparoscopic resection of intestinal endometriosis: a 5-year experience. J Minim Invasive Gynecol 13:442–446

    Article  PubMed  Google Scholar 

  44. Panel P, Chis C, Gaudin S, Letohic A, Raynal P, Mikhayelyan M, Fraleu B, Sangana G, Almeras C, Dufour C, Boidart F (2006) Laparoscopic surgery of deep endometriosis. About 118 cases. Gynecol Obstet Fertil 34:583–592

    Article  CAS  PubMed  Google Scholar 

  45. Jatan AK, Solomon MJ, Young J, Cooper M, Pathma-Nathan N (2006) Laparoscopic management of rectal endometriosis. Dis Colon Rectum 49:169–174

    Article  PubMed  Google Scholar 

  46. Lyons SD, Chew SS, Thomson AJ, Lenart M, Camaris C, Vancaillie TG, Abbott JA (2006) Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis. J Minim Invasive Gynecol 13:436–441

    Article  PubMed  Google Scholar 

  47. Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Daraï E (2008) Urinary complications after surgery for posterior deep infiltrating endometriosis are related to the extent of dissection and to uterosacral ligaments resection. J Minim Invasive Gynecol 15:235–240

    Article  PubMed  Google Scholar 

  48. Anaf V, Simon P, El Nakadi I, Fayt I, Buxant F, Simonart T, Peny MO, Noel JC (2000) Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod 15:1744–1750

    Article  CAS  PubMed  Google Scholar 

  49. Possover M, Quakernack J, Chiantera V (2005) The LANN technique to reduce postoperative functional morbidity in laparoscopic radical pelvic surgery. J Am Coll Surg 201:913–917

    Article  PubMed  Google Scholar 

  50. Landi S, Ceccaroni M, Perutelli A, Allodi C, Barbieri F, Fiaccavento A, Ruffo G, McVeigh E, Zanolla L, Minelli L (2006) Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? Hum Reprod 21:774–781

    Article  CAS  PubMed  Google Scholar 

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Disclosures

Authors Emile Daraï, Marcos Ballester, Elisabeth Chereau, Charles Coutant, Roman Rouzier, and Estelle Wafo have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris 6, France

    Emile Daraï, Marcos Ballester, Elisabeth Chereau, Charles Coutant, Roman Rouzier & Estelle Wafo

  2. Service de Gynécologie-Obstétrique Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France

    Emile Daraï

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  1. Emile Daraï
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Daraï, E., Ballester, M., Chereau, E. et al. Laparoscopic versus laparotomic radical en bloc hysterectomy and colorectal resection for endometriosis. Surg Endosc 24, 3060–3067 (2010). https://doi.org/10.1007/s00464-010-1089-8

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