Skip to main content

Advertisement

SpringerLink
Log in

Quality of life and low anterior resection syndrome before and after deep endometriosis surgery

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Deep endometriosis (DE) is defined by the presence of ectopic endometrial glands, with rectal involvement ranging from 5.3 to 12%. The prevalence of low anterior resection–like syndrome (LARS) in patients with DE, how it affects quality of life (QoL), and its evolution after surgery is unclear. The objective of this study was to assess the gastrointestinal functional outcomes and QoL in patients who underwent surgery for DE.

Patients and methods

A prospective study was conducted from 2017 to 2019, recruiting patients who underwent DE surgery with and without rectal resection. Patients completed LARS and SF-36 questionnaires before, at 6 months and at 1 year after surgery.

Results

Eighty-two patients were enrolled. Rectal segmental resection was required in 16 (19.5%) patients, shaving in 16 (19.5%) and discoid resection in 8 (9.8%). All 8 domains of the SF-36 questionnaire showed improvement during follow-up, reflecting improved QoL after surgery (p ≤ 0.05) in all patients. Mean LARS scores for patients without rectal surgery were 7.5 ± 10.4 before and 13.7 ± 14.2 1 year after surgery; rectal surgery was 13.6 ± 13.6 and 14.6 ± 13.1, respectively (p = 0.17). No significant differences were found in the rectal surgery patients’ postoperative LARS score among the 3 rectal DE surgical techniques (p = 0.97), and the SF-36 scores improved independent of the technique performed.

Conclusions

Patients with DE present a LARS-like syndrome before surgery that does not appear to be negatively affected after rectal surgery, independent of the technique performed. Rectal surgery improves the QoL of patients with DE patients as measured by the SF-36 questionnaire at 1 year of follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Availability of data and material

The data that support the findings of this study are available from the corresponding author (SG) upon reasonable request.

References

  1. Falcone T, Lebovic DI (2011) Clinical management of endometriosis. Obstet Gynecol 118(3):691–705

    Article  CAS  Google Scholar 

  2. Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P (2018) Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis [cited 2018 Jun 23];33(7):835–47. Available from: http://link.springer.com/10.1007/s00384-018-3082-y

  3. Hernández Gutiérrez A, Spagnolo E, Zapardiel I, Garcia-AbadilloSeivane R, López Carrasco A, Salas Bolívar P et al (2019) Post-operative complications and recurrence rate after treatment of bowel endometriosis: comparison of three techniques. Eur J Obstet Gynecol Reprod Biol X. 4:100083

    Article  Google Scholar 

  4. Perandini A, Perandini S, Montemezzi S, Bonin C, Bellini G, Bergamini V (2018) Defining probabilities of bowel resection in deep endometriosis of the rectum: prediction with preoperative magnetic resonance imaging. J Obstet Gynaecol Res 44(2):292–297

    Article  Google Scholar 

  5. Bray-Beraldo F, Pereira AMG, Gazzo C, Santos MP, Lopes RGC (2018) Surgical treatment of intestinal endometriosis: outcomes of three different techniques. Rev Bras Ginecol e Obstet 40(7):390–396

    Article  Google Scholar 

  6. Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G (2007) Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol 19:308–13

  7. Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J (2012) Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril [cited 2021 Oct 29];98:564–71. Available from: https://doi.org/10.1016/j.fertnstert.2012.07.1061

  8. Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin D (2007) Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv [cited 2021 Oct 29];62(7):461–70. Available from: https://pubmed.ncbi.nlm.nih.gov/17572918/

  9. Young S, Burns MK, Difrancesco L, Nezhat A, Nezhat C (2017) Diagnostic and treatment guidelines for gastrointestinal and genitourinary endometriosis. J Turkish Ger Gynecol Assoc 18(4):200–209

    Article  Google Scholar 

  10. Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M et al (2013) The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update [cited 2021 Oct 28];19(6):625–39. Available from: https://pubmed.ncbi.nlm.nih.gov/23884896/

  11. Sepulcri Rde P, do Amaral V (2009) Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis. Eur J Obstet Gynecol Reprod Biol [cited 2021 Oct 29];142(1):53–6. Available from: https://pubmed.ncbi.nlm.nih.gov/19010584/

  12. Zondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Viganò P (2018) Endometriosis. Nat Rev Dis Prim 2018 41 [cited 2021 Oct 28];4(1):1–25. Available from: https://www.nature.com/articles/s41572-018-0008-5

  13. Riiskjær M, Egekvist A, Hartwell D, Forman A, Seyer-Hansen M, Kesmodel U (2017) Bowel endometriosis syndrome: a new scoring system for pelvic organ dysfunction and quality of life. Hum Reprod [cited 2021 Oct 29];32(9):1812–8. Available from: https://pubmed.ncbi.nlm.nih.gov/28854723/

  14. Emmertsen KJ, Laurberg S (2012) Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg 255(5):922–928

    Article  Google Scholar 

  15. Bokor A, Hudelist G, Dobó N, Dauser B, Farella M, Brubel R et al (2021) Low anterior resection syndrome following different surgical approaches for low rectal endometriosis: a retrospective multicenter study. Acta Obstet Gynecol Scand 100(5):860–867

    Article  Google Scholar 

  16. Scheepers WFW, Maas JWM, van de Kar MMA (2021) Bowel function and quality of life following surgery for deep endometriosis. J Psychosom Obstet Gynecol 0(0):1–6. Available from: https://doi.org/10.1080/0167482X.2021.1952570

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  18. Spagnolo E, Hernández A, Pascual I, Cabanes M, López A, Zapardiel I (2020) Bowel and ureteral assessment by indocyanine green real-time visualization during deep infiltrating endometriosis surgery – a video vignette. Color Dis [cited 2021 Oct 29];22(10):1464–5. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/codi.15093

  19. Stull D, Wasiak R, Kreif N, Raluy M, Colligs A, Seitz C et al (2014) Validation of the SF-36 in patients with endometriosis. Qual Life Res [cited 2021 Oct 29];23(1):103–17. Available from: https://pubmed.ncbi.nlm.nih.gov/23851974/

  20. Alonso J, Regidor E, Barrio G, Prieto L, Rodríguez C de la FL (1998) Valores poblacionales de referencia de la versión española del Cuestionario de Salud SF-36 [Population reference values of the Spanish version of the Health Questionnaire SF-36]. Med Clin (Barc) 111(11):410–6. Spanish

  21. Coloma JL, Martínez-Zamora MA, Collado A, Gràcia M, Rius M, Quintas L et al (2019) Prevalence of fibromyalgia among women with deep infiltrating endometriosis. Int J Gynecol Obstet 146(2):157–163

    Article  Google Scholar 

  22. Vieira X, Arcoverde L, Xmd X, Xmarina X, Andres P, Moys Es Borrelli X et al (2019) Surgery for endometriosis improves major domains of quality of life: a systematic review and meta-analysis. J Minim Invasive Gyne-cology [cited 2021 Oct 26];26:278. Available from: https://doi.org/10.1016/j.jmig.2018.09.774

  23. Garavaglia E, Inversetti A, Ferrari S, De Nardi P, Candiani M (2018) Are symptoms after a colorectal segmental resection in deep endometriosis really improved? The point of view of women before and after surgery. J Psychosom Obstet Gynecol [cited 2018 Mar 21];1–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29514537

  24. Anaf V, El Nakadi I, Simon P, Van de Stadt J, Fayt I, Simonart T et al (2004) Preferential infiltration of large bowel endometriosis along the nerves of the colon. Hum Reprod [cited 2021 Oct 29];19(4):996–1002. Available from: https://pubmed.ncbi.nlm.nih.gov/15016784/

  25. Riiskjær M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, Seyer-Hansen M (2016) Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG An Int J Obstet Gynaecol 123(8):1360–1367

    Article  Google Scholar 

  26. Bray-Beraldo F, Pellino G, Ribeiro MAF, Pereira AMG, Lopes RGC, Mabrouk M et al (2021) Evaluation of bowel function after surgical treatment for intestinal endometriosis: a prospective study. Dis Colon Rectum 64(10):1267–1275

    Article  Google Scholar 

  27. Uccella S, Marconi N, Casarin J, Ceccaroni M, Boni L, Sturla D et al (2016) Impact of endometriosis on surgical outcomes and complications of total laparoscopic hysterectomy. Arch Gynecol Obstet [cited 2021 Oct 5];294(4):771–8. Available from: https://pubmed.ncbi.nlm.nih.gov/27168180/

  28. Pieniowski E, Nordenvall C, Palmer G, Johar A, Tumlin Ekelund S, Lagergren P et al (2020) Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study. BJS Open [cited 2021 Oct 29];4(5):935–42. Available from: https://pubmed.ncbi.nlm.nih.gov/32530135/

Download references

Author information

Authors and Affiliations

  1. General Surgery Department, University Hospital La Paz, Madrid, Spain

    Sara Gortázar de las Casas, Isabel Pascual Miguelañez & Mario Álvarez-Gallego

  2. Obstetrics and Gynecology Department, University Hospital La Paz, Madrid, Spain

    Emanuela Spagnolo, Ana López Carrasco, María Carbonell López & Alicia Hernández Gutiérrez

Authors
  1. Sara Gortázar de las Casas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isabel Pascual Miguelañez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emanuela Spagnolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Álvarez-Gallego
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ana López Carrasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. María Carbonell López
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alicia Hernández Gutiérrez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara Gortázar de las Casas.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients signed an informed consent document regarding publishing their data and photographs.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gortázar de las Casas, S., Pascual Miguelañez, I., Spagnolo, E. et al. Quality of life and low anterior resection syndrome before and after deep endometriosis surgery. Langenbecks Arch Surg 407, 3671–3679 (2022). https://doi.org/10.1007/s00423-022-02705-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-022-02705-3

Keywords

Search

Navigation