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Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery

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Abstract

Background

To evaluate the long-term symptoms, quality of life (QOL), and fertility after colorectal resection for endometriosis.

Methods

Extended analysis of a randomized controlled trial including 52 patients with colorectal endometriosis, comparing laparoscopically assisted to open colorectal resection. All included patients were invited to complete questionnaires evaluating the presence and intensity of symptoms and QOL using the SF-36 and fertility at a mean (SD) follow-up of 50.7 (13.8) months. We compared symptoms intensity and QOL before and after surgery at short- (mean follow-up of 19 months) and long-term (mean follow-up of 51 months).

Results

Persistent improvement in QOL was noted after surgery without differences between short and long term. Self-catheterization >6 months was the sole factor decreasing the long-term QOL (P = 0.02). No difference in symptoms and QOL was noted according to the route. Among the 28 patients (53.8 %) wishing to conceive, 12 (42.9 %) conceived within a mean (SD) time of 17 (13) months. No difference in fertility including pregnancy after IVF was noted between the routes, but spontaneous pregnancy occurred only after laparoscopy (P = 0.016).

Conclusions

Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.

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References

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

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Ballweg ML (2004) Impact of endometriosis on women’s health: comparative historical data show that the earlier the onset, the more severe the disease. Best Pract Res Clin Obstet Gynaecol 18:201–218

    Article  PubMed  Google Scholar 

  4. 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 

  5. Pereira RM, Zanatta A, Serafini PC, Redwine D (2010) The feasibility of laparoscopic bowel resection performed by a gynaecologist to treat endometriosis. Curr Opin Obstet Gynecol 22:344–353

    Article  PubMed  Google Scholar 

  6. Darai E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251:1018–1023

    Article  PubMed  Google Scholar 

  7. Dousset B, Leconte M, Borghese B, Millischer AE, Roseau G, Arkwright S, Chapron C (2010) Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg 251:887–895

    Article  PubMed  Google Scholar 

  8. Roman H, Loisel C, Resch B, Tuech JJ, Hochain P, Leroi AM, Marpeau L (2010) Delayed functional outcomes associated with surgical management of deep rectovaginal endometriosis with rectal involvement: giving patients an informed choice. Hum Reprod 25:890–899

    Article  PubMed  Google Scholar 

  9. Meuleman C, Tomassetti C, D’Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D’Hooghe T (2011) Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 17:311–326

    Article  PubMed  Google Scholar 

  10. 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 

  11. Thomassin I, Bazot M, Detchev R, Barranger E, Cortez A, Darai E (2004) Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography. Am J Obstet Gynecol 190:1264–1271

    Article  PubMed  Google Scholar 

  12. Leplege 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  CAS  PubMed  Google Scholar 

  13. Perneger TV, Leplege A, Etter JF, Rougemont A (1995) Validation of a French-language version of the MOS 36-item short form health survey (SF-36) in young healthy adults. J Clin Epidemiol 48:1051–1060

    Article  CAS  PubMed  Google Scholar 

  14. 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 

  15. Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Darai 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 

  16. Fourquet J, Baez L, Figueroa M, Iriarte RI, Flores I (2011) Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity. Fertil Steril 96:107–112

    Article  PubMed  PubMed Central  Google Scholar 

  17. Busacca M, Chiaffarino F, Candiani M, Vignali M, Bertulessi C, Oggioni G, Parazzini F (2006) Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 195:426–432

    Article  PubMed  Google Scholar 

  18. Fedele L, Bianchi S, Zanconato G, Bergamini V, Berlanda N, Carmignani L (2005) Long-term follow-up after conservative surgery for bladder endometriosis. Fertil Steril 83:1729–1733

    Article  PubMed  Google Scholar 

  19. Vercellini P, Barbara G, Buggio L, Frattaruolo MP, Somigliana E, Fedele L (2012) Effect of patient selection on estimate of reproductive success after surgery for rectovaginal endometriosis: literature review. Reprod Biomed Online 24:389–395

    Article  PubMed  Google Scholar 

  20. Seracchioli R, Poggioli G, Pierangeli F, Manuzzi L, Gualerzi B, Savelli L, Remorgida V, Mabrouk M, Venturoli S (2007) Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG 114:889–895

    Article  CAS  PubMed  Google Scholar 

  21. Pereira RM, Zanatta A, Preti CD, de Paula FJ, da Motta EL, Serafini PC (2009) Should the gynecologist perform laparoscopic bowel resection to treat endometriosis? Results over 7 years in 168 patients. J Minim Invasive Gynecol 16:472–479

    Article  PubMed  Google Scholar 

  22. Ballester M, Chereau E, Dubernard G, Coutant C, Bazot M, Darai E (2011) Urinary dysfunction after colorectal resection for endometriosis: results of a prospective randomized trial comparing laparoscopy to open surgery. Am J Obstet Gynecol 204(303):e301–e306

    Google Scholar 

  23. Darai E, Zilberman S, Touboul C, Chereau E, Rouzier R, Ballester M (2012) Urological morbidity of colorectal resection for endometriosis. Minerva Med 103:63–72

    CAS  PubMed  Google Scholar 

  24. Bonneau C, Cortez A, Lis R, Mirshahi M, Fauconnier A, Ballester M, Darai E, Touboul C (2013) Lymphatic and nerve distribution throughout the parametrium. Gynecol Oncol 131:708–713

    Article  CAS  PubMed  Google Scholar 

  25. Bonneau C, Zilberman S, Ballester M, Thomin A, Thomassin-Naggara I, Bazot M, Darai E (2013) Incidence of pre- and postoperative urinary dysfunction associated with deep infiltrating endometriosis: relevance of urodynamic tests and therapeutic implications. Minerva Ginecol 65:385–405

    CAS  PubMed  Google Scholar 

  26. Ballester M, Belghiti J, Zilberman S, Thomin A, Bonneau C, Bazot M, Thomassin-Naggara I, Darai E (2014) Surgical and clinical impact of extraserosal pelvic fascia removal in segmental colorectal resection for endometriosis. J Minim Invasive Gynecol. doi:10.1016/j.jmig.2014.04.018

    Google Scholar 

  27. Donnez J, Squifflet J (2010) Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 25:1949–1958

    Article  PubMed  Google Scholar 

  28. Roman H, Vassilieff M, Tuech JJ, Huet E, Savoye G, Marpeau L, Puscasiu L (2013) Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 99:1695–1704

    Article  PubMed  Google Scholar 

  29. Roman H, Vassilieff M, Gourcerol G, Savoye G, Leroi AM, Marpeau L, Michot F, Tuech JJ (2011) Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 26:274–281

    Article  PubMed  Google Scholar 

  30. Meuleman C, Tomassetti C, Wolthuis A, Van Cleynenbreugel B, Laenen A, Penninckx F, Vergote I, D’Hoore A, D’Hooghe T (2014) Clinical outcome after radical excision of moderate-severe endometriosis with or without bowel resection and reanastomosis: a prospective cohort study. Ann Surg 259:522–531

    Article  PubMed  Google Scholar 

  31. Mathieu d’Argent E, Coutant C, Ballester M, Dessolle L, Bazot M, Antoine JM, Darai E (2010) Results of first in vitro fertilization cycle in women with colorectal endometriosis compared with those with tubal or male factor infertility. Fertil Steril 94:2441–2443

    Article  PubMed  Google Scholar 

  32. Ballester M, Oppenheimer A, d’Argent EM, Touboul C, Antoine JM, Coutant C, Darai E (2012) Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. Hum Reprod 27:451–456

    Article  CAS  PubMed  Google Scholar 

  33. de Ziegler D, Borghese B, Chapron C (2010) Endometriosis and infertility: pathophysiology and management. Lancet 376:730–738

    Article  PubMed  Google Scholar 

  34. Benaglia L, Somigliana E, Santi G, Scarduelli C, Ragni G, Fedele L (2011) IVF and endometriosis-related symptom progression: insights from a prospective study. Hum Reprod 26:2368–2372

    Article  PubMed  Google Scholar 

  35. Stepniewska A, Pomini P, Bruni F, Mereu L, Ruffo G, Ceccaroni M, Scioscia M, Guerriero M, Minelli L (2009) Laparoscopic treatment of bowel endometriosis in infertile women. Hum Reprod 24:1619–1625

    Article  CAS  PubMed  Google Scholar 

  36. Giudice LC (2010) Clinical practice. Endometriosis. New Engl J Med 362:2389–2398

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Adamson GD, Pasta DJ (2010) Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 94:1609–1615

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Touboul, Ballester, Dubernard, Zilberman, Thomin and Daraï have no conflicts of interest or financial ties to disclose.

Author information

Author notes

  1. Cyril Touboul

    Present address: Department of Obstetrics and Gynecology, Hôpital Intercomunal de Créteil, Université Paris Est Paris XII, 40 avenue de Verdun, 94000, Créteil, France

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, GRC-UPMC 6 (Centre Expert En Endometriose (C3E)), UMRS938, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie Paris VI, Paris, France

    Cyril Touboul, Marcos Ballester, Gil Dubernard, Sonia Zilberman, Anne Thomin & Emile Daraï

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

    Cyril Touboul & Emile Daraï

Authors
  1. Cyril Touboul
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  2. Marcos Ballester
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  3. Gil Dubernard
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  4. Sonia Zilberman
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  5. Anne Thomin
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  6. Emile Daraï
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Corresponding authors

Correspondence to Cyril Touboul or Emile Daraï.

Additional information

Trial registration number: NCT00939861.

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Touboul, C., Ballester, M., Dubernard, G. et al. Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery. Surg Endosc 29, 1879–1887 (2015). https://doi.org/10.1007/s00464-014-3880-4

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  • DOI: https://doi.org/10.1007/s00464-014-3880-4

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