Radical endometriosis surgery is 'effective'

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Radical endometriosis surgery is 'effective'
Examining the long-term response to radical excision of rectovaginal endometriosis.

Researchers have reported a generally favorable response to radical excision of rectovaginal endometriosis, adding to the growing body of evidence supporting excisional surgery in patients with deep infiltrating disease.

"Because of the inadequacy of conservative measures [in the treatment of rectovaginal endometriosis], many authors advocate the complete dissection and surgical removal of rectovaginal disease, even if surgery involving the rectum is required," the team explains.

To determine the long-term response to such surgery, James English and co-workers from the Worthing and Southlands Hospitals Trust in the UK surveyed 44 patients at a median follow-up period of 12 months after surgery.

Twelve radical resections were performed by laparotomy, 48 by laparoscopy. Ten patients had a hysterectomy. Forty-eight patients underwent shaving of the pre-rectal fascia, two had a disc resection of the rectum, 10 had an anterior rectal resection. Two patients required a colostomy and two needed subsequent dilation of a stenosed anastomosis. Forty-four of the first 46 patients replied. The median follow up period was 12 months (range 2 to 22 months) and 86% (38/44) reported an improvement or whom 27 (61%) had a good response (pain completely gone or greatly improved). Patients having a hysterectomy or a disc or segmental resection of the rectum reported a good response and had a normal quality of life. Quality of life scores in the study group overall were lower than the background population.

Interestingly, patients who underwent hysterectomy and those who received segmental or disc resection reported the greatest improvements and a normal quality of life.

English and colleagues conclude that "radical resection is an effective treatment for rectovaginal endometriosis," and encourage research to further assess the value of rectal resection and hysterectomy.

Source: English J et al. Pain, quality of life and complications following the radical resection of rectovaginal endometriosis. BJOG. 2004 Apr;111(4):353-6


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