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Deep infiltrating endometriosis (DIE) represents the most severe form of endometriosis and is present in 20-35% of all women suffering from the disease. Intestinal nodules are observed in 3% to 37% of endometriosis patients. In cases of colorectal DIE, adequate therapy depends on the depth of infiltration and the size of the lesion as well as the woman's quality of life . Removal of the specimen after segmental bowel resection can be performed by either mini-laparotomy or by the natural orifice specimen extraction (NOSE) technique .
The assessment of the quality of life and fertility outcome of the patients was done by using electronic questionnaires before and after surgery.
The conventional method raises concerns because this could disrupt the integrity of the abdominal wall. Moreover, extraction site laparotomy is associated with higher postoperative pain scores . The occurrence of particular complications such as incisional hernias and wound infections is also higher than after conventional laparoscopic procedures .
In order to avoid these complications, NOSE technique has been introduced. During NOSE colectomy the specimen is extracted through a natural orifice and an intracorporeal anastomosis is performed For the operative treatment of bowel endometriosis both transrectal and transvaginal NOSE have been performed.
From 1st of February 2018, 234 consecutive patients underwent segmental bowel resection because of colorectal DIE at the Dept. of Obstetrics and Gynecology Semmelweis University Budapest.
The surgical plan was made individually, tailored to the symptoms of the patients. Nodules larger than 3cm causing obstructive problems and affecting more than 50% of the bowel circumference or multifocal DIE nodules (less than 2 cm from the principal lesion) or multicentric (more than 2 cm from the principal lesion) nodules were treated by segmental resection and anastomosis.
Apart from obstructive sequelae severe (visual analog scale, VAS) endometriosis related pain represented surgical indication as well.
The procedures, namely the transrectal NOSE technique and the conventional segmental laparoscopic resection were randomized using simple randomization, the coin flipping method.
At the time of admission patients filled a questionnaire (Endometriosis Health Profile, EHP 30;Gastrointestinal Quality of Life Index,GIQLI; LARS-Low Anterior Resection Syndrome , and a validated questionnaire pain catastrophisation) regarding their symptoms and fertility .
The endometriosis related pain was measured by using Visual Analog Scale (VAS scores) The patients were asked to fill the questionnaires at 30 days, 60months, 1year and 2 years after the surgery.
During the present study investigators are planning an average follow-up of 24 months.
Surgical procedures( conventional laparoscopic and NOSE technique) for the treatment of colorectal DIE
Published on BioPortfolio: 2019-10-04T08:31:38-0400
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