Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel: A Prospective Cohort Study

Abstract Study Objective Endometriosis can affect 10% of women at reproductive age. Of those, 5.3% to 12% will have endometriosis affecting the bowel. Although outcomes after surgery for severe endometriosis affecting the bowel have previously been studied and have shown improvement in generic quality of life indices and sexual function, few studies have evaluated bowel function or symptoms specific to endometriosis. Our aim was to determine the quality of life after radical excision of rectovagina endometriosis compromising the bowel. Design Single-center prospective cohort study (Canadian Task Force classification II-2). Setting Specialist referral center for the management of advanced endometriosis. Patients Women with severe rectovaginal endometriosis compromising the bowel. Interventions Comparison of preoperative data with a 2-, 6-, and 12-month follow-up was made for consecutive patients who underwent surgery for endometriosis with bowel involvement. The main outcome measures were quality of life using the Endometriosis Health Profile 30 and EuroQol-5 dimension questionnaires. Bowel symptoms were measured using the Gastrointestinal Quality of Life Index. Dysmenorrhea, dyspareunia, dyschezia, and chronic pain were measured using a visual analogue scale. To compare preoperative and postoperative scores, a Freidman test was performed followed by a preoperative and 12-month postoperative Wilcoxon signed-rank test. A Mann-Whitney U test was used to compare the results between those who had pelvic clearance and those who did not. Measurements and Main Results In total, 137 patients had surgery, of which 100 completed follow-up to 12 months. The serious perioperative and postoperative complication rate was 7.3%. The results show significant improvement in almost all variables measured (p