Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre potential cohort examine.
BMJ Open. 2018 Apr 09;eight(four):e018924
Authors: Byrne D, Curnow T, Smith P, Cutner A, Saridogan E, Clark TJ, BSGE Endometriosis Centres
OBJECTIVE: To estimate the effectiveness and security of laparoscopic surgical excision of rectovaginal endometriosis.
DESIGN: A multicentre, potential cohort examine.
SETTING: 51 hospitals accredited as specialist endometriosis centres.
PARTICIPANTS: 5162 girls of reproductive age with rectovaginal endometriosis of which 4721 girls had deliberate laparoscopic excision.
INTERVENTIONS: Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal area.
MAIN OUTCOME MEASURES: Standardised symptom questionnaires enquiring about continual pelvic ache, bladder and bowel signs, analgesia use and high quality of life (EuroQol) accomplished previous to surgical procedure and at 6, 12 and 24 months postoperatively. Severe perioperative and postoperative problems together with main haemorrhage, an infection and visceral damage had been recorded.
RESULTS: At 6 months postsurgery, there have been vital reductions in premenstrual, menstrual and non-cyclical pelvic ache, deep dyspareunia, dyschezia, low again ache and bladder ache. As well as, there have been vital reductions in voiding problem, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions had been maintained at 2?years, apart from voiding problem. International high quality of life considerably improved from a median pretreatment rating of 55/100 to 80/100 at 6?months. There was a big enchancment in high quality of life in all measured domains and in quality-adjusted life years. These enhancements had been sustained at 2?years. All analgesia use was diminished and, specifically, opiate use fell from 28.1% previous to surgical procedure to 16.1% at 6?months. The general incidence of problems was 6.eight% (321/4721). Gastrointestinal problems (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder?damage or leak) in 49 (1.zero%) procedures.
CONCLUSION: Laparoscopic surgical excision of rectovaginal endometriosis seems to be efficient in treating pelvic ache and bowel signs and bettering health-related high quality of life and has a low price of main problems when carried out in specialist centres.
PMID: 29632080 [PubMed – in process]