Segmental and Discoid Resection are Preferential to Bowel Shaving for Medium-Term Symptomatic Relief in Patients With Bowel Endometriosis

Abstract

Objective: To evaluate and compare medium-term clinical outcomes and recurrence rates in the laparoscopic surgical management of bowel endometriosis comparing 3 different surgical techniques (shaving, discoid, and segmental resection).

Design: Retrospective study (Canadian Task Force classification II-2).

Setting: Endometriosis tertiary referral center.

Patients: A retrospective cohort of 106 patients with histological confirmation of bowel endometriosis undergoing laparoscopic surgical treatment between January 1, 2010, and September 1, 2012.

Intervention: Assessment of laparoscopic bowel shaving, discoid or segmental resection for the treatment of painful symptoms related to deep endometriosis (DE) involving the bowel with 24 months of follow-up.

Measurements and main results: A total of 92 patients were included in the study and were divided into 3 groups according to the surgical procedure performed (shaving, n = 47; discoid resection, n = 15; segmental resection, n = 30). All symptoms improved significantly in the immediate postoperative follow-up, with significant reduction in all visual analog scale scores for pain. Compared with the discoid resection and segmental resection groups, the shaving group had a significantly higher rate of medium-term recurrence of dysmenorrhea and dyspareunia. Furthermore, the shaving group had a higher rate of reintervention for recurrent DE lesions compared with the segmental resection group (27.6% vs 6.6%; relative risk [RR], 4.14; 95% confidence interval [CI], 1.0-17.1). Postoperative complication rates were similar across all 3 groups with a rate of major complications of 4.2% in the shaving group, 6.6% in the discoid resection group, and 6.6% in the segmental resection group. According to our data, the patients with a nodule >3 cm had an RR of 2.5 (95% CI, 1.66-3.99) of requiring bowel resection.

Conclusion: All 3 treatment modalities are effective in terms of immediate symptom relief with acceptable complication rates. However, significantly higher rates of symptom recurrence and reintervention were noted in the shaving group, whereas segmental resection is more likely to be indicated in cases of large nodules.

Keywords: Bowel endometriosis; Bowel shaving; Deep endometriosis; Discoid resection; Laparoscopic segmental resection; Laparoscopic treatment.