OBJECTIVE: To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision. DESIGN: "Before and after" comparative retrospective study. SETTING: University tertiary referral center. PATIENT(S): Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum. INTERVENTION(S): Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted. MAIN OUTCOMES MEASURE(S): Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score. RESULT(S): Preoperative patient characteristics, rectal nodule features, and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life Score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency. CONCLUSION(S): It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection.
OBJECTIVE: To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision. DESIGN: "Before and after" comparative retrospective study. SETTING: University tertiary referral center. PATIENT(S): Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum. INTERVENTION(S): Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted. MAIN OUTCOMES MEASURE(S): Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score. RESULT(S): Preoperative patient characteristics, rectal nodule features, and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life Score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency. CONCLUSION(S): It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection.
Authors: Gil Kamergorodsky; Nucelio Lemos; Francisco C Rodrigues; Fernando Yassuo Asanuma; Paulo D'Amora; Eduardo Schor; Manoel J B C Girão Journal: Surg Endosc Date: 2014-11-08 Impact factor: 4.584
Authors: Antonio Matos Rocha; Maurício Mendes de Albuquerque; Eduardo Miguel Schmidt; Cristiano Denoni Freitas; João Paulo Farias; Fernanda Bedin Journal: Arq Bras Cir Dig Date: 2018-12-06