Horace Roman1, Salwa Moatassim-Drissa2, Noemie Marty2, Mathilde Milles2, Aurélie Vallée2, Eulalie Desnyder2, Emanuela Stochino Loi2, Carole Abo2. 1. Expert Center for Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group EA 4308 Spermatogenesis and Male Gamete Quality, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com. 2. Expert Center for Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
Abstract
OBJECTIVE: To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum. DESIGN: Retrospective study using data prospectively recorded in the CIRENDO database. SETTING: University tertiary referral center. PATIENT(S): One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years. INTERVENTION(S): Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively. MAIN OUTCOME MEASURE(S): Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS). RESULT(S): Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously. CONCLUSION(S): Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.
OBJECTIVE: To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum. DESIGN: Retrospective study using data prospectively recorded in the CIRENDO database. SETTING: University tertiary referral center. PATIENT(S): One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years. INTERVENTION(S): Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively. MAIN OUTCOME MEASURE(S): Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS). RESULT(S): Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously. CONCLUSION(S): Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.