Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis
Abstract
Study objective To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality-of-life outcomes.Design Prospective observational cohort study (Canadian Task Force classification II-2).Setting Australian tertiary referral center for the surgical treatment of endometriosis.Patients Seven consecutive patients with known endometriosis involving the bowel.Intervention Laparoscopic resection of all endometriosis, including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy.Measurements and main results Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and dyschezia. Validated research tools (SF12, EuroQOL, and Sexual Activity Questionnaire) also assessed quality of life. Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 (interquartile range 43-85) versus 5 (0-10); p=.028, nonmenstrual pelvic pain 74 (48-85) versus 11 (0-18); p=.046, dyspareunia 66 (0-98) versus 5 (0-8); p=.080, and dyschezia 48 (20-64) versus 20 (0-40); p=.173. All measures of quality of life were improved at 12 months after surgery, although not reaching statistical significance because of the small sample size. All three women wishing to conceive after operation have been successful, resulting in three live births at term. There were few complications associated with this surgery.Conclusion Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life. Results appear to parallel published data for conservative resection of endometriosis not involving bowel. For women with severe endometriosis involving bowel, this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility.
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Earlier studies found that endometriosis patients had lower PCS and MCS scores than the general population.
“In both studies, patients with endometriosis scored lower in the physical (PCS) and mental parameters (MCS) as compared to the general population.”
From Quantification of the impact of endometriosis symptoms on health-related quality of life and work productivity (2011) · cites this paper as [40]
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- Authors
- Lyons, S. D., Chew, S. S. B., Thomson, A. J. M., Lenart, M., Camaris, C., Vancaillie, T. G., & Abbott, J. A.
- Affiliations
- Royal Hospital for Women (AU)
- Nepean Hospital (AU)
- Prince of Wales Hospital (AU)
- Corresponding author
- Lyons, Stephen D.
- Venue
- Journal of Minimally Invasive Gynecology
- Publisher
- Elsevier BV
- Published
- 2006-09
- Volume
- 13
- Issue
- 5
- Pages
- 436-441
- ISSN
- 1553-4650 (ISSN-L)
- OpenAlex
- W2166847183
- Cited by
- 88
- References
- 1
- Citations by year
- 2026: 3 · 2024: 4 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 4 · 2016: 5 · 2015: 6 · 2014: 5 · 2013: 4 · 2012: 4
- FWCI
- 7.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Minimally Invasive Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- endometriosis, bowel endometriosis, fertility-sparing surgery, laparoscopic resection, bowel resection, end-to-end anastomosis, temporary ileostomy, quality of life, dysmenorrhea, dyspareunia, dyschezia, live birth, fertility preservation
- MeSH terms
- Adult, Endometriosis, Female, Follow-Up Studies, Humans, Ileostomy, Intestinal Diseases, Laparoscopy, Pilot Projects, Prospective Studies, Quality of Life, Rectum, Treatment Outcome
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