Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach

Horace Roman, M. Vassilieff, Maud Vassilieff, Guillaume Gourcerol, Guillaume Savoye, Anne‐Marie Leroi, Anne Marie Leroi, L. Marpeau, Loïc Marpeau, Francis Michot, F Michot, Jean-Jacques Tuech, J.‐J. Tuech
Human Reproduction · 2010 · vol. 26(2) , pp. 274–281 · doi:10.1093/humrep/deq332 · PMID:21131296 · W2115780546
article OA: bronze CC0 ⤵ 138 in-corpus citations
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This paper argues for a symptom-guided surgical approach to deep infiltrating endometriosis of the rectum, favoring nodule excision over colorectal resection to minimize morbidity while effectively relieving symptoms.

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Abstract

Two surgical approaches are usually employed in the treatment of deep infiltrating endometriosis of the rectum (DIER): colorectal resection removing the rectal segment affected by the disease, and nodule excision either without opening the rectum (shaving) or by removing the nodule along with the surrounding rectal wall (full thickness or disc excision). Although the present available data are from retrospective series reported by surgeons who generally perform only one technique, there is no evidence to support the risk of recurrences as a valid argument in favour of colorectal resection over rectal nodule excision. The advantage of a lower morbidity associated with nodule excision is not necessarily at the cost of an increased rate of pain recurrences, especially in women benefiting from post-operative medical treatment. The symptom-guided surgical approach in DIER primarily focuses on the relief of digestive symptoms and pelvic pains, rather than on mandatory 'carcinologic' resection of lesions. In addition, the risk of new post-operative unpleasant symptoms as a result of a compulsory and systematic excision of all endometriotic foci may be avoided. In a majority of cases, pelvic anatomy and digestive function can be restored by shaving or disc excision, as well as by colorectal resection; thus digestive complaints can be resolved even when the rectum is conserved. The most accurate evaluation of the results of DIER surgery should be provided by post-operative evolution in digestive function. Even though quality of life is improved for the majority of patients managed by colorectal resection, the question is whether or not a greater health improvement can be achieved by performing nodule excision, which avoids various post-operative and functional digestive complications. In addition, continuous medical treatment leads to a decrease in endometriotic nodules and prevents post-operative pain recurrences. Instead of choosing between medical and surgical management in the treatment of DIER, it is most likely that the two therapies should be associated.

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Condition tags

mesh:D004414mesh:D004715mesh:D017699endometriosisdie_deep_infiltrating

MeSH descriptors

Digestive System Surgical Procedures Endometriosis Rectal Diseases Combined Modality Therapy Constriction, Pathologic Constriction, Pathologic Digestive System Surgical Procedures Dyspareunia Dyspareunia Dyspareunia Endometriosis Female Humans Middle Aged Pelvic Pain Pelvic Pain Postoperative Complications Quality of Life Rectal Diseases Rectum

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (39)

Cited by (50)

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