8419 Retrospective Review of Outcomes in Patients with Endometriosis and Colonic Segmental Resection (CSR) or Low Anterior Resection (LAR)

Abstract

<h3>Study Objective</h3> To further the understanding of long-term outcomes of endometriosis patients requiring CSR/LAR. To improve counseling of patients with bowel endometriosis. <h3>Design</h3> Retrospective chart review at a single academic institution between 2000-2018 with 3-year follow-up of patients with CSR/LAR for endometriosis. <h3>Setting</h3> Clinic/OR. <h3>Patients or Participants</h3> 21 patients aged 18-45 at single academic institution between 1/1/2000 and 12/31/2018 with ICD9&10 codes of endometriosis AND CSR/LAR were included; 9 met criteria for endometriosis as indication for CSR/LAR were reviewed. <h3>Interventions</h3> CSR/LAR for the indication of bowel endometriosis and long-term effects. <h3>Measurements and Main Results</h3> Pre- and post-operative symptoms were categorized into GI (hematochezia, dyschezia, tenesmus, incontinence, incomplete evacuation of bowel, and pre-operative colonoscopy), GYN (dysmenorrhea, dyspareunia, pelvic pain, and infertility), and GU (dysuria, frequency, urgency, incontinence, and incomplete emptying). Pre-operatively, GI symptoms: 3/9(33.33%) endorsed hematochezia and underwent a colonoscopy, 7/9(77.78%) dyschezia, and 1/9(11.11%) fecal incontinence. GYN: 7/9(77.78%) endorsed dysmenorrhea, 5/9(55.56%) dyspareunia, 9/9(100%) pelvic pain. GU: 1/9(11.11%) endorsed urinary incontinence. Intraoperatively, 9/9(100%) underwent anastomosis, 3/9(33.33%) concurrent hysterectomy and 6/9(66.67%) oophorectomy. Average operative time was 165.8 minutes. Median EBL 50cc. Median days spent inpatient 3. Post-operatively, no complications were noted. There was 88.89% decrease in pelvic pain and complete resolution of all other pre-operative symptoms of hematochezia, dyschezia, fecal incontinence, dysmenorrhea, dyspareunia and urinary incontinence. <h3>Conclusion</h3> We found a clinically significant reduction in symptoms of hematochezia, dyschezia, fecal incontinence, dysmenorrhea, pelvic pain, dyspareunia and urinary incontinence in patients who underwent bowel resection for the indication of endometriosis. In all patients who had hematochezia and underwent a colonoscopy with positive findings of lesions or masses, the pathology also returned positive for endometriosis. Therefore, if a patient has hematochezia on presentation or review of systems, it is important to consider a colonoscopy in work up and CSR/LAR.