Predicting Colorectal Involvement in Surgery for Treatment of Severe Endometriosis

Abstract

Study Objective: To assess the predictive value of preoperative assessment for colorectal involvement in the management of endometriosis. Design: A prospective study between October 2004 and September 2008. Setting: University-affiliated tertiary referral centre for endometriosis. Patients: 454 consecutive women who underwent laparoscopic surgery for treatment of pelvic pain and/or infertility- associated endometriosis. Intervention: Preoperative assessment included a detailed systematic clinical and vaginal examination. Using these data, women deemed to be at high risk of requiring disc or full segmental bowel resection were referred to the colorectal team preoperatively. Logistic regression analyses were performed to investigate the predictive value of the various domains of preoperative assessment in regards to needing a colorectal surgeon intraoperatively. Measurements and Main Results: 165 out of 454 (36.3%) women were confirmed laparoscopically to have bowel endometriosis. 41 out of 454 (9.0%) women were referred for a colorectal assessment preoperatively. A colorectal surgeon was required at surgery in 32 out of 41 (78.0%) of these cases. The author (AL) was able to proceed with bowel surgery without colorectal involvement in the remaining nine cases. A colorectal surgeon was asked to attend theatre on three occasions out of 454 cases (0.7%) where a preoperative colorectal referral had not been made. Conclusion: Our triage system which combines clinical history and vaginal examination is useful and effective in the management of patients with endometriosis. Patients who are deemed to be at high risk of requiring bowel surgery are referred appropriately to our colorectal colleagues. The need to call for a colorectal surgeon intraoperatively without prior arrangement is minimal.