Short and Long-Term Patient Outcomes Following Discoid Bowel Resection for Deep Infiltrative Endometriosis

Abstract

Study Objective: Deep infiltrating endometriosis (DIE) of the bowel is an important gynecological condition. Segmental bowel resection has been the traditional treatment method; unfortunately, it is associated with significant and often unacceptable morbidity. The aim of this study is to evaluate the short and long-term efficacy of discoid bowel resection as a treatment for DIE of the bowel. Design: Retrospective analysis of 31 patients who underwent either partial or full thickness discoid bowel resection for treatment of DIE. Setting: Chattanooga Women's Surgery Center from 1996 through 2007. Patients: Thirty-one women with DIE of the large bowel identified during laparoscopy for pelvic pain. Intervention: Partial or full thickness discoid bowel resection of endometriotic implants. Measurements and Main Results: Of the 31 patients who underwent surgery, 20 had full thickness discoid resections and 11 had partial thickness shavings. Post-operative complications affected 4/20 (20%) and 2/11 (18.2%) of the full thickness and partial thickness populations, respectively. No complication was related to enterotomy site leakage. A total of 19/31 (61.3%) patients were contacted for long-term follow-up, averaging 65.7months. For combined full and partial thickness populations, significant reduction in dyschezia and dypareunea was noted (p = 0.002 and p = 0.041, respectively). In the full thickness resection population, 5/7 (71.4%) individuals desiring fertility bore one or more children. Only 2/19 (10.5%) patients experienced long term bowel or urinary symptoms (both underwent full thickness discoid resection). Conclusion: Patients undergoing either full or partial thickness discoid bowel resection experience few post-operative complications or long-term bowel/urinary symptoms. Symptom relief is significant. Discoid bowel resection is a safe, effective treatment for DIE of the bowel. Greatest symptom resolution and fertility is observed when full thickness discoid bowel resection is completed.