Abstract
Purpose: To investigate the postoperative outcomes regarding bowel functions in women and the pattern of symptoms after surgical treatment for deep infiltrating endometriosis in comparison with healthy subjects. Methods: This cross-sectional study was designed as a single tertiary-level academic center. We included 130 female adult patients who had undergone (recto) sigmoid resection for deep infiltrating endometriosis between January 2005 and December 2015. Patients were randomly age-matched to two controls derived from the general population in the Netherlands. We measured the prevalence of constipation, fecal incontinence, Irritable Bowel Syndrome and the Low Anterior Resection Syndrome Score. Results: The prevalence of constipation, fecal incontinence, and irritable bowel syndrome in the patients was significantly higher than in the controls (50.8% versus 26.2% and 15.4% versus 5.4%, and 14.6% versus 5.4%, respectively, P < 0.05 for each). The prevalence of constipation and fecal incontinence was lower in the patients who had undergone surgery longer than 24 months ago, in comparison with those who had undergone surgery less than 24 months ago (46.7% versus 69.9% and 15.0% versus 17.4%), which was still significantly higher in comparison to the control group. The low anterior resection syndrome score was significantly higher in the patients than in the controls. Conclusion: The postoperative outcomes in patients treated for deep infiltrated endometriosis regarding constipation, fecal incontinence, and irritable bowel syndrome are suboptimal and do not come close to outcomes in the general female population in the Netherlands. These patients should be screened postoperatively and if necessary, treated for bowel functions.
Highlights
Deep infiltrating endometriosis (DIE) is often associated with functional disorders of muscles and organs located in the pelvic floor [1,2,3]
We found that the prevalence of constipation and fecal incontinence (FI) was not significantly different in patients who had undergone either resection procedure (P = 0.577 and P = 0.492)
We found that the prevalence of FI after sigmoid resection for DIE was significantly higher than in the control group (15.4% versus 5.4%, P = 0.001), Table 1
Summary
Deep infiltrating endometriosis (DIE) is often associated with functional disorders of muscles and organs located in the pelvic floor [1,2,3]. Previous publications already showed that women with DIE report significant postoperative improvement of their bowel functions after surgical removal of the DIE [10, 11] in comparison to preoperative conditions. Such findings could, give patients the vain hope that their health will be restored to the same state as before they fell ill, especially when taking into account that most improvement is based on pain reduction. That patients who underwent surgical treatment for DIE still tend to experience pelvic floor muscle tenderness [12] that can give rise to symptoms other than pain.
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