Surgical Removal of Bowel Tissue Affected by Endometriosis Is Beneficial for Patients, Study Shows

Surgical Removal of Bowel Tissue Affected by Endometriosis Is Beneficial for Patients, Study Shows

Danish researchers report that surgery can significantly reduce pain and improve the quality of life of patients with endometriosis affecting the bowels.

This finding was reported in the study, “Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis: A Prospective, Observational Study,” published in the journal Diseases of the Colon & Rectum.

The deep, infiltrating lesions characteristic of endometriosis can occasionally occur in the bowels and bladder, causing painful urination, irregular bleeding, menstrual cramps, constipation, or diarrhea. With no cure available, pain medications and hormonal therapies are common treatment options used to manage the disease symptoms.

Surgical removal of the lesions is also a treatment strategy used to prevent disease progression in patients that present severe pelvic pain and compromised quality of life, who are resistant to conventional treatments. But the procedure can cause long-term adverse side effects, including chronic dysfunction of the pelvic organs.

To date, doctors have preferred a conservative surgical approach in which only the lesion is removed. However, a more aggressive method that requires opening the bowel and removing both the lesion and the adjacent rectal wall has also been proposed.

“The aims of this study were to prospectively assess the clinical effects of bowel resection for rectosigmoid [bowel] endometriosis on quality of life and pelvic pain, and to examine the association of these parameters with patient- and treatment-related factors,” the researchers stated.

The study included 175 women who underwent laparoscopic bowel resection for rectosigmoid endometriosis at Aarhus University Hospital in Denmark between February 2011 and November 2015. An analysis of the tissue collected confirmed the diagnosis of bowel endometriosis in all participants.

The team evaluated pain symptoms and quality of life of all women before and one year after the surgery by self-reported questionnaire data.

The patients reported a significant improvement in all pelvic pain parameters, which included intermenstrual and menstrual pain, and constipation reflexive pain.

In addition, significant improvements in quality of life were also reported in all assessed domains. The majority of the patients (81%) reported to be “much better” and “somewhat better” than before the surgery when questioned about general health status.

This positive outcome was followed by a significant decrease in the use of hormonal and pain therapies. Before the surgery, only 18.5% of patients said they did not use hormonal therapies, and 6.3% said they didn’t use analgesic pain drugs. These numbers increased to 43.7% and 38.3%, respectively, one year after the surgery.

Occurrence of surgical complications or the type of surgical approach used were not found to change the outcome of the patients.

“Our study indicates that laparoscopic bowel resection has a profound clinically relevant and statistically significant positive effect on pain and quality of life in these patients,” the researchers said.

“We strongly recommend surgery for rectosigmoid endometriosis that is unresponsive to conservative treatment,” they added.