General obstetrics and gynecology: gynecology
Long-term follow-up after conservative surgery for rectovaginal endometriosis

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Abstract

Objective

The purpose of this study was to evaluate long-term results in patients who received conservative surgical treatment for rectovaginal endometriosis.

Study design

We analyzed the follow-up data for 83 women who underwent surgery for rectovaginal endometriosis. The inclusion criteria were age 20 to 42 years, moderate-to-severe pain symptoms, conservative treatment with retention of the uterus, and at least 1 ovary; the follow-up period was ≥12 months. Kaplan-Meier analysis and Cox regression were used to calculate recurrence rates.

Results

The cumulative rates of pain recurrence, clinical or sonographic recurrence, and new treatment were 28%, 34%, and 27%, respectively. The younger patients had the higher risk of recurrence. Pregnancy had protective effects against the recurrence of symptoms and a need for a new treatment. Patients who underwent bowel resection had fewer recurrences.

Conclusion

Segmental resection and anastomosis of the bowel, when necessary, improves the outcome without affecting chances of conception. Higher recurrence rates in younger patients seems to justify a more radical treatment in this group of women.

Section snippets

Material and methods

We conducted a descriptive study on the clinical follow up after conservative surgery for rectovaginal endometriosis, for which Institutional Board approval was not requested. We considered a series of 106 patients who underwent surgery by the senior author for rectovaginal endometriosis from November 1995 to November 2001 at the University Hospital of Verona and from December 2001 to June 2002 at University of Milano. To be part of the study population, the following criteria had to be

Results

Of the 106 patients, 10 patients (9.4%) were treated with a not conservative treatment in consideration of their age and no further fertility desire; 13 patients (12.6%) were lost to follow-up; and 83 patients (80.6%) satisfied the inclusion criteria and form the actual study population. The clinical characteristics of these patients are given in Table I. Twenty-one patients were treated with laparoscopy, and 62 patients required a laparotomy approach. Thirty patients, all at stage IV according

Comment

Our results show that symptomatic disease recurrence within 3 years affects only approximately 25.0% of the patients who receive conservative treatment for rectovaginal endometriosis. The risk is higher for younger women and lower if surgical excision has included also a segmental bowel resection and anastomosis. Our study has some intrinsic limitations that are worth mentioning: the study population is rather small and as such does not allow a detailed evaluation of the numerous different

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