Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series

Rectal shaving, a valuable treatment for deep rectal endometriosis, allows a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.

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Volume 106, Issue 6, Pages 1438-1445

Authors:

Horace Roman, M.D., Ph.D., Salwa Moatassim-Drissa, M.D., Noemie Marty, M.D., Mathilde Milles, M.D., Aurélie Vallée, M.D., Eulalie Desnyder, M.D., Emanuela Stochino Loi, M.D., Carole Abo, M.D.

Abstract:

Objective

To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum.

Design

Retrospective study using data prospectively recorded in the CIRENDO database.

Setting

University tertiary referral center.

Patient(s)

One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years.

Intervention(s)

Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively.

Main Outcome Measure(s)

Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS).

Result(s)

Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (9.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously.

Conclusion(s)

Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.


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Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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