Quality of life in patients with deep endometriosis and laparoscopic colorectal resection

C.B. Coroleucă, R. Munteanu, A. Ihciman, L. Răpeanu, C.A. Coroleuca, A. Manu, A. Baușic, E. Brătilă, R. Vlădăreanu

Rezumat: Objective. The aim of this paper is to evaluate the effectiveness of laparoscopic colorectal resection in cases of deep endometriosis, as well as the impact on the quality of life, on gynecological and digestive symptoms. Materials and method. Following the preoperative evaluation (MRI, transvaginal ultrasound, endorectal ultrasound, hydrocolon CT), 42 cases with deep endometriosis were included in the studied group. All patients included in the study completed a questionnaire on preoperative endometriosis symptoms and quality of life (SF-36 Questionnaire). The status and quality of life were assessed. Gynecological and digestive symptoms, as well as the rate of perioperative complications were also assessed. Laparoscopic surgeries were performed by the same operating team (E.B., C.C.B., R.M., A.I., L.R.). Results. The average age of the patients was 34 years old. The conversion rate to laparotomy was zero. Following surgery, there was a significant improvement regarding dysmenorrhea, dyspareunia, chronic pelvic pain, defecation pain, and lower abdominal pain. In cases with deep endometriosis and colorectal resection, an improvement in the score for the quality of life, assessed by the SF-36 Questionnaire, was observed. One patient (2.38%) refused the colorectal resection for objective reasons. The rate of perioperative complications was 4.76%, including an inadvertent cystotomy (2.38%) and a reintervention (2.38%) at five days postoperatively – protective ileostomy. The rate of hemoperitoneum, rectovaginal fistula, uroperitoneum and pelvic abscess was zero. Conclusions. Laparoscopic segmental colorectal resection for endometriosis significantly improves the quality of life and the gynecological and digestive symptoms. However, women should be informed about the risk of complications, including rectovaginal fistula. The need to adhere to a guideline on the therapeutic conduct in cases of deep endometriosis and the standardization of treatment allow to obtain satisfactory results in terms of improving the quality of life in patients with colorectal resection. Preoperative investigations allow the planning of surgery and the formation of a multidisciplinary team for the correct management and the complete excision of endometriotic lesions.
Cuvinte cheie: minimally invasive surgery, laparoscopy, deep endometriosis, superficial endometriosis, rectosigmoid resection, mechanical end-to-end anastomosis