Long term surgical outcomes after segmental colorectal resection in women with severe endometriosis

Purpose: The aim of this study is to assess post-operative complications, symptoms, patient satisfaction, and fertility outcome after a long-term follow-up period in patients with severe intestinal endometriosis. Methods: In this retrospective study (January 1998 - December 2008) patients scheduled for a segmental colorectal resection by laparotomy were identified. Surgery was performed by a multidisciplinary team. Data were obtained from medical records and supplemented by a questionnaire. Results: A total of 41 patients (median age 30 years [24-45]) were included with a mean follow-up of 50 months. Three patients were lost to follow-up. Chronic pelvic pain, dysmenorrhea, dyschezia, hematochezia, constipation, pencil like stool, diarrhea, and tenesmus decreased, respectively, in 24, 16, 31, 25, 26, 12, 11, and 21 patients. Post-operatively, one patient conceived naturally and eleven out of fifteen patients conceived after in vitro fertilization. The post-operative patient satisfaction rate (mean 7.4) was significantly higher compared to prior to surgery (mean 4.6). Four major complications were reported in the first year after surgery. The cumulative complication rate was 12%. Conclusions: Segmental colorectal resection by laparotomy in patients with severe intestinal endometriosis effectively reduces symptoms and increases patient satisfaction with an acceptable risk on treatable complications.