Surgical treatment for deep infiltrating endometriosis: Long-term results

Objective. To evaluate the clinical symptoms of deep infiltrating endometriosis and its surgical treatment in women with this condition. Subjects and methods. Fifty-two patients with deep infiltrating endometriosis were followed up in 2010 to 2013 and allocated into groups according to their age: 1) 4 (4.7%) women of early reproductive age; 2) 33 (63.5%) women of middle reproductive age; 3) 11 (21.15%) women of late reproductive age; 4) 4 (7.7%) women aged 46 years or older. All the patients underwent clinical, laboratory, and instrumental examination involving ultrasonography, magnetic resonance imaging, colonoscopy with biopsy, as well as surgical treatment. The diagnosis was verified by histological examination. After testing for the normality of data distribution, Spearman’s rank correlation coefficient was calculated to determine a relationship (correlation) between the variables. The data were statistically processed using the freely distributed software product WINPEPI version 9.7 (Abramson J.H. WINPEPI (PEPI-for-Windows): computer programs for epidemiologists. Epidemiologic Perspectives & Innovations 2004, 1: 6), Statsoft Statistica 8.0.725, IBM SPSS Statistics 19.0 for Windows. Results. The volume of surgical treatment depended on the site and depth of injury. The investigators excised and coagulated endometriotic foci, resected the vaginal wall and ovaries, and carried out segmental bowel resection. After performing surgical treatment, pain syndrome and dyspareunia were absent in 14 (27%) and 8 (15.4%) patients and remained only in 8 (15.4%) and 2 (3.8%) patients, respectively. Reproductive function was recovered in 14 (27%) patients; 12 (23%) women reported to have persistent infertility. Twenty (38.5%) patients pointed to the recovery of their menstrual cycle; menstrual dysfunction persisted in 10 (19%). After surgical treatment, all the patients who had previously complained of dyschezia, cyclic intestinal bleeding, diarrhea, and abdominal distension pointed out that these symptoms were absent. Complaints of blood and mucus in the stool were retained in 1 (1.9%) woman. Those of hematuria and dysuria were absent after treatment for urinary tract endometriosis. Pregnancy occurred in 21 women; delivery took place in 12 women. The correlation analysis revealed a weak positive correlation (p = 0.35822) between the older age of patients and the volume of surgical intervention (sigmoid colon resection). Conclusion. Our findings have indicated that single treatment with its maximum volume improves the results of surgery.

colorectal endometriosis, rectovaginal septum and vaginal endometriosis, urinary tract endometriosis, deep infiltrating endometriosis, cyclic rectal bleeding, colonoscopy, ultrasound study, magnetic resonance imaging