Radical excision of rectovaginal endometriosis results in high rate of pain relief - results of a long-term follow-up study

Abstract

Objective: To evaluate the long-term results of radical excision for rectovaginal endometriosis (RVE) with special emphasis on current symptoms and risk factors as regards recurrence.

Methods: A total of 116 patients operated upon because of RVE were offered a clinical follow-up evaluation visit; 60 (52%) consented. The time (mean +/- SD) from the index surgery to the follow-up visit was 4.0 +/- 0.5 years.

Main outcome measures: Daily symptoms using a visual analogue scale for 30 consecutive days prior to clinical assessment; the amount of uterine bleeding was also assessed. Endometriosis recurrence was evaluated via clinical and ultrasonographic examination.

Results: The symptom sum scores (maximum 300) were low with median scores (range) of 3 (0-32) for dysmenorrhea and 9 (0-72) for pelvic pain. Evidence of RVE recurrence was found or suspected in 29 (48%) of the 60 women assessed. Clinical recurrence was not associated with pain symptoms. In univariable analysis, amenorrhea at the time of clinical assessment was associated with a lower risk of recurrence (odds ratio; OR 0.13; 95% CI (confidence interval) 0.02-0.65, p = 0.01); the effect of bowel resection was not significant (OR 0.37: 95% CI 0.13-1.07, p = 0.07). In multivariable analysis, the protective effect of bowel resection on recurrence was significant (OR 0.23; 95% CI 0.06-0.89, p = 0.03).

Conclusions: Radical surgery may result in long-term pain relief in cases of RVE. Bowel resection is associated with a lower risk of RVE recurrence. Therapy that induces amenorrhea may be effective in preventing recurrence following surgical treatment of RVE.