Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis

Abstract

Objective: To compare laparoscopic anterior discoid resection (ADR) with low anterior resection (LAR).

Methods: This is a retrospective review of a cohort (Canadian Task Force classification II-2) of patients undergoing laparoscopic ADR or LAR at a university hospital. Chart review and telephone questionnaires were conducted to examine long-term outcomes. Preoperative and operative findings, short- and long-term outcomes were compared. SF-12 quality of life scores, need for further interventions, and overall satisfaction were also compared.

Results: Twenty-two patients underwent laparoscopic ADR (n 8) or LAR (n 14) for rectosigmoid endometriosis between January 2001 and December 2009. Mean follow-up time was 41.26 months (range, 14 to 70). Patients undergoing laparoscopic ADR had significantly less blood loss and shorter operative time and hospital stay. Patients who required LAR had a significantly higher rate of mucosal involvement (61.5% v. 0%). No statistically significant difference was found in the size, depth of invasion, location of lesions, or operative complications. Fifty percent of the LAR group had several lesions as opposed to 12.5% of the ADR group. Median age was significantly higher in patients who required LAR (39) than in patients who required ADR (32). Three patients in the LAR group (21.4%) had anastomotic strictures; 2 required dilation. The ADR group had consistently higher increments of improvement in bowel symptoms and dyspareunia. Overall satisfaction rate with the procedures was 93.3%. SF-12 scores were comparable between the 2 groups.

Conclusion: ADR compared with LAR is associated with decreased operative time, blood loss, and hospital stay and a lower rate of anastomotic strictures. Other outcomes and satisfaction rates are comparable between the 2 procedures.

Figure 1.

A. Q1–Q5 Memorial Sloan-Kettering Cancer Center Bowel Function Instrument.* Indicates a statistically significant difference. 1. Have you had diarrhea (no form, watery stool)? 2. Have you had loose stool? 3. Have you been able to control the passage of gas? 4. Have you had soilage (leakage of stool) of your garments during the day? 5. Have you had to alter your activities because of your bowel function? B. Q6–Q8 Constipation Severity Instrument. 6. How often do you experience straining or difficulty in having a bowel movement? 7. How severe is this for you? 8. How much does this bother you?. C. Q9. Constipation Severity Instrument. 9. Do you experience any rectal or anal pain while having bowel movements? D. Q10–Q12 Constipation Severity Instrument. 10. During the last month, on average, how severe was the pain in your rectum/anus while having a bowel movement? 11. How much suffering do you experience because of rectal/anal pain? 12. During the past month, due to your bowel habits, how often have you had rectal bleeding during/after a bowel movement? E. Q13–Q15 Female Sexual Function Index (FSI) 13. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal intercourse? 14. Over the past 4 weeks, how often did you experience discomfort or pain following vaginal intercourse? 15. Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal intercourse?.

Figure 1.

A. Q1–Q5 Memorial Sloan-Kettering Cancer Center Bowel Function Instrument.* Indicates a statistically significant difference. 1. Have you had diarrhea (no form, watery stool)? 2. Have you had loose stool? 3. Have you been able to control the passage of gas? 4. Have you had soilage (leakage of stool) of your garments during the day? 5. Have you had to alter your activities because of your bowel function? B. Q6–Q8 Constipation Severity Instrument. 6. How often do you experience straining or difficulty in having a bowel movement? 7. How severe is this for you? 8. How much does this bother you?. C. Q9. Constipation Severity Instrument. 9. Do you experience any rectal or anal pain while having bowel movements? D. Q10–Q12 Constipation Severity Instrument. 10. During the last month, on average, how severe was the pain in your rectum/anus while having a bowel movement? 11. How much suffering do you experience because of rectal/anal pain? 12. During the past month, due to your bowel habits, how often have you had rectal bleeding during/after a bowel movement? E. Q13–Q15 Female Sexual Function Index (FSI) 13. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal intercourse? 14. Over the past 4 weeks, how often did you experience discomfort or pain following vaginal intercourse? 15. Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal intercourse?.