Comparative pregnancy rate after colorectal resection versus other surgical procedures for deep infiltrating rectal endometriosis: a systematic review and meta-analysis

Abstract

The debate around colorectal surgery for endometriosis has been ongoing, but to date no meta-analysis has investigated the impact of the different surgical approaches on the pregnancy rate. The aim of this meta-analysis study was to determine in women with deep infiltrating rectal endometriosis, how does colorectal resection surgery compare to other surgical techniques (e.g., rectal shaving, disc excision) in terms of pregnancy rates. We searched PubMed, Web of Science, Cochrane library and Clinical Trials for relevant studies published from inception to December 2024. We performed a systematic review and meta-analysis of all English language full-text articles addressing colorectal resection compared with other management of deep infiltrating rectal endometriosis and presenting pregnancy outcomes. We included a study when it (i) provided data on surgical management (shaving, disc excision, and/or colorectal resection) and (ii) detailed the pregnancy outcomes in each subgroup. Four authors independently performed the initial search to evaluate the eligibility criteria. Four authors extracted the data and a fifth author checked this extraction. Of the 113 full-text articles assessed for eligibility, we included 13 in the meta-analysis. These studies represented a total of 3,248 patients. Pregnancy information was available for 2,131 patients: 1073 colorectal resection, 502 shaving, 172 disc excisions, and 384 other practices (expectant management). Colorectal resection was associated with a lower pregnancy rate compared with the other techniques (N = 2,131, odds ratio [OR] = 0.64 [95% confidence interval 0.52-0.79], p < 0.001, I2 = 35%). There were similar results when comparing colorectal resection with rectal shaving (N = 952, OR = 0.51 [95% confidence interval 0.36-0.73], p < 0.001, I2 = 0%), but not when comparing colorectal resection with disc excision (N = 432, OR = 0.65 [95% confidence interval 0.37-1.13], p = 0.13). Conclusions Rectal resection for endometriosis is associated with a lower pregnancy rate compared with other type of surgery, such as shaving. Trial registration: PROSPERO registration number CRD42024512328.

Keywords: Colorectal resection; Disc excision; Endometriosis; Pregnancy; Shaving.

Fig. 1

Flowchart.

Fig. 2

Forest plot of the pregnancy rate comparing colorectal resection with other techniques.

Fig. 3

Forest plot of the pregnancy rate comparing colorectal resection with shaving.

Fig. 4

Forest plot of the pregnancy rate comparing colorectal resection with disc excision.

Fig. 5

Funnel plots for (A) colorectal resection compared with all options, (B) colorectal resection compared with shaving, and (C) colorectal resection compared with disc excision.

Fig. 6

Forest plot of the occurrence of spontaneous pregnancy rate comparing colorectal resection to other techniques.