Not just the pain stops but also the bowel function improves after DIE surgery

Bowel function improvement after DIE surgery and the long term follow-up results

Key Points

Highlights:

• Complete surgical excision of endometriosis foci on the bowel improves bowel functions and quality of life in women with endometriosis.

Importance:

• This prospective study focuses on the importance of complete surgical excision of all endometriosis lesions from the bowel while taking care of the nerve disturbance of gastrointestinal organs.

What's done here:

• All patients operated on with bowel-involved deep infiltrating endometriosis (DIE) diagnosis in a tertiary center by a single surgeon have been included.
• Patients with preoperative intestinal surgeries were excluded.
• All patients were evaluated with Low Anterior Resection Syndrome (LARS) score instruments from the preoperative 4 weeks to 6 months and 1-year postoperatively.
• The relations between the scores [0-20 (no LARS), 21-29 (minor LARS), and 30-42 (major LARS)] and the age, obesity, parity, prior constipation, medical treatment, type of surgery [intestinal resections (rectosigmoid resection and segmental resection) and nodulectomies (transanal disc excision or shaving)], gynecological symptoms and postoperative complications were compared.

Key Results:

• 37 women who had surgery with the matching inclusion criteria have been analyzed.
• All patients were symptomatic with cyclic /noncyclic pelvic pain, and all had medical treatment preoperatively
• 64.9% of all procedures were nodulectomy.
• Dyschezia was the only predictive symptom associated with positive high LARS scores.
• On the 1st year follow-up, fecal incontinence, clustering of stools, and fecal urgency symptoms have all statistically significantly decreased.
• The comparison of pre and postoperative LARS scores showed statistically significant improvement (p<0.0001).

Limitations:

• The small number of study participants might have affected the statistical results and their impact on expanding the result to the whole population.

Lay Summary

Bowel endometriosis and the techniques to operate it have always been a challenge.

The study conducted by Beraldo et al., from Brazil, highlighted the results of an effective nerve-sparing bowel surgery on endometriosis lesions and its long-term effects on patients. The results were recently published in the journal named "Diseases of the Colon & Rectum".

The authors have included 37 patients who had undergone surgery by the same team and evaluated their preoperative and postoperative long-term results by using Low Anterior Resection Syndrome (LARS) scores. Scores ranging between 0-20 are regarded as “no LARS”, 21-29 as “minor LARS”, and 30-42” as major LARS.

Dyschezia was found to be the only predictive symptom associated with positive high LARS scores.

On the 1st year follow-up, fecal incontinence, clustering of stools, and fecal urgency symptoms have all statistically significantly decreased. The comparison of pre and postoperative LARS scores showed statistically significant improvement, the median LARS score reduced from 20 to 4.

Even given the credit to the effect of low numbers of patients included, the authors thought these positive gain is coming from the effective resection rates and the techniques used in the operations which enables nerve-sparing for the intestinal tract.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34133393/