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Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series
Horace Roman1, Salwa Moatassim-Drissa2, Noemie Marty2
1Expert Center for Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group EA 4308 Spermatogenesis and Male Gamete Quality, IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France.
Objective:
To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum.
Design:
Retrospective study using data prospectively recorded in the CIRENDO database.
Setting:
University tertiary referral center.
Patient(S):
One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years.
Intervention(S):
Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively.
Main Outcome Measure(S):
Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS).
Result(S):
Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously.
Conclusion(S):
Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes.