Pain, Quality of Life and Complications Following the Radical Resection of Rectovaginal Endometriosis

Objective: To determine the long term response, quality of life and levels of pain following the radical excision of rectovaginal endometriosis.

Design: A cohort study.

Setting: A tertiary referral centre for the management of advanced endometriosis.

Sample: All patients who had undergone radical resection.

Methods: Case note review and patient questionnaire.

Main Outcome Measures: Surgical complications. Overall improvement. Dysmenorrhoea, dyspareunia, dyschezia and chronic pain were measured using a visual analogue scale. Quality of life was measured using the EQ-5D questionnaire.

Results: Twelve radical resections were performed by laparotomy, 48 by laparoscopy. Ten patients had a hysterectomy. Forty-eight patients underwent shaving of the pre-rectal fascia, two had a disc resection of the rectum, 10 had an anterior rectal resection. Two patients required a colostomy and two needed subsequent dilation of a stenosed anastomosis. Forty-four of the first 46 patients replied. The median follow up period was 12 months (range 2 to 22 months) and 86% (38/44) reported an improvement or whom 27 (61%) had a good response (pain completely gone or greatly improved). Patients having a hysterectomy or a disc or segmental resection of the rectum reported a good response and had a normal quality of life. Quality of life scores in the study group overall were lower than the background population.

Conclusions: Radical resection is an effective treatment for rectovaginal endometriosis. Hysterectomy and rectal resection were associated with a better response and quality of life.