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- Title
Treatment of rectosigmoid endometriosis by laparoscopic reverse submucosal dissection (LRSD): The Sydney partial thickness discoid excision technique.
- Authors
Robertson, Jessica; Abbott, Jason; Corbett‐Burns, Sophie; Bukhari, Mujahid; Perera, Shevy; Kalantan, Assem; Sarofim, Mikhail; Chou, Rebecca; Cario, Greg; Rosen, David; Choi, Sarah; Wynn‐Williams, Michael; Condous, George; Chou, Danny
- Abstract
Background: Laparoscopic reverse submucosal dissection (LRSD) is a standardised surgical technique for removal of rectosigmoid endometriosis which optimises the anatomical dissection plane for excision of endometriotic nodules. Aim: This cohort study assesses the outcomes of the first cohort of women treated by LRSD, for deeply infiltrating rectosigmoid endometriosis. Materials and Methods: Primary outcomes assessed were complication rate as defined by the Clavien–Dindo system, and completion of the planned LRSD. Secondary outcomes include mucosal breach, specimen margin involvement, length of hospital admission, and a comparison of pre‐operative and post‐operative pain, bowel function and quality of life surveys. These included the Endometriosis Health Profile Questionnaire (EHP‐30), the Knowles‐Eccersley‐Scott Symptom Questionnaire (KESS) and the Wexner scale. Results: Of 19 patients treated, one required a segmental resection. The median length of hospital admission was two days (range 1–5) and no post‐operative complications occurred. Median pain visual analogue scales (scale 0–10) were higher prior to surgery (dysmenorrhoea 9.0, dyspareunia 7.5, dyschezia 9.0, pelvic pain 6.0) compared to post‐surgical median scores (dysmenorrhoea 5.0, dyspareunia 4.0, dyschezia 2.0, pelvic pain 4.0) at a median of six months (range 4–32). Quality of life studies suggested improvement following surgery with pre‐operative median EHP‐30 and KESS scores (EHP‐30: 85 (5–106), KESS score 9 (0–20)) higher than post‐operative scores (EHP‐30: 48.5 (0–80), KESS score: 3 (0–19)). Conclusion: This series highlights the feasibility of LRSD with low associated morbidity as a progression of partial thickness discoid excision (rectal shaving) for the treatment of rectosigmoid deep infiltrating endometriosis.
- Subjects
PELVIC physiology; OVARIAN physiology; TREATMENT of endometriosis; RECTUM physiology; RECTAL diseases; RISK assessment; LAPAROSCOPY; QUALITATIVE research; QUESTIONNAIRES; POSTOPERATIVE pain; SAMPLE size (Statistics); TREATMENT effectiveness; RETROSPECTIVE studies; HOSPITALS; DESCRIPTIVE statistics; ENDOMETRIOSIS; LONGITUDINAL method; SURGICAL complications; DISEASES; DYSPAREUNIA; QUALITY of life; DYSMENORRHEA; PELVIC pain; COMPARATIVE studies; CONSTIPATION; NONPARAMETRIC statistics; DISEASE complications
- Publication
Australian & New Zealand Journal of Obstetrics & Gynaecology, 2024, Vol 64, Issue 2, p147
- ISSN
0004-8666
- Publication type
Article
- DOI
10.1111/ajo.13762