BOWEL RESECTION FOR INTESTINAL ENDOMETRIOSIS

PURPOSE: The study contained herein was undertaken to evaluate which f actors predict a good outcome following intestinal resection for endom etriosis. METHODS: A retrospective analysis of all patients undergoing bowel resection for severe (American Fertility Society Stage IV) endo metriosis at one institution between the years 1992 and 1996 was condu cted using systematic chart review and follow-up by telephone intervie w. RESULTS: Twenty-nine patients were identified within the study peri od. The most frequent symptoms were pelvic pain, abdominal pain, recta l pain, and dysmenorrhea. Nearly all patients (93 percent) underwent l ow anterior resection of the rectum and distal sigmoid. Other intestin al procedures were appendectomy, terminal ileal resection, cecectomy. and sigmoid resection. Thirty-four percent of patients had simultaneou s total abdominal hysterectomy and bilateral salpingooophorectomy. Com plete follow-up was obtained on 26 patients (90 percent; mean follow-u p 22.6 (range, 8-63) months). All patients (100 percent) reported subj ective improvement. Forty-six percent of patients were ''cured'' accor ding to the prospectively applied definition (resolution of symptoms w ithout need for further medical or surgical therapy). The only variabl e analyzed that was associated with ''cure'' was con comitant total ab dominal hysterectomy and bilateral salpingooophorectomy (odds ratio, 1 2; 95 percent confidence interval, 1.8-81.7). This association remaine d significant after correcting for age and the presence of gastrointes tinal symptoms. CONCLUSION: intestinal resection can be performed safe ly in most women with severe endometriosis and bowel involvement, alth ough many of these patients experience persistent or recurrent symptom s. Total abdominal hysterectomy and bilateral salpingooophorectomy at the time of bowel resection correlates with improved outcome.