Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study.
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STUDY OBJECTIVE: To assess long-term bowel symptoms in women who underwent segmental bowel resection for deep-infiltrating endometriosis (DIE) compared with women who underwent resection of severe endometriosis without bowel resection. DESIGN: Cohort study with matched controls (Canadian Task Force classification II-2). SETTING: Cleveland Clinic. PATIENTS: 71 patients (36 cases and 35 controls). INTERVENTIONS: Patients who were at least 4 years out from undergoing segmental bowel resection due to DIE were matched with patients who had undergone resection of stage III/IV endometriosis without bowel resection. The patients completed validated questionnaires, and data were analyzed using the Wilcoxon rank-sum, χ(2), and Fisher exact tests. MEASUREMENTS AND MAIN RESULTS: The Bristol Stool Form Scale, Patient Assessment of Constipation Symptoms Questionnaire (PAC-SYM), and St Mark's Vaizey Fecal Incontinence Grading System were used to elicit information. The median duration of follow-up was 10.1 years (range, 4-18 years). The mean patient age and body mass index were comparable in the cases and the controls. A larger proportion of cases than controls reported new bowel symptoms (58% [21 of 36] vs 14% [5 of 35]; p = .001), as well as abdominal pain, incomplete bowel movements, and false alarms on the PAC-SYM questionnaire; however, total PAC-SYM and Vaizey Fecal Incontinence Grading System scores were similar in the 2 groups (median, 8 [interquartile range, 8-10] vs 8 [8-10]; p = .86). Similarly, the proportion of patients with normal stool consistency (Bristol Stool Form Scale score 2-6) was similar in the 2 groups (80.6% [29 of 36] vs 94.3% [33 of 35]; p = .59). CONCLUSION: Segmental bowel resection for DIE may be associated with a higher incidence of new bowel symptoms (possibly due to abdominal pain, incomplete bowel movements, and/or false alarms), but not with worse constipation or fecal incontinence, compared with surgery without bowel resection.
Deep infiltrating endometriosis
Segmental bowel resection
Digestive System Surgical Procedures
Surveys and Questionnaires
Published Version (Please cite this version)10.1016/j.jmig.2016.03.004
Publication InfoSoto, E; Catenacci, M; Bedient, C; Jelovsek, John E; & Falcone, T (2016). Assessment of Long-Term Bowel Symptoms After Segmental Resection of Deeply Infiltrating Endometriosis: A Matched Cohort Study. J Minim Invasive Gynecol, 23(5). pp. 753-759. 10.1016/j.jmig.2016.03.004. Retrieved from https://hdl.handle.net/10161/15124.
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Associate Professor of Obstetrics and Gynecology
Dr. Jelovsek is the Vice Chair of Education and the Director of Data Science for Women’s Health in Department of Obstetrics & Gynecology (OBGYN) at Duke University. He is Board Certified in OBGYN by the American Board of OBGYN and Board Certified in Female Pelvic Medicine & Reconstructive Surgery by the American Board of OBGYN and American Board of Urology. He currently practices Female Pelvic Medicine and Reconstructive Surgery (FPMRS). He has expertise in the development and v
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