Quality of life following radical excision of rectovaginal endometriosis associated with complete obliteration of the posterior cul de sac

Objectives To review the available literature and studies, both published and unpublished on the effect of radical surgery for obliterative endometriotic cul de sac disease on the quality of life. Design Review of literature and audit studies of rectovaginal disease. Setting Two specialist endometriosis practices, one in the United States and the other in a UK district general hospital. Subjects Patients presenting with rectovaginal endometriosis. Interventions Radical laparoscopic excision. Main outcome measures Reduction of pain as measured on ranked ordinal, scales and quality of life measures. Results Radical laparoscopic surgery for the excision of rectovaginal endometriosis is associated with a significant diminution in symptoms and an improvement in quality of life. This is particularly so for patients who rated their symptoms as severe prior to surgery. Conclusion Initial studies show promising results for radical surgery. There is however, a need for randomized controlled trials and proper audit to assess the efficacy and morbidity of this surgery.