Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study

Objective: To evaluate the efficacy of discoid resection for the treatment of deep infiltrating endometriosis and whether it could be considered to be a valid alternative to the rectosigmoid segmental resection. Design: Case-control study. Setting: Departments of Obstetrics and Gynecology, Ospedale Sacro Cuore of Negrar, Verona, and Catholic University of the Sacred Heart, Rome, Italy. Patient(s): Women with deep infiltrating and intestinal endometriosis divided into study group (48 patients) and control group (88 patients). Intervention(s): All patients underwent laparoscopic endometriosis excision plus discoid rectosigmoid resection (study group) or segmental resection (control group). Main Outcome Measure(s): Short-and long-term outcomes. Result(s): In the study group, median operating time was 200 minutes, with a median estimated blood loss of 203 mL. Median ileus was 3 days with a median postoperative hospitalization of 7 days. Early complications were observed in six patients (12.5%), and in two of them (4.16%) a surgical management was necessary. Median follow-up period was 33 months, and five recurrences (10.4%) were registered. In the control group, no significant differences were noticed except for longer operative time, more temporary ileostomy, postoperative fever, and long-term bladder dysfunctions. Conclusion(s): Laparoscopic mechanical discoid resection is feasible, markedly improved endometriosis related symptoms, and could be considered as a worthy alternative to classic segmental resection in selected patients. (Fertil Steril(R) 2010;94:444-9. (C) 2010 by American Society for Reproductive Medicine.)