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Pelvic Pain and Quality of Life Before and After Laparoscopic Bowel Resection for Rectosigmoid Endometriosis: A Prospective, Observational Study

Riiskjær, Mads, M.D.1; Forman, Axel, M.D., D.M.Sc.1; Kesmodel, Ulrik, S., M.D., Ph.D.2; Andersen, Lars, M., M.D., M.P.G.3; Ljungmann, Ken, M.D., Ph.D.4; Seyer-Hansen, Mikkel, M.D., Ph.D.1

doi: 10.1097/DCR.0000000000000970
Original Contributions: Benign
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BACKGROUND: Surgery for rectosigmoid endometriosis carries a substantial risk of short- and long-term complications, which has to be counterbalanced against the potential effect of the procedure. Prospective data are scarce in the field of deep infiltrating endometriosis surgery.

OBJECTIVE: The study aimed to assess pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis.

DESIGN: The study involved prospectively collected data regarding pelvic pain and quality of life before and after surgery.

SETTINGS: It was conducted at a tertiary endometriosis referral unit at Aarhus University Hospital.

PATIENTS: A total of 175 women were included.

INTERVENTION: Patients underwent laparoscopic bowel resection for endometriosis.

MAIN OUTCOME MEASURES: Questionnaires for pain (Numerical Rating Scale) and quality of life (RAND Short Form-36) were answered before and 1 year after surgery. Data on analgesic and hormone treatment were collected. Preoperative and postoperative pelvic pain and quality-of-life scores were compared, and risk factors for improvement/worsening were identified.

RESULTS: A total of 97.1% of the women completed the 1-year follow up. A significant decrease (p = 0.0001) was observed on all pelvic pain parameters. Most profound was the decrease in dyschezia. A significant improvement on all quality-of-life scores was observed (p = 0.0001). A surgical complication did not have a negative impact on outcome 1 year after surgery. The postoperative outcome was not related to the type of surgery.

LIMITATIONS: This is an observational study without a control group. Risk factor data should be interpreted with caution, because the study was relatively underpowered for some of the rare outcomes.

CONCLUSIONS: A significant and clinically relevant improvement in pelvic pain and quality of life 1 year after laparoscopic bowel resection for endometriosis was found. We strongly recommend surgery for rectosigmoid endometriosis that is unresponsive to conservative treatment. See Video Abstract at

1 Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark

2 Department of Obstetrics and Gynecology, Herlev University Hospital, Copenhagen, Denmark

3 Department of Surgery, Randers Regional Hospital, Randers, Denmark

4 Department of Surgery, Aarhus University Hospital, Aarhus, Denmark

Funding/Support: The study was funded by a grant from the Graduate School of Health, Aarhus University.

Financial Disclosure: None reported.

Correspondence: Mads Riiskjær, M.D., Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons