PAIN, GASTROINTESTINAL FUNCTION AND FERTILITY OUTCOMES OF MODIFIED NERVE-VESSEL SPARING AND FULL THICKNESS DISCOID RESECTION FOR DEEP COLORECTAL ENDOMETRIOSIS – A PROSPECTIVE COHORT STUDY - COGI 2023 The 31st World Congress on Controversies in Obstetrics, Gynecology & Infertility

Gernot Hudelist ¹ Daria Pashkunova ² Ezgi Darici ³ Anna Rath ² Johanna Mitrowitz ² Bernhard Dauser ⁴ Birgit Senft ⁶ Attila Bokor ⁵

¹Department of Gynecology, Center for Endometriosis, Hospital of St. John of God, Vienna
²Department of Gynecology, Rudolfinerhaus Private Clinic and Campus, Vienna
³Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel
⁴Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna
⁵Department of Obstetrics and Gynecology, Center for Endometriosis, Semmelweis University Budapest, Budapest
⁶Statistix, Statistical Calculations Company, Klagenfurt

Problem statement: There is an ongoing debate on surgical techniques for colorectal deep endometriosis (DE) and their effects on gastrointestinal (GI) function. The aim of this study was to prospectively investigate differences in pre- and postsurgical GI function, health profiles and pain symptoms in women undergoing colorectal surgery for symptomatic DE either with a modified segmental resection technique, so-called nerve-vessel sparing segmental resection (NVSSR) or full thickness discoid resection (FTDR). Besides, complication rates and fertility outcomes were evaluated.

Methods: One hundred and sixty-two consecutive patients were included out of which 125 (77.2%) underwent NVSSR and 37 (22.8%) underwent FTDR. Complication rates, pain symptoms, endometriosis health profile (EHP-30) parameters, lower anterior resection syndrome (LARS) scores and gastrointestinal function related quality of life (GIQLI) were evaluated pre- and postsurgically in a final cohort of 121 patients.

Results: There were no differences between postsurgical prevalence of LARS in both surgery groups (14/98, 14.1% NVSSR; 2/23, 8.6% FTDR) with significantly decreased LARS scores and increased GIQLI values before versus after surgery in both groups (p<0.001). The overall grade III complication rate was 7/162 (4.3%) with no significant differences between NVSSR and FTDR groups. Overall EPH-30 and pain scores significantly decreased after a median follow-up of 41 (±17.6) months (EPH-30 51.1, SD 21.5 vs. 12.7, SD 19.3, p<0.001; dysmenorrhea, dyspareunia, dyschezia all p<0.001 both cohorts, respectively). The overall postsurgical pregnancy and life birth rate in infertile patients undergoing NVSSR and FTDR was 25/43, 58.1%; 5/9, 55.6%; 14/25, 56.0% and 5/5, 100%.

Conclusions: NVSSR and FTDR for symptomatic colorectal DE confer a significant amelioration of GI function reflected by decreased LARS symptoms and increased GIQLI scores with no differences in postsurgical function in between the 2 techniques. Both techniques confer similar complication rates and effects on pain reduction and health profiles.

Conflict of interest: The authors have no conflicts of interest to declare.