Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study
Objective To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.Design A multicentre, prospective cohort study.Setting 51 hospitals accredited as specialist endometriosis centres.Participants 5162 women of reproductive age with rectovaginal endometr...
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BMJ Publishing Group
2018-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/8/4/e018924.full |
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| author | Paul Smith Lucky Saraswat Sanjay Vyas Thomas Ind Ertan Saridogan Elizabeth Ball Edward Morris James Clark Tony Chalhoub David Rowlands Moiad Alazzam Dominic Byrne Tamara Curnow Alfred Cutner T Justin Clark Iris Menninger Yousri Afifi Kevin Phillips Saikat Banerjee Robert Richardson Jeremy Hawe Barry Whitlow Emmanuel Ofuasia Ashwini Trehan Tyrone Carpenter Christian Becker Stuart Jack Kumar Kunde Chris Barnick Alan Farthing Graham Phillips John Bidmead Mohamed Abdel-aty George Botros Marlin Mubarak Christian Kremer Stanley Okolo Edmond Edi-osagi Kamel Shehata-iskander Gaity Ahmad Jonathan Frappell Brice Rodriguez Yemi Coker Gourab Misra Adam Moors Chris Guyer Caroline Overton Suku George Oliver Chappatte Richard Penketh Funlayo Odejinmi Keith Louden Jon Hughes |
| author_facet | Paul Smith Lucky Saraswat Sanjay Vyas Thomas Ind Ertan Saridogan Elizabeth Ball Edward Morris James Clark Tony Chalhoub David Rowlands Moiad Alazzam Dominic Byrne Tamara Curnow Alfred Cutner T Justin Clark Iris Menninger Yousri Afifi Kevin Phillips Saikat Banerjee Robert Richardson Jeremy Hawe Barry Whitlow Emmanuel Ofuasia Ashwini Trehan Tyrone Carpenter Christian Becker Stuart Jack Kumar Kunde Chris Barnick Alan Farthing Graham Phillips John Bidmead Mohamed Abdel-aty George Botros Marlin Mubarak Christian Kremer Stanley Okolo Edmond Edi-osagi Kamel Shehata-iskander Gaity Ahmad Jonathan Frappell Brice Rodriguez Yemi Coker Gourab Misra Adam Moors Chris Guyer Caroline Overton Suku George Oliver Chappatte Richard Penketh Funlayo Odejinmi Keith Louden Jon Hughes |
| collection | DOAJ |
| description | Objective To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.Design A multicentre, prospective cohort study.Setting 51 hospitals accredited as specialist endometriosis centres.Participants 5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.Interventions Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.Main outcome measures Standardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded.Results At 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures.Conclusion Laparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres. |
| format | Article |
| id | doaj-art-df80618e5440472b9cea7c6f8f946111 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2018-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-df80618e5440472b9cea7c6f8f9461112025-02-09T09:15:08ZengBMJ Publishing GroupBMJ Open2044-60552018-04-018410.1136/bmjopen-2017-018924Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study Paul Smith0Lucky SaraswatSanjay Vyas1Thomas Ind2Ertan Saridogan3Elizabeth Ball4Edward Morris5James Clark6Tony ChalhoubDavid Rowlands7Moiad Alazzam8Dominic Byrne9Tamara Curnow10Alfred Cutner11T Justin Clark12Iris MenningerYousri AfifiKevin PhillipsSaikat BanerjeeRobert RichardsonJeremy HaweBarry WhitlowEmmanuel OfuasiaAshwini TrehanTyrone CarpenterChristian BeckerStuart JackKumar KundeChris BarnickAlan FarthingGraham PhillipsJohn BidmeadMohamed Abdel-atyGeorge BotrosMarlin MubarakChristian KremerStanley Okolo13Edmond Edi-osagiKamel Shehata-iskanderGaity AhmadJonathan FrappellBrice RodriguezYemi CokerGourab MisraAdam MoorsChris GuyerCaroline OvertonSuku GeorgeOliver ChappatteRichard PenkethFunlayo Odejinmi14Keith LoudenJon Hughes1Infinitopes Ltd, Oxford, UKconsultant gynaecologistDepartment of Gynaecological Oncology, Royal Marsden Hospital, London, UKprofessor1 Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK1 Royal College of Obstetricians and Gynaecologists, London, UKMelanoma and Renal Unit, Royal Marsden NHS Foundation Trust, London, UK15 Department of Gastroenterology, Queen Elizabeth II Hospital, Hertfordshire, UKDepartment of Gynaecological Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK1 Royal Cornwall Hospitals Trust, Truro, UK2 Bodriggy Health Centre, Hayle, UK4 University College London Hospitals, London, UKAcademic Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UKGeneral Directorate, West African Health Organisation, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso4Whipps Cross University Hospital, Barts Health NHS Trust, London, UKObjective To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.Design A multicentre, prospective cohort study.Setting 51 hospitals accredited as specialist endometriosis centres.Participants 5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.Interventions Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space.Main outcome measures Standardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded.Results At 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2 years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6 months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2 years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6 months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder injury or leak) in 49 (1.0%) procedures.Conclusion Laparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.https://bmjopen.bmj.com/content/8/4/e018924.full |
| spellingShingle | Paul Smith Lucky Saraswat Sanjay Vyas Thomas Ind Ertan Saridogan Elizabeth Ball Edward Morris James Clark Tony Chalhoub David Rowlands Moiad Alazzam Dominic Byrne Tamara Curnow Alfred Cutner T Justin Clark Iris Menninger Yousri Afifi Kevin Phillips Saikat Banerjee Robert Richardson Jeremy Hawe Barry Whitlow Emmanuel Ofuasia Ashwini Trehan Tyrone Carpenter Christian Becker Stuart Jack Kumar Kunde Chris Barnick Alan Farthing Graham Phillips John Bidmead Mohamed Abdel-aty George Botros Marlin Mubarak Christian Kremer Stanley Okolo Edmond Edi-osagi Kamel Shehata-iskander Gaity Ahmad Jonathan Frappell Brice Rodriguez Yemi Coker Gourab Misra Adam Moors Chris Guyer Caroline Overton Suku George Oliver Chappatte Richard Penketh Funlayo Odejinmi Keith Louden Jon Hughes Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study BMJ Open |
| title | Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study |
| title_full | Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study |
| title_fullStr | Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study |
| title_full_unstemmed | Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study |
| title_short | Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study |
| title_sort | laparoscopic excision of deep rectovaginal endometriosis in bsge endometriosis centres a multicentre prospective cohort study |
| url | https://bmjopen.bmj.com/content/8/4/e018924.full |
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