Evolution of symptoms and quality of life of patients after surgery of digestive endometriosis

Objectives. - Prospective evaluation of symptoms and quality of life before and after surgical treatment of endometriosis with bowel involvement. Patients and methods. - Changes in symptoms, sexuality and quality of life before and after surgery of 41 patients operated for bowel endometriosis at the centre hospitalier de Versailles (CHV) were assessed with a self-assessment questionnaire. Pains were assessed using five visual analog scales, symptoms using 26 questions with a four-level Likert item, sexuality using the SEXACQ and quality of life using the EHP-5 and the EQ-5D VAS. Results. - Surgical treatment improves pain: VAS scores for main pain (P < 0.0001), dysmenorrhea (P = 0.0039), defecation pain (P = 0.0312), non-cyclic pelvic pain (P = 0.0002), and dyspareunia (P = 0.0084). Twelve intestinal symptoms are improved, including three significantly. It also improves SEXACQ score (P = 0.0068) and quality of life scores EHP-5 and EQ-5D VAS (P = 0.0001 and P = 0.0003 respectively). No difference was found between disk resection and segmental resection in terms of symptoms, sexuality and quality of life. Histological analysis suggests that when a segmental resection is done, the stage of the endometriosis bowel involvement is more advanced. Discussion and conclusion. - Surgery of bowel endometriosis improves symptoms and quality of life. When the stage of the bowel endometriosis is advanced, a segmental resection should be done. Moreover, self-assessment questionnaire used at the CHV seems an appropriate tool to evaluate functional outcome. (C) 2013 Elsevier Masson SAS. All rights reserved.