Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series

Objective: To report postoperative outcomes after rectal shaving for deep endometriosis infiltrating the rectum. Design: Retrospective study using data prospectively recorded in the CIRENDO database. Setting: University tertiary referral center. Patient(s): One hundred and twenty-two consecutive patients whose follow-up observation ranged from 1 to 6 years. Intervention(s): Rectal shaving performed using ultrasound scalpel or scissors and plasma energy in 68 and 54 women, respectively. Main Outcome Measure(s): Postoperative digestive function assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index (GIQLI) and the Knowles-Eccersley-Scott-Symptom Questionnaire (KESS). Result(s): Nodules were between 1 and 3 cm, <1 cm, and >3 cm in diameter, in 73.7%, 11.5%, and 14.8% of cases, respectively. They were located on the middle (49.2%) and upper rectum (50.8%). Clavien-Dindo 3a, 3b, 4a, and 4b complications occurred in 0.8%, 5.7%, 1.6%, and 0.8% of cases, respectively. Excepting two rectal fistulas (1.6%), the majority of complications were not related to rectal shaving itself. Gastrointestinal scores revealed statistically significant improvement in digestive function and pelvic pain at 1 and 3 years after rectal shaving, but not constipation. Rectal recurrences occurred in 4% of patients, 2.4% of whom had segmental resection, 0.8% shaving, and 0.8% disc excision. Three years postoperatively, the pregnancy rate was 65.4% among patients with pregnancy intention, 59% of whom conceived spontaneously. Conclusion(s): Our data suggest that rectal shaving is a valuable treatment for deep endometriosis infiltrating the rectum, providing a low rate of postoperative complications, good improvement in digestive function, and satisfactory fertility outcomes. (C) 2016 by American Society for Reproductive Medicine.