Background: Prevalence of Deep infiltrating endometriosis (DIE) is estimated to be as high as 5% of the population (1). There is scarce and contradicting data in the literature regarding long term results of surgery for DIE. As surgeries for treatment of DIE may be associated with high incidence of surgical morbidity (2), treatment of DIE possess a therapeutic dilemma for the gynaecological surgeon.
Objective: To prospectively evaluate long term pain relief and bladder, bowel and sexual function after surgery for DIE.
Methods: Patients aged 18-50 who attended the pelvic pain focused gynaecology clinic at the Royal Women’s Hospital, Victoria and who were suspected to have DIE and booked for surgery were recruited to the trial. All patients completed five pre-operative validated questionnaires: (1) Visual Analogue Scale (VAS) pain questionnaire; (2) ICIQ-FLUTS (bladder symptoms questionnaire); (3) ICIQ-B (bowel symptoms questionnaire); (4) Female Sexual Function Index questionnaire and (5) EQ-5D-5L Health (Quality of Life (QOL)) Questionnaire. All patients underwent excisional laparoscopic surgery after which an operation report including a detailed description of surgical findings and rAFS and EFI scores was filled. Patients with surgery-proven DIE are followed-up with the same questionnaires 6 weeks, 6 months and 12 months post-surgery.
Results: To date, 64 patients with surgery-proven DIE have completed the 6-weeks follow up and 28 have completed the 6-months follow up. Pelvic, period and abdominal pain VAS scores have significantly improved at 6 weeks and 6 months as compared to before surgery. At 6 weeks of follow-up, incontinence score improved from 2.8 to 1.7 (p=0.005). There was also a 1.1-points average reduction in the amount this bothered the patients. This was not statistically significant at 6-months. Bowel-related QOL scores had improved by 0.9 points at 6-weeks (p=0.04) and by 2.65 points at 6-months (p= 0.003). Pain and control of bowel motions had improved at 6 weeks (p=0.001) but not at 6-months. Whereas all sexual function scores improved at 6 weeks (p<0.001-0.04), only the desire score was still significantly better at 6 months (p=0.04). Self-perception of health, pain/discomfort and anxiety/depression health scores had significantly improved at 6 weeks (p=0.02-0.03).
Conclusions: Pain symptoms improve 6 months after surgery for DIE. Whereas bladder, bowel and sexual function improve in the short term, the long term effect of surgery for DIE on pelvic organ function might be clearer after completion of the 12-months follow-up of all patients of this study.