Gastrointestinal function outcomes following radical and conservative colorectal surgery for deep endometriosis: A systematic review and meta-analysis.

Abstract

Introduction: Patients who have undergone colorectal surgery for symptomatic deep endometriosis may still encounter persistent or worsening digestive complaints. The aim of the present work was to analyze gastrointestinal function outcomes after radical and conservative colorectal surgery to further elucidate the effect of surgery on postoperative bowel function.

Material and methods: PubMed, EMBASE, Web of Science, Clinical Trials.gov and the Cochrane Database databases were searched from January 1, 2010 until April 1, 2024. The quality of included studies was assessed by the Downs and Black quality checklist. Studies including patients with colorectal endometriosis who either underwent segmental resection (SR) or conservative approaches and reported data on bowel function were included.

Results: From the initial pool of 55 studies, 14 reported patient reported outcome measures eligible to be pooled in the meta-analysis. Conservative surgery was less associated with constipation and increased number of daily stool (>3/day) when compared to SR (p = 0.02 and p = 0,0004, respectively). No difference was found in the occurrence of gas and stool incontinence (p = 0.72), postsurgical defecation pain (p = 0.44) and time to defer defecation (≤ 15 min; p = 0.64). Patients in the conservative surgery group reported higher postoperative Gastrointestinal Quality of Life Index (GIQLI) when compared to SR (p = 0.01). However, when comparing changes between pre- and postsurgical patient reported outcome measures within the respective groups, rather than evaluating postsurgical outcomes alone, none of the intervention groups showed significant changes between pre- and postsurgical GIQLI, Knowles Eccersley Scott Symptom Score(KESS) and Wexner scores (p = 0.28, p = 0.94 and p = 0.78, respectively).

Conclusions: Segmental resection seems to be associated with higher rates of post-operative constipation and lower GIQLI scores when compared to conservative surgery. However, when comparing the change of gastrointestinal function symptoms reflected by changes of gastrointestinal function parameters from pre- to postoperative rather than focusing on purely postoperative parameters alone, no significant difference of these parameters was observed between surgical techniques.