Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain
Abstract Introduction Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion‐to‐anal‐verge distance (LAVD) of DE, as well as the severity of the s...
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2024-09-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14921 |
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| author | Daria Pashkunova Ezgi Darici Birgit Senft Attila Bokor Theresa Hudelist Ayman Tammaa Gernot Hudelist |
| author_facet | Daria Pashkunova Ezgi Darici Birgit Senft Attila Bokor Theresa Hudelist Ayman Tammaa Gernot Hudelist |
| author_sort | Daria Pashkunova |
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| description | Abstract Introduction Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion‐to‐anal‐verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. Nevertheless, it is not yet known to what extent the size and LAVD of bowel DE influence the severity of gastrointestinal symptoms. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms. Material and Methods In this prospective study, premenopausal patients with histologically confirmed DE undergoing modified limited nerve‐vessel sparing rectal segmental bowel resection or full‐thickness discoid resection were evaluated. Extent of endometriosis was defined according to the #Enzian classification during surgery. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome was differences in presurgical numeric rating scale pain scores of dyschezia, dyspareunia, and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity. Results Of 162 consecutive patients, 151 were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS‐like symptoms (p = 0.314 and p = 0.185, respectively) or pain symptoms (dyschezia, p = 0.440; dyspareunia, p = 0.136; and dysmenorrhea p = 0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 vs. C3; p = 0.611). In addition, LAVD did not affect the degree of dyschezia (p = 0.892), dyspareunia (p = 0.395), or dysmenorrhea (p = 0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p = 0.493) or dysmenorrhea (p = 0.128) but showed a trend toward affecting gastrointestinal function (p = 0.078) and was significantly associated with dyspareunia (p = 0.035). Conclusions In present study, we could not find a correlation between colorectal DE lesion size and location (LAVD) and gastrointestinal function impairment or intensity of dyschezia and dysmenorrhea. Additional involvement of vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) exerts a significant impact on the degree of dyspareunia in women with colorectal DE. |
| format | Article |
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| issn | 0001-6349 1600-0412 |
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| publishDate | 2024-09-01 |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-b6ca0515d68942d4a8beb06f5f5fa7122025-08-20T02:09:35ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-09-0110391764177010.1111/aogs.14921Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and painDaria Pashkunova0Ezgi Darici1Birgit Senft2Attila Bokor3Theresa Hudelist4Ayman Tammaa5Gernot Hudelist6Department of Gynecology, Center for Endometriosis Hospital St. John of God Vienna AustriaDepartment of Obstetrics and Gynecology, Center for Endometriosis Semmelweis University Budapest HungaryStatistix Statistical Calculations Company Klagenfurt AustriaDepartment of Obstetrics and Gynecology, Center for Endometriosis Semmelweis University Budapest HungaryRudolfinerhaus Private Clinic and Campus Vienna AustriaDepartment of Gynecology and Obstetrics Floridsdorf Hospital Vienna AustriaDepartment of Gynecology, Center for Endometriosis Hospital St. John of God Vienna AustriaAbstract Introduction Presence of deep infiltrating bowel endometriosis (DE) is associated with occurrence of dyschezia and gastrointestinal symptoms. The degree of the disease, the lesion length, and the location, that is, lesion‐to‐anal‐verge distance (LAVD) of DE, as well as the severity of the symptoms appear to be correlated. Nevertheless, it is not yet known to what extent the size and LAVD of bowel DE influence the severity of gastrointestinal symptoms. The present study aims to evaluate a possible correlation of lesion location (LAVD) and size (according to the #Enzian classification) with preoperative symptoms. Material and Methods In this prospective study, premenopausal patients with histologically confirmed DE undergoing modified limited nerve‐vessel sparing rectal segmental bowel resection or full‐thickness discoid resection were evaluated. Extent of endometriosis was defined according to the #Enzian classification during surgery. The primary outcome measure was the correlation between lesion size and location with the GI function impairment reflected by presurgical lower anterior resection syndrome (LARS) scores; the secondary outcome was differences in presurgical numeric rating scale pain scores of dyschezia, dyspareunia, and dysmenorrhea as well as the impact of concomitant DE of other locations on symptom intensity. Results Of 162 consecutive patients, 151 were included in the final analysis. No significant correlation was observed between lesion size (#Enzian compartments C1/C2/C3) or LAVD and GI dysfunction reflected by LARS‐like symptoms (p = 0.314 and p = 0.185, respectively) or pain symptoms (dyschezia, p = 0.440; dyspareunia, p = 0.136; and dysmenorrhea p = 0.221). Furthermore, no significant correlation was observed between lesion size and GI dysfunction when merging two severity grades (#Enzian compartments C1 plus C2 vs. C3; p = 0.611). In addition, LAVD did not affect the degree of dyschezia (p = 0.892), dyspareunia (p = 0.395), or dysmenorrhea (p = 0.705). Finally, the presence of concomitant DE lesions infiltrating the vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) did not alter the severity of preoperative dyschezia (p = 0.493) or dysmenorrhea (p = 0.128) but showed a trend toward affecting gastrointestinal function (p = 0.078) and was significantly associated with dyspareunia (p = 0.035). Conclusions In present study, we could not find a correlation between colorectal DE lesion size and location (LAVD) and gastrointestinal function impairment or intensity of dyschezia and dysmenorrhea. Additional involvement of vagina/rectovaginal space (#Enzian compartment A) and/or sacrouterine ligaments/parametrium (#Enzian compartment B) exerts a significant impact on the degree of dyspareunia in women with colorectal DE.https://doi.org/10.1111/aogs.14921deep endometriosisdyscheziadysmenorrheagastrointestinal functionlow anterior resection syndromenerve‐vessel sparing segmental resection |
| spellingShingle | Daria Pashkunova Ezgi Darici Birgit Senft Attila Bokor Theresa Hudelist Ayman Tammaa Gernot Hudelist Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain Acta Obstetricia et Gynecologica Scandinavica deep endometriosis dyschezia dysmenorrhea gastrointestinal function low anterior resection syndrome nerve‐vessel sparing segmental resection |
| title | Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain |
| title_full | Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain |
| title_fullStr | Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain |
| title_full_unstemmed | Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain |
| title_short | Lesion size and location in deep infiltrating bowel endometriosis: Correlation with gastrointestinal dysfunction and pain |
| title_sort | lesion size and location in deep infiltrating bowel endometriosis correlation with gastrointestinal dysfunction and pain |
| topic | deep endometriosis dyschezia dysmenorrhea gastrointestinal function low anterior resection syndrome nerve‐vessel sparing segmental resection |
| url | https://doi.org/10.1111/aogs.14921 |
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