Objective

The objective of our study was to study the impact of discoid excision for deep endometriosis (DE) with colorectal involvement on fertility outcomes.

Methods

49 patients with a desire for pregnancy treated with discoid excision for colorectal endometriosis in our endometriosis expert center between January 2015 and August 2020 were selected from our prospectively maintained database. Indications for surgery were either infertility and / or pelvic pain. Postoperative complications were graded according to the Clavien-Dindo classification. Fertility outcomes, both spontaneous and post-ART pregnancies, were analyzed.

Results

Among the 49 patients who underwent discoid excision exclusively (no other digestive resection) with a desire to conceive, 25 had a pregnancy after surgery and 24 did not. Double discoid excision was performed in 6.1 % of the cases (3/49). A colpectomy was performed in 12.2 % of the patients (6/49), and a protective stoma in 12.2 % (6/49). Fenestration of endometriomas was performed in 28.6 % of the patients (14/49), and parametrectomy in 40.8 % (20/49). The postoperative complication rate was 24.5 % (12/49) including 10.2 % (5/49) grade I, 12.2 % (6/49) grade II, and 2 % (1/49) grade III. Prior to surgery, 28 (57.1 %) patients had infertility including 13 (52 %) that successfully conceived following surgery and 15 (62.5 %) that remain infertile. Spontaneous pregnancy was achieved in 60 % (15/25) of infertile patients’ prior surgery. The live-birth rate in patients conceiving spontaneously was 75 % (12/16).

Conclusion

Our results support that discoid excision is safe and associated with good fertility outcomes. Whether first-line surgery using discoid excision is superior to first-line ART remains to be determined.

中文翻译：

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盘状切除术治疗结直肠子宫内膜异位症相关不孕症：生育结果和并发症发生率之间的平衡

客观的

我们研究的目的是研究盘状切除术治疗累及结直肠的深部子宫内膜异位症 (DE) 对生育结果的影响。

方法

从我们前瞻性维护的数据库中选择了2015年1月至2020年8月期间在我们的子宫内膜异位症专家中心接受盘状切除术治疗结直肠子宫内膜异位症的49名有怀孕意愿的患者。手术指征是不孕症和/或盆腔疼痛。术后并发症根据 Clavien-Dindo 分类进行分级。对自然妊娠和 ART 后妊娠的生育结果进行了分析。

结果

在 49 例单纯接受盘状切除术（未进行其他消化道切除术）且希望怀孕的患者中，25 例术后妊娠，24 例未妊娠。6.1% 的病例进行了双盘状切除（3/49）。12.2% 的患者 (6/49) 进行了阴道切除术，12.2% (6/49) 的患者进行了保护性造口。28.6% 的患者 (14/49) 进行了子宫内膜瘤开窗术，40.8% (20/49) 的患者进行了宫旁切除术。术后并发症发生率为24.5%（12/49），其中I级10.2%（5/49）、II级12.2%（6/49）、III级2%（1/49）。手术前，28 名患者（57.1%）患有不孕症，其中 13 名患者（52%）在手术后成功受孕，15 名患者（62.5%）仍然不孕。60% (15/25) 接受过手术的不孕患者实现了自然妊娠。自然受孕患者的活产率为 75% (12/16)。

结论

我们的结果支持盘状切除是安全的并且与良好的生育结果相关。使用盘状切除的一线手术是否优于一线 ART 仍有待确定。