Suboptimal Bowel Function after (Recto) Sigmoid Resection in Patients with Deep Infiltrating Endometriosis

Purpose: To investigate the postoperative outcomes regarding bowel functions in women and the pattern of symptoms after surgical treatment for deep infiltrating endometriosis in comparison with healthy subjects. Methods: This cross-sectional study was designed as a single tertiary-level academic center. We included 130 female adult patients who had undergone (recto) sigmoid resection for deep infiltrating endometriosis between January 2005 and December 2015. Patients were randomly age-matched to two controls derived from the general population in the Netherlands. We measured the prevalence of constipation, fecal incontinence, Irritable Bowel Syndrome and the Low Anterior Resection Syndrome Score. Results: The prevalence of constipation, fecal incontinence, and irritable bowel syndrome in the patients was significantly higher than in the controls (50.8% versus 26.2% and 15.4% versus 5.4%, and 14.6% versus 5.4%, respectively, P < 0.05 for each). The prevalence of constipation and fecal incontinence was lower in the patients who had undergone surgery longer than 24 months ago, in comparison with those who had undergone surgery less than 24 months ago (46.7% versus 69.9% and 15.0% versus 17.4%), which was still significantly higher in comparison to the control group. The low anterior resection syndrome score was significantly higher in the patients than in the controls. Conclusion: The postoperative outcomes in patients treated for deep infiltrated endometriosis regarding constipation, fecal incontinence, and irritable bowel syndrome are suboptimal and do not come close to outcomes in the general female population in the Netherlands. These patients should be screened postoperatively and if necessary, treated for bowel functions.