Conservative Management versus Rectal Resection in Deep Infiltrating Endometriosis of the Rectum

Rectal deep infiltrating endometriosis has become an increasing problem with two main management strategies; radical surgery by segmental colorectal resection, and a conservative surgery that includes removal of the lesion with rectal conservation. Aim was to compare between conservative management of deep infiltrating endometriosis of the rectum by shaving or disc excision and segmental radical colorectal resection regarding short term patients' outcome, digestive and urinary outcomes. Patients and methods: Included 60 patients with deep endometriosis infiltrating the rectum were randomly divided into 2 equal groups the first group underwent conservative surgery by either rectal shaving or disc excision and the second group underwent colorectal resection. We showed that rectal stenosis was more in the group of patients who are managed by segmental resection (some of patients with secondary stenosis underwent secondary resection of colo-rectum and the others under general anesthesia had endoscopic dilatation. Risks of postoperative complication, as recto-vaginal fistula and dysfunction of the urinary bladder which required long term self-catheterization were more common in the patients who underwent segmental resection. Constipation is recorded in (11.1%) of the conservative group and in (9.1%) of the segmental resection group, frequent bowel movements is recorded in (8%) the conservative group and in 7 (22%) of the segmental resection group, defecation pain is recorded in (19%) of the conservative group and in 6 (19%) the segmental resection group, and involuntary loss of gas or stools were recorded in (12%) the conservative group and in (30%) in the segmental resection group. Spontaneous conception was recorded in (70%) and (60%) of patients in both groups respectively. we showed a slightly better outcome of patient who underwent conservative surgery for deep infiltrating endometriosis of rectum management and it might improves functional digestive and urinary outcomes, in comparison to resection of colo-rectum.