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Medline ® Abstract for Reference 59

of 'Endometriosis: Treatment of rectovaginal and bowel disease'

Long-term follow-up after conservative surgery for rectovaginal endometriosis.
Fedele L, Bianchi S, Zanconato G, Bettoni G, Gotsch F
Am J Obstet Gynecol. 2004;190(4):1020.
OBJECTIVE: The purpose of this study was to evaluate long-term results in patients who received conservative surgical treatment for rectovaginal endometriosis.
STUDY DESIGN: We analyzed the follow-up data for 83 women who underwent surgery for rectovaginal endometriosis. The inclusion criteria were age 20 to 42 years, moderate-to-severe pain symptoms, conservative treatment with retention of the uterus, and at least 1 ovary; the follow-up period was>or =12 months. Kaplan-Meier analysis and Cox regression were used to calculate recurrence rates.
RESULTS: The cumulative rates of pain recurrence, clinical or sonographic recurrence, and new treatment were 28%, 34%, and 27%, respectively. The younger patients had the higher risk of recurrence. Pregnancy had protective effects against the recurrence of symptoms and a need for a new treatment. Patients who underwent bowel resection had fewer recurrences.
CONCLUSION: Segmental resection and anastomosis of the bowel, when necessary, improves the outcome without affecting chances of conception. Higher recurrence rates in younger patients seems to justify a more radical treatment in this group of women.
Clinica Ostetrico-Ginecologica dell' Universitàdi Milano, Ospedale San Paolo, Milan, Italy. luigi.fedele@unimi.it