Avaliação da Função Intestinal e da Qualidade de Vida de Pacientes com Endometriose Pélvica Profunda Submetidas à Ressecção Colorretal

Abstract

Objective: To identify factors related to the occurrence of bowel dysfunction and negative impact on the Quality of life (QoL) of women undergoing segmental (SR) or disc resection (RD) for intestinal endometriosis. Method: This was a retrospective study with women undergoing RS or RD for the treatment of intestinal endometriosis,with consecutive medical record, in a tertiary hospital (Biocor, Instituto) by a multidisciplinary team from 2008 to 2018. Inclusion criteria were: anastomosis up to 15 cm above anal margin histological confirmation of intestinal endometriosis, minimum postoperative follow-up of 12 months,no previous colorectal surgery and signature of the consent form. Those with inflammatory bowel disease or with systemic disease or other serious pathological condition affecting quality of life were excluded. Validated questionnaires were used to assess bowel function: (Low Anterior Resection Syndrome Score (LARS score) and quality of life (Short – Form Health Survey SF – 36). Clinical, surgical and socio-demographic data were also recorded. Variables that could be related to bowel dysfunction were investigated. Statistical analysis included logistic regression to study the association of the study variables with the response variable LARS and p<0.05 w considered significant. The study was approved by the local ethics committee.Results: 144 women with an average age of 34 years were studied, with pain being the main indication for surgery (n= 130;90.3%), followed by infertility (n=74; 51.4%). All surgeries were laparoscopies performed by the same coloproctologist: RS was performed in 91 patients (63.2%), while 53 (35.8%) were submitted to DR. The incidence of LARS was 42.36% (n=61) with 20.8% classified as mild and 21. 5% severe. There was no significant difference in the incidence of LARS between patients who underwent either RS (47%) or RD (34%) (p=0.120). As for those submitted to RS, a small group presented evacuation frequency from 4 to 7 times a day (p=0.011), and the rest from 1 to 3 times. The only variables responsible for the occurrence of LARS were: previous or concomitant hysterectomy (OR 2.94 95% CI 1.24;6.97, p=0.014), distance to anastomosis ≤ 5 cm and RS associated with distance to anastomosis ≤ 5 cm from the anal margin (OR 4.22 95% CI 1.70; 10.50 p=0.002). The occurrence of LARS in patients undergoing RS was higher in those with anastomosis ≤ 5 cm from the anal margin (37.6% versus 6.2%; p < 0.001), being also significantly higher when compared to DR (p = 0.006). Patients, in general, had good QoL, regardless of the surgical technique used, with all domains above 60. Regarding QoL versus LARS, patients who had LARS had a significant impact on the emotional aspects (p=0.006) and mental health domains (p=0.011) compared to those without LARS. The overall morbidity rate was 10.3%, with 6.3% minor complications and 4.2% major complications, according to the Clavien-Dindo classification. Complications did not impact QoL nor the LARS score (p= 0.655). Conclusion: Patients undergoing surgery for endometriosis developed bowel dysfunction regardless of the surgical technique, with an impact on QoL in the emotional aspects and mental health domains. Hysterectomy and anastomosis ≤ 5 cm with RS significantly increase the risk of bowel dysfunction.