Letters to the editor |
Post-operative digestive symptoms after colorectal resection for endometriosis
Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Genoa, Italy
1 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, San Martino Hospital, Largo R. Benzi 1,Genoa 16132, Italy. E-mail: simone.ferrero{at}fastwebnet.it
Sir,
We read with interest the recent manuscript by Dubernard et al. (in press)
evaluating the quality of life after laparoscopic colorectal resection for endometriosis. On the basis of our own experience, we totally agree with their findings. However, we would like to bring to your attention a finding of the study which may deserve further discussion.
The authors evaluated the symptoms after a follow-up ranging from 2 to 55 months from surgery (median 22.5 months). In our experience, although gynaecological symptoms (i.e. dysmenorrhoea and dyspareunia) improve immediately after surgery, a longer period of time (up to 1 year) may be required for a complete recovery of gastrointestinal function. De-novo digestive symptoms may appear after laparoscopic colorectal resection (Thomassin et al., 2004; Darai et al., 2005; Landi et al., 2006); in particular, severe constipation may be frequent, and it has recently been correlated with a damage of pelvic autonomic nerves (Landi et al., 2006). It would be interesting to know whether the absence of post-operative improvement in tenesmus and constipation described by the authors is confirmed when the analysis is limited to the subgroup of patients with a minimum follow-up of 1 year.
We believe that this information is particularly relevant, as it should be included in the pre-operative consultation of patients undergoing bowel resection for endometriosis.
References
Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M. (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192:394–400.[CrossRef][Web of Science][Medline]
Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod (in press).
Landi S, Ceccaroni M, Perutelli A, Allodi C, Barbieri F, Fiaccavento A, Ruffo G, McVeigh E, Zanolla L, Minelli L. (2006) Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? Hum Reprod 21:774–781.
Thomassin I, Bazot M, Detchev R, Barranger E, Cortez A, Darai E. (2004) Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography. Am J Obstet Gynecol 190:1264–1271.[CrossRef][Web of Science][Medline]
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