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Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study.

ABSTRACT: OBJECTIVE:To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis. DESIGN:A multicentre, prospective cohort study. SETTING:51 hospitals accredited as specialist endometriosis centres. PARTICIPANTS:5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision. INTERVENTIONS:Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of the pararectal space. MAIN OUTCOME MEASURES:Standardised symptom questionnaires enquiring about chronic pelvic pain, bladder and bowel symptoms, analgesia use and quality of life (EuroQol) completed prior to surgery and at 6, 12 and 24 months postoperatively. Serious perioperative and postoperative complications including major haemorrhage, infection and visceral injury were recorded. RESULTS:At 6 months postsurgery, there were significant reductions in premenstrual, menstrual and non-cyclical pelvic pain, deep dyspareunia, dyschezia, low back pain and bladder pain. In addition, there were significant reductions in voiding difficulty, bowel frequency, urgency, incomplete emptying, constipation and passing blood. These reductions were maintained at 2?years, with the exception of voiding difficulty. Global quality of life significantly improved from a median pretreatment score of 55/100 to 80/100 at 6?months. There was a significant improvement in quality of life in all measured domains and in quality-adjusted life years. These improvements were sustained at 2?years. All analgesia use was reduced and, in particular, opiate use fell from 28.1% prior to surgery to 16.1% at 6?months. The overall incidence of complications was 6.8% (321/4721). Gastrointestinal complications (enterotomy, anastomotic leak or fistula) occurred in 52 (1.1%) operations and of the urinary tract (ureteric/bladder?injury or leak) in 49 (1.0%) procedures. CONCLUSION:Laparoscopic surgical excision of rectovaginal endometriosis appears to be effective in treating pelvic pain and bowel symptoms and improving health-related quality of life and has a low rate of major complications when performed in specialist centres.

SUBMITTER: Byrne D

PROVIDER: S-EPMC5892761 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study.

Byrne Dominic D Curnow Tamara T Smith Paul P Cutner Alfred A Saridogan Ertan E Clark T Justin TJ

BMJ open 20180409 4

<h4>Objective</h4>To estimate the effectiveness and safety of laparoscopic surgical excision of rectovaginal endometriosis.<h4>Design</h4>A multicentre, prospective cohort study.<h4>Setting</h4>51 hospitals accredited as specialist endometriosis centres.<h4>Participants</h4>5162 women of reproductive age with rectovaginal endometriosis of which 4721 women had planned laparoscopic excision.<h4>Interventions</h4>Laparoscopic surgical excision of rectovaginal endometriosis requiring dissection of t ...[more]

PMID: 29632080

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Project description:ObjectiveTo compare the health-related quality of life and cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional 'straight stick' laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy.DesignMulticentre prospective observational cohort study.SettingPatients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 National Health Service (NHS) cancer units and centres in England between August 2017 and February 2020.Participants275 patients recruited with 159 RALS, 73 CLS eligible for analysis.Outcome measuresPrimary outcome was the European Organisation for Research and Treatment of Cancer Quality of Life measure (EORTC). Secondary outcomes included EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 prices and cost-effectiveness. The cost-effectiveness evaluation compared EQ-5D-5L quality adjusted life years and costs between RALS and CLS.ResultsNo difference identified between RALS and CLS for EORTC, EQ-5D-5L utility and 6MWT. RALS had unadjusted mean cost difference of £556 (95% CI -£314 to £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 to £827) and QALY difference of 0.0024 (95% CI -0.0008 to 0.0057).ConclusionsFindings suggest that RALS versus CLS in women undergoing hysterectomy (after adjusting for differences in morbidity) is cost-effective with lower costs and QALYs. Results are highly sensitive to the usage of robotic hardware with higher usage increasing the probability of cost-effectiveness. Non-inferiority randomised controlled trial would be of benefit to decision-makers to provide further evidence on the cost-effectiveness of RALS versus CLS but may not be practical due to surgical preferences of surgeons and the extensive roll out of RALS.

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Dataset Information

Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study.

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Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study.

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