Surgery for Lower Rectum Deep Endometriosis (Segmental/Disc) - Prospective Comparison of Digestive Symptoms and Pain

NCT ID: NCT04398641

Last Updated: 2021-10-08

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 300 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-07-01
• Study Completion Date: 2022-05-01

Brief Summary

Several studies show a significant drop in pain scores, improved fertility outcomes and amelioration of impaired sexual functioning in women following surgical resection of colorectal endometriosis. However, intermediate and long-term bowel dysfunction may occur as a consequence of radical surgery with typical symptoms such as constipation, feeling of incomplete evacuation, clustering of stools and urgency. This is described as low anterior resection syndrome (LARS).

The primary aim of this study is the prospective comparison of two surgical approaches for full thickness excision, i.e. transanal disc excision (TADE) and nerve-vessel sparing limited segmental resection (NVSSR), regarding gastrointestinal functional outcomes using the LARS / Gastrointestinal Quality of Life Index (GIQLI) by Eypasch questionnaires.

Detailed Description

Several studies show a significant drop in pain scores, improved fertility outcomes and amelioration of impaired sexual functioning in women following surgical resection of colorectal endometriosis. However, there is inceasing evidence that intermediate and long-term bowel dysfunction may occur as a consequence of radical surgery for rectal deep endometriosis (DE). Typical symptoms include constipation, feeling of incomplete evacuation, clustering of stools and urgency. This is described in the colorectal surgical literature as low anterior resection syndrome (LARS). The choice of operation is largely dependent on the extent of disease. Statistically significant differences in functional outcomes were found in favor of the conservative surgical approach, i.e. resection of endometriotic tissue with preservation of the luminal structure of the rectal wall thereby avoiding segmental bowel resection. In a recent retrospective multicentric cohort analysis, the incidence of LARS after either nerve and vessel sparing segmental resection (NVSSR) or transanal disc excision (TADE) performed for the surgical treatment of colorectal DE was assessed. All patients underwent a low rectum resection, with a resection line lower than 7cm from anal verge. In contrast to previoisly published data, no statistically significant difference between the incidence of the LARS among patients operated using TADE when compared to women treated by NVSSR were found. Interestingly, the occurence of LARS was positively associated with the use of protective ileo-or colostomy. A higher rate of severe complications was observed in the TADE group than among patients who underwent a NVSSR. Weaknesses of this study are the retrospective design and a possible bias in the TADE regarding larger DE nodules as well as the possibility of bowel dysfunction prior to surgery in women with DE.

The primary aim of the present study is the prospective comparison of two surgical approaches for full thickness excision of rectal DE resulting in an anastomotic height ≤7 cm distance from the anal verge. One technique involves the preservation of the residual luminal wall integrity (disc resection) known as Rouen technique/ TADE. The other technique involves limited resection of the bowel wall with preservation of all adjacent structures (autonomic pelvic plexus, rectal vascular supply) known as NVSSR. Gastrointestinal functional outcomes of the two procedures will be compared using the LARS / GIQLI by Eypasch questionnaires. Since digestive complaints may also be present presurgically, evaluation of digestive complaints will be recorded pre- and post surgery.

Conditions

Endometriosis, Rectum

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Nerve and vessel sparing segmental resection (NVSSR)

Women undergoing surgery for deep endometriosis of the lower rectum using the surgical technique of nerve and vessel sparing segmental resection (NVSSR)

Evaluation of pre- and postoperative gastrointestinal functional outcomes

Intervention Type: OTHER

Gastrointestinal functional outcomes will be evaluated using the LARS and the GIQLI by Eypasch questionnaires.

Transanal disc excision (TADE)

Women undergoing surgery for deep endometriosis of the lower rectum using the surgical technique of transanal disc excision (TADE)

Evaluation of pre- and postoperative gastrointestinal functional outcomes

Intervention Type: OTHER

Gastrointestinal functional outcomes will be evaluated using the LARS and the GIQLI by Eypasch questionnaires.

Interventions

Evaluation of pre- and postoperative gastrointestinal functional outcomes

Gastrointestinal functional outcomes will be evaluated using the LARS and the GIQLI by Eypasch questionnaires.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Premenopausal women undergoing full thickness excision of rectal deep endometriosis (DE) resulting in an anastomotic height ≤7 cm distance from the anal verge

Exclusion Criteria

• Diagnosed or suspected malignancy
• Previous colorectal surgery
• Previous history of chronic inflammatory diseases of the gastrointestinal tract and/or chronic defecation dysfunction related to other factors such as birth trauma etc.

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Univ.-Doz. Dr.med.univ. Gernot Hudelist, MSc.

OTHER

Sponsor Role: lead

Responsible Party

Univ.-Doz. Dr.med.univ. Gernot Hudelist, MSc.

MD, MSc Clinical Lecturer

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Gernot Hudelist, MD, MSc

Role: PRINCIPAL_INVESTIGATOR

Woman & Health Private Clinic Vienna

Locations

Woman & Health Vienna

Vienna, , Austria

Site Status: RECRUITING

Hospital St. John of God Vienna

Vienna, , Austria

Site Status: RECRUITING

Countries

Austria

Central Contacts

Gernot Hudelist, MD, MSc

Role: CONTACT

gernot.hudelist@womanandhealth.com

0043 1 5333 654

Facility Contacts

Gernot Hudelist, MD, MSc

Role: primary

Gernot Hudelist, MD, MSc

Role: primary

Other Identifiers

2

Identifier Type: -

Identifier Source: org_study_id