Resection of rectosigmoid endometriosis may not impact pregnancy and live birth rates after surgery

A new study published in European Journal of Obstetrics and Gynecology and Reproductive Biology shows that when compared to the literature, postoperative pregnancy and live birth rates following excision of rectosigmoid endometriosis are consistent with conservative therapy.

Endometriosis is a common benign gynecological disorder that is characterized by the ectopic presence of endometrium-like tissue with a local inflammatory component that is dependent on estrogen. Endometriotic subperitoneal invasion that is more than 5 mm deep is known as deep infiltrating endometriosis (DIE), and it can occur uterosacrally, in the colon, vagina, bladder, and ureter. Hormonal therapy is the main treatment for endometriosis, particularly for pain symptoms. In order to determine if problems have an impact on the pregnancy and live birth rates following surgical removal of rectosigmoid deep infiltrating endometriosis, Maja Raos and colleagues undertook this study.

In this study, historical case series were used. From January 2009 to May 2019, 193 individuals with rectosigmoid DIE and a desire to become pregnant underwent a rectosigmoid resection. The Department of Obstetrics and Gynecology at Aarhus University Hospital in Denmark handled all procedures. Data on surgical and reproductive outcomes were gleaned from patient records. Statistics were used to examine anonymized data. Means are used to express normally distributed continuous variables, percentages are used to express categorical data, and the Kaplan-Meier failure function is used to express the time to pregnancy. The chi2 test was used to analyze live birth rates stratified by complications.

The key findings of this study were:

A total of 117 patients experienced postoperative pregnancy, with the rates of live births and pregnancies being 60.6% and 53.9%, respectively. 

39 patients (20.2%) naturally became pregnant, compared to 78 patients (40.4%) who used assisted reproductive techniques or intrauterine insemination. 

After surgery, the median duration to pregnancy was 12.4 months (range: 0.4 – 58). 16.6% of patients had a grade III (none grade IV) Clavien-Dindo complication. 

The 50% pregnancy and live birth rates experienced by these individuals were not statistically different from those of people without problems.

In conclusion, it's interesting to note that complications (Clavien-Dindo grade III) had no impact on the live birth rate or gestational age.

Reference: 

Raos, M., Mathiasen, M., & Seyer-Hansen, M. (2022). Impact of surgery on fertility among patients with deep infiltrating endometriosis. In European Journal of Obstetrics & Gynecology and Reproductive Biology. Elsevier BV. https://doi.org/10.1016/j.ejogrb.2022.12.004