When a woman has deeply infiltrating endometriosis affecting the rectum, particularly the rectosigmoid section, surgery is often recommended because of pain and deterioration in quality of life. However, like all surgery, this has its risks, one of the most important, and perhaps less talked about, is the so-called Low Anterior Resection Syndrome, or LARS.
LARS is a bowel dysfunction that develops after a colostomy and can be associated with frequent bowel movements, difficulty in retaining stools or even faecal leakage. While this phenomenon has been most commonly associated with bowel cancer surgery, a new study has put the spotlight on the risk of bowel surgery for endometriosis.
A team of researchers from the Dexeus University Hospital in Barcelona, led by Dr Coll, analysed 16 years of data: 124 cases of women who had undergone segmental bowel resection for rectosigmoid endometriosis. Their aim was to assess how often LARS occurs and to identify possible risk factors.
The results are encouraging, but also cautionary: 5.6% of patients developed LARS in the first year after surgery, two of them mild and five more severe. Serious surgical complications also occurred (8%), such as suture failure or peritoneal bleeding, but reassuringly no rectovaginal fistula occurred.
But the most important lesson was that parametrial resection, the removal of the nerve-rich connective tissue around the uterus, significantly increases the risk of developing LARS. According to the analysis, this increases the risk of developing the syndrome by a factor of six (!).
This confirms the emerging view that a conservative, nerve-sparing surgical approaches are not only safer, but can also protect patients' long-term quality of life. Although recurrence of the disease remains a challenge (37 women in the study were diagnosed with recurrent endometriosis), it is important to plan surgical intervention "judiciously".
So the study not only provides data, but also a clear message: bowel resection is not an enemy in itself, but it is not a panacea. Surgical treatment of endometriosis is not only about removing visible lesions, but also about keeping women in balance. The risk of LARS is a good reminder of this.
The researchers call for further prospective studies with larger numbers of cases. In the meantime, conservative anatomy- and nerve-sparing surgery seems to be the best way forward to protect the female intestinal tract and quality of life (if surgery is necessary, I'll add that)
Link: https://onlinelibrary.wiley.com/doi/10.1111/codi.70113
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