Introduction: Patients who have undergone colorectal surgery for symptomatic deep
endometriosis may still encounter persistent or worsening digestive complaints. The
aim of the present work was to analyze gastrointestinal function outcomes after radical
and conservative colorectal surgery to further elucidate the effect of surgery on
postoperative bowel function. Material and Methods: PubMed, EMBASE, Web of Science,
Clinical and the Cochrane Database databases were searched from January 1, 2010 until
April 1, 2024. The quality of included studies was assessed by the Downs and Black
quality checklist. Studies including patients with colorectal endometriosis who either
underwent segmental resection (SR) or conservative approaches and reported data on
bowel function were included. Results: From the initial pool of 55 studies, 14 reported
patient reported outcome measures eligible to be pooled in the meta-analysis. Conservative
surgery was less associated with constipation and increased number of daily stool
(>3/day) when compared to SR (p = 0.02 and p = 0,0004, respectively). No difference
was found in the occurrence of gas and stool incontinence (p = 0.72), postsurgical
defecation pain (p = 0.44) and time to defer defecation (<= 15 min; p = 0.64). Patients
in the conservative surgery group reported higher postoperative Gastrointestinal Quality
of Life Index (GIQLI) when compared to SR (p = 0.01). However, when comparing changes
between pre- and postsurgical patient reported outcome measures within the respective
groups, rather than evaluating postsurgical outcomes alone, none of the intervention
groups showed significant changes between pre- and postsurgical GIQLI, Knowles Eccersley
Scott Symptom Score(KESS) and Wexner scores (p = 0.28, p = 0.94 and p = 0.78, respectively).
Conclusions: Segmental resection seems to be associated with higher rates of post-operative
constipation and lower GIQLI scores when compared to conservative surgery. However,
when comparing the change of gastrointestinal function symptoms reflected by changes
of gastrointestinal function parameters from pre- to postoperative rather than focusing
on purely postoperative parameters alone, no significant difference of these parameters
was observed between surgical techniques.
