LAUSR

STUDY OBJECTIVE To assess the risk of low anterior resection syndrome (LARS) between women managed by either disk excision or rectal resection for low rectal endometriosis. DESIGN Retrospective study of a prospective database. SETTING University Hospital. PATIENTS 172 patients managed by disk excision or rectal resection, for deep endometriosis infiltrating the rectum less than 7 cm from the anal verge. INTERVENTIONS Rectal disk excision and/or segmental resection using transanal staplers. MEASUREMENT AND MAIN RESULTS 108 patients (62.8%) were treated by disk excision (group D) and 64 (37.2%) by rectal resection (group R). All patients answered the LARS score questionnaire. Follow up was 33.3+/-22 months for group D (range 12 to 108 months) and 37.3 +/-22.1 months (range 12 to 96 months) for group R (P=0.25). The rates of rectovaginal fistula and pelvis abscess requiring radiological drainage and surgery in the D and R groups were respectively 7.4% and 8.3% vs. 7.8% and 9.3%. The rate of women with normal bowel movements postoperatively was higher in group D (61.1% versus 42.8%, p=.05). Women enrolled in group R reported higher frequency of stools (p<.001), clustering of stools (p=.02) and fecal urgency (p=.05). Regression logistic model revealed two independent risk factors for minor/major LARS: performing low rectal resection (aOR=2.28, 95%CI 1.1-4.7) and presenting with bladder atony requiring self-catheterization beyond postoperative day 7 (aOR=2.52, 95%CI 1.1-5.8). CONCLUSIONS The probability of normal bowel movements is higher following disk excision versus low rectal resection in women with deep endometriosis infiltrating the low rectum.