RRM Academy Synopsis
Transvaginal bowel surgery for endometriosis came with shorter stays
In five women at one Oregon practice, bowel surgery through the vagina, guided by a camera, came with shorter hospital stays and lower total hospital charges than open surgery, a 1996 look-back study found. Ten matched women had open surgery. Three had fully laparoscopic surgery.
Key Findings
- Surgeons removed part of the lower colon in three ways: fully laparoscopic (3 women), laparoscopically assisted transvaginal (5 women), or laparotomy (10 consecutive women matched for bowel disease extent).
- Against laparotomy, the transvaginal route meant a shorter hospital stay, operating room charges that were equivalent, and lower total hospital charges.
- Average operating time for transvaginal surgery was faster than fully laparoscopic surgery and slightly slower than laparotomy.
- No woman had an intestinal complication. One transvaginal patient needed office treatment for lingering granulation tissue at the vaginal incision.
- The authors' referral practice treated 1,545 women surgically for endometriosis. Of these, 415 had intestinal disease, leading to 113 segmental colonic resections.
Interpretation
The authors looked back at one private practice in a rural Oregon hospital. The transvaginal group holds the first five women to have the operation, a number the authors call small. Laparotomy patients were matched to the laparoscopy groups for severity of bowel disease. Two transvaginal patients also had a hysterectomy, and charges were not adjusted for that. The authors note that hospital charges do not necessarily reflect hospital costs. They call the technique promising, best suited to low rectosigmoid lesions, and say more study is needed.
RRM Context
Restorative reproductive medicine aims to find and remove the cause of disease. Every woman here, in all three groups, also had excision of her endometriosis alongside the bowel surgery. The authors write that intestinal endometriosis frequently is missed by intestinal studies, so surgery is necessary for diagnosis. The study reports surgery time, hospital stay and charges. It reports no fertility or pain outcomes.
Abstract not indexed.