Evaluation of Rectal Endometriosis Treatment With HIFU Versus Surgery: A Comparative Retrospective Bicentric Study

Comparing rectal endometriosis treatment with HIFU and surgery in terms of symptoms at 6 months and treatments-related morbidity. Comparative retrospective, bicentric study in 2 endometriosis reference centers. Patients operated by HIFU or laparoscopic resection in the operating room under anesthesia. 120 patients, including 60 patients in each arm, were treated and followed for 6 months. Endo-rectal HIFU treatment versus laparoscopic surgery of rectal endometriosis nodule. Patients’ symptomatology was assessed with questionnaires prior to receiving treatment then again 6 months later using questionnaires: gynecological and digestive symptoms (VAS), health status (MOSSF-36), fecal incontinence (WEXNER), constipation (KESS) and overall sexual health (FSFI). We also assessed the morbidity of both treatments according to the Clavien-Dindo classification. 120 patients, 60 in each group, received HIFU or rectal surgery. Rectal nodules characteristics were comparable in both groups. In the HIFU and surgery groups, Clavien-Dindo grade 2 and 3 complication rates were respectively 3.3% vs. 21.7% (p=0.002) and 0% vs. 10% (p=0.01). Hospitalization duration was also significantly shorter for HIFU group (1 day vs. 3 days, p<0.001). In the HIFU group, significative improvement was observed in acute pelvic pain/dysmenorrhea, dyspareunia, diarrhea, rectal spasms, pain during bowel movement and urinary urgency. In the surgical arm, significative improvement was observed in acute pelvic pain/dysmenorrhea, diarrhea, rectal spasms and pain during bowel movement. In both groups, we can witness an improvement in FSFI, KESS and WEXNER scores and health status at 6 months. HIFU treatment enables significant reduction in the risk of postoperative complications while allowing at least similar symptoms and quality of life outcomes and could be used as an alternative to surgical treatment for suitable patients. Long-term complications and relapse risks require further research.