Conservative vs radical bowel surgery for endometriosis: A systematic analysis of complications.

BACKGROUND: Endometriosis of the bowel can be associated with significant morbidity. Surgery to remove it carries risks. Options include conservative shaving or discoid resection and more radical segmental bowel resection. AIMS: To determine if more conservative shaving or discoid bowel resection is associated with fewer risks than more radical segmental resection. MATERIAL AND METHODS: This study is a systematic review. We considered eligible any cohort, observational or randomised controlled trial (RCT) study of at least ten women per arm comparing conservative vs radical bowel surgery for endometriosis. We divided complications into two groups, major and minor. One additional article was added due to its significance in answering our study question as well as the high quality of the study design as an RCT. RESULTS: There were 3041 studies screened. Eleven studies were included (n = 1648). For major complications, the risk ratio for shaving and disc excision vs segmental resection is 0.31 (95% CI 0.21-0.46), while the risk difference is -0.25 (95% CI -0.41 to 0.10). For minor complications, the risk ratio is 0.63 (95% CI 0.36-1.09), while the risk difference is -0.03 (95% CI -0.12 to 0.05). CONCLUSIONS: Conservative shaving or discoid excision surgery is associated with reduced complications. Previous studies demonstrated a trend toward this finding, but suffered from relatively low participant numbers, increasing the risk of type one statistical error. Our results allow surgeons to make informed choices about potential complications when deciding how to approach bowel endometriosis. The results also allow patients to have more information about the risks. However, outcomes in the studies analysed are heterogenous and are from low-quality evidence.

Differential effects of cigarette smoking on birth weight by maternal body mass index.

Links between low birth weight and tobacco exposure in utero are well established, as are associations between maternal body mass index (BMI) and birth weight. This study further develops those relationships. In particular, this article analyses whether high maternal weight acts to dampen the previously established link between tobacco exposure and low birth weight. A retrospective cohort study was undertaken, reviewing the birth weights of 13,473 live singleton pregnancies born at a Sydney regional hospital between 1998 and 2003. Results demonstrated a statistically significant decline in reduced birth weight as BMI increased. That is, as body weight increases, tobacco use has a smaller effect on reducing birth weight. Inversely, the effect on reducing birth weight for each cigarette smoked by leaner women was greater. In effect, the adverse influence of tobacco use on birth weight appears to be modulated by increasing maternal BMI.