2991 Planned Multidisciplinary Surgical Approach to Deep Infiltrating Endometriosis

Abstract

Study Objective To describe a multidisciplinary minimally invasive approach to deep infiltrating endometriosis (DIE) with colorectal and gynecologic surgeons. Design A retrospective cohort study. Setting Between 2014-2018, all patients with suspected DIE and intestinal involvement were assessed by a team of minimally invasive gynecologic surgeons (MIGS) and colorectal surgeons at the University of North Carolina Hospitals. Perioperative data were abstracted from medical records and analyzed. Patients or Participants Women ≥18 years of age with suspected DIE. Interventions MIGS and colorectal surgical teams planned combined cases in patients with clinical suspicion, prior diagnosis or radiographical evidence of DIE. Preoperative work-up included imaging, predominately lower endoanal ultrasound or pelvic MRI. Interventions indicated by patient's goals and disease burden included variable combinations of gynecologic and colorectal procedures. Measurements and Main Results Thirty-three patients were included, with a mean age of 37 years and average BMI of 30.5. Most were African American (48.5%) or Caucasian (33.3%) and had a prior laparotomic (56.7%) or laparoscopic (90.9%) surgery. At the initial gynecologic consult, patients reported hematochezia (21.2%), constipation (45.5%), dyschezia (66.7%), and straining during bowel movement (21.2%). An endoanal ultrasound (54.6%) and/or pelvic MRI (39.4%) were obtained based on symptoms and exam for suspected DIE. Imaging findings suggestive of bowel disease were strongly correlated (80%), therefore all patients underwent a preoperative colorectal consult. Combined hysterectomy and bowel resection were performed in 18 cases (54.5%), excision of endometriosis and bowel resection for DIE in six cases (18.1%). Six excision of DIE cases required bowel adhesiolysis alone (18.1%) and one case needed no colorectal intervention (3%). One case required conversion to laparotomy (3%). Conclusion A planned multidisciplinary gynecological–colorectal approach for the management of DIE can be performed in a minimally invasive manner in patients with suspected colorectal disease. We recommend a stepwise approach of preoperative imaging and a colorectal consult to coordinate two surgical teams.