Is Ileostomy Always Necessary Following Rectal Resection for Deep Infiltrating Endometriosis?

Abstract

ObjectiveTo verify the hypothesis that in most patients bowel segmental resection to treat endometriosis can be safely performed without creation of a stoma and to discuss the limitations of this statement. DesignRetrospective study (Canadian Task Force classification III). SettingTertiary referral center. PatientsForty-one women with sigmoid and rectal endometriotic lesions who underwent segmental resection. InterventionSegmental resection procedures performed between 2004 and 2011. Patient demographic, operative, and postoperative data were compared. Measurements and Main ResultsSigmoid resection was performed in 6 patients (15%), and rectal anterior resection in 35 patients (high in 21 patients [51%], and low, i.e., <10 cm from the anal verge, in 14 [34%]). In 4 patients a temporary ileostomy was created. There was 1 anastomotic leak (2.4%), in a patient with an unprotected anastomosis, which was treated via laparoscopic surgery and creation of a temporary ileostomy. Other postoperative complications included hemoperitoneum, pelvic abscess, pelvic collection, and a ureteral vaginal fistula, in 1 patient each (all 2.4%). ConclusionA protective stoma may be averted in low anastomosis if it is >5 cm from the anal verge and there are no adverse intraoperative events.