Multiple Nodule Removal by Disc Excision and Segmental Resection in Multifocal Colorectal Endometriosis

Abstract

Study ObjectiveTo report postoperative outcomes after dual digestive resection for deep endometriosis infiltrating the rectum and the colon. DesignA retrospective study using data prospectively recorded in the CIRENDO database (Canadian Task Force classification II-2). SettingA university tertiary referral center. PatientsTwenty-one patients managed for multiple colorectal deep endometriosis infiltrating nodules. InterventionsConcomitant disc excision and segmental resection of both the rectum and sigmoid colon. Measurements and Main ResultsThe assessment of postoperative outcomes was performed. Rectal nodules were managed by disc excision and segmental resection in 20 patients and 1 patient, respectively. Sigmoid colon nodules were removed by short segmental resection and disc excision in 15 and 6 patients, respectively. The rectal nodule diameter was between 1 and 3 cm and over 3 cm in 33% and 67% of patients, respectively. Associated vaginal infiltration requiring vaginal excision was recorded in 76.2% of patients. The mean diameter of the rectal disc removed averaged 4.6 cm, and the mean height of the rectal suture was 5.8 cm. The length of the sigmoid colon specimen and the height of the anastomosis were 7.3 cm and 18.5 cm, respectively. The mean operative time was 290 minutes, and the mean postoperative follow-up averaged 30 months. Clavien-Dindo 3 complications occurred in 28% of patients, including 4 with rectal fistulae (19%). The pregnancy rate was 67% among patients with pregnancy intention. ConclusionOur data suggest that combining disc excision and segmental resection to remove multiple deep endometriosis nodules infiltrating the rectum and the sigmoid colon can preserve the healthy bowel located between 2 consecutive nodules. However, the rate of postoperative complications is high, particularly in patients with large low rectal nodules.