Abstract
Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). This study was to determine outcomes in IMA-sparing surgery in endometriosis cases. A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. During the study period, 1497 patients had major gynecological surgery in our referral center, of whom 253 (17%) for endometriosis. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Short-term complications occurred in 4 cases (7%) without any case of anastomotic leak. Preservation of the IMA in colorectal surgery for endometriosis is feasible, safe and enables a tension-free anastomosis without an increase of postoperative complication rates.
Highlights
Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery
14 (18.7%) showed multiple endometriosis nodules on the same bowel tract and in three cases the length of bowel resected was longer than 10 cm ( 12, 16 and 18 cm) with sigmoid involvement, a low transection of the IMA was made
This study demonstrates that IMA-sparing surgery in laparoscopic rectosigmoid resection for endometriosis is feasible without any increase in postoperative complication rate
Summary
Laparoscopic rectosigmoid resection for endometriosis is usually performed with the section of the inferior mesenteric artery (IMA) distal to the left colic artery (low-tie ligation). A single-center retrospective study based on the analysis of clinical notes of women who underwent laparoscopic rectosigmoid segmental resection and IMA-sparing surgery for deep infiltrating endometriosis with bowel involvement between March the 1st, 2018 and February the 29th, 2020 in a referral hospital. Of the 100 patients (39%) who had bowel endometriosis, 56 underwent laparoscopic nerve-sparing rectosigmoid segmental resection and IMA-sparing surgery was performed in 53 cases (95%). Bowel surgery is indicated in cases of evidence of significant stenosis[8], symptomatic lesions (chronic pelvic pain resistant to medical therapy, dyschezia, rectal bleeding, and progressive constipation up to bowel obstruction)[9,10], or to improve fertility[4,8,11]. Several procedures for bowel surgery (rectal shaving, discoid excision, and colorectal resection) could be considered according to size (longitudinal and transverse diameters)[12], appearance (plane, convex, multifocal), location (distance from the anal verge) of the n odule[13], and previous bowel s urgery[8]. It is a complex intervention that should be performed in a multidisciplinary setting, including expert gynecologists and colorectal surgeons
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