Very long-term outcomes after surgery for colorectal endometriosis: a 15-year follow-up study.

Disc Excision for Colorectal Endometriosis As a Feasible and Safe Alternative to Segmental Resection: 5-Year Follow-up Study

Laparoscopic mesentery-sparing NOSE bowel resection for endometriosis: when and how?

S4054 Colorectal Endometriosis Masquerading as Metastatic Colorectal Cancer: Rethinking Diagnostic Certainty

Current trends in colorectal endometriosis: A bibliometric analysis of the past two decades

Abstract Study question I there a difference between the gastrointestinal functional outcomes of patients who underwent nerve- vessel-sparing segmental resection (NVSSR) or full-thickness discoid resection(FTDR) for colorectal DE Summary answer Compared to presurgical values, long-term GI function reflected by LARS-scores remains improved following NVSSR, whereas it remains unchanged following FTDR. What is known already Patients undergoing colorectal surgery for symptomatic deep endometriosis(DE) may experience postoperative impairment of gastrointestinal (GI) function. However,there is limited information on long-term follow up of this surgical sequela. Study design, size, duration This prospective study included patients who either underwentnerve- vessel-sparing segmental resection (NVSSR) or full-thickness discoid resection(FTDR) for symptomatic colorectal DE from April 2017 to May 2022 at two tertiary referralcenters. As published previously, GI function was evaluated by LARS and GIQLI scores pre-and postsurgically (postoperative visit 1) and were now re-evaluated (postoperative visit 2) togain information on long-term outcomes. Participants/materials, setting, methods Out of 121 patients, 92 were eligible for the final analysis at postoperative visit 2.The mean follow-up interval was 58.5±17.9 months in the NVSSR group and 61.6±10.7months in the FTDR group. As published previously, GI function was evaluated by LARS and GIQLI scores pre-and postsurgically (postoperative visit 1) and were now re-evaluated (postoperative visit 2) togain information on long-term outcomes. Main results and the role of chance Compared to preoperative LARS scores, patients in the NVSSR-group showed a significant reduction of LARS scores at long term postoperative visit 2(p = 0.001), with LARS scores remaining stable over postoperative visit 1 and visit 2(p = 0.09) at 5 years postoperatively. In women following FTDR, presurgical and long-term postoperative visit 2 LARS scores remained statistically unchanged (p = 0.73), with worsening of LARS scores between postoperative visit 1 and visit 2 (p = 0.02). In contrast, significant improvement of GIQLI was observed between the preoperative visit and postoperative visit 2at five years follow up in both, NVSSR and FTDR groups (p = 0.001 and p = 0.001, respectively). Limitations, reasons for caution The utilization of PROMs such as LARS may yield different results in certain subgroups and should be interpreted with caution. Wider implications of the findings Gastrointestinal function, as indicated by GIQLI scores remains permanently improved following conservative or radical surgery for symptomatic colorectal DE at a mean long-termfollow-up of five years. Trial registration number No

Colorectal endometriosis surgery: Technical and technological innovations in service of a complex surgery

Robotic-assisted surgery (RAS) offers a broader surgical field, enhanced visualization, and greater instrument maneuverability, suggesting potential advantages over traditional laparoscopic surgery (LPS), which is currently the gold standard for treating colorectal endometriosis. To address this gap, we conducted a comprehensive review of existing studies to compare the perioperative outcomes of RAS and LPS in the management of colorectal endometriosis. A comprehensive search was conducted in the databases of PubMed, Web of Science, the Cochrane Library, and SpringerLink to identify any studies that prior to February 2nd, 2025. To compare RAS to LPS for colorectal endometriosis, we looked at things like operation duration, expected blood loss, length of stay, conversion to laparotomy, all complications, and bowel endometriosis resection. The operative time for RAS in colorectal endometriosis resection was significantly longer than that for LPS (data aggregated from six studies; WMD 21.51min, 95% CI 4.58-38.43, p < 0.05). However, there were no significant differences between the two groups in intraoperative blood loss (four studies; WMD 1.2ml, 95% CI - 34.01-36.41, p = 0.95), length of hospital stay (four studies; WMD 0.2days, 95% CI - 1.09-1.49, p = 0.76), or the number of cases requiring conversion to laparotomy (four studies; OR 2.27, 95% CI 0.52-9.95, p = 0.28) (Fig. 2). LPS demonstrated a significantly higher utilization of segmental resection (six studies; OR 0.71, 95% CI 0.54-0.93, p < 0.05), while no significant differences were observed in the rates of shaving (six studies; OR 1.06, 95% CI 0.77-1.47, p = 0.71) or double discoid excision (six studies; OR 1.3, 95% CI 0.95-1.78, p = 0.1) (Fig. 3). Additionally, the included studies reported no significant differences in overall complication rates (five studies; OR 0.9, 95% CI 0.64-1.28, p = 0.57) (Fig. 3) or the incidence of Clavien-Dindo classification complications classified as Grade I(five studies; OR 0.85, 95% CI 0.44-1.65, p = 0.64), II(five studies; OR 0.59, 95% CI 0.35-1.0, p = 0.5), III(five studies; OR 1.12, 95% CI 0.63-2.0, p = 0.7), or IV(five studies; OR 0.8, 95% CI 0.14-4.59, p = 0.81). Our study found that, apart from a significantly longer operative time for RAS compared to LPS, RAS demonstrated comparable outcomes in intraoperative blood loss, length of hospital stay, conversion to open surgery, bowel endometriosis resection, and postoperative complication rates. These findings suggest that RAS has the potential to become a viable alternative to LPS in the future. However, this conclusion still requires validation through large-scale, prospective, randomized controlled trials.

Rectovaginal/colorectal endometriosis is severe form of endometriosis requiring complex surgery, where pre-operative gonadotrophin releasing hormone agonists (GnRHa) are used to improve the surgical outcomes but the evidence supporting this is limited. To evaluate the association between pre-operative use of GnRHa and perioperative and postoperative complications in patients undergoing surgery for rectovaginal or colorectal endometriosis. We analysed prospectively collected data from British Society for Gynaecological Endoscopy-accredited endometriosis centres between 2009 and 2021. Multivariable logistic regression analysis was performed to model the odds of each complication by pre-operative GnRHa use, controlling for patient age, body mass index, smoking status, whether a hysterectomy was performed, history of previous endometriosis surgery and surgical complexity. The association of GnRHa use with perioperative and postoperative complications. We included 9,433 patients aged 18-55 years from 101 specialist endometriosis centres from six countries including UK, USA, Sri Lanka, Saudi Arabia, Turkey and Iran. Patients receiving pre-operative GnRHa were associated with higher rate of perioperative complications [odds ratio (OR): 1.31, 95% confidence interval (CI): 1.08-1.59, P=0.007], late complications (OR: 1.477, 95% CI: 1.15-1.9, P=0.002) and pelvic haematoma (OR: 2.251, 95% CI: 1.41-3.64, P<0.001). After controlling for confounding factors, GnRHa use remained significantly associated with colostomy (aOR: 4.05: 95% CI: 1.51-12.7, P=<0.001] pelvic haematoma (aOR: 3.08, 95% CI: 1.72-5.75, P<0.001) and abscess (aOR: 2.25, 95% CI: 1.10-4.79, P=0.029). Health related quality of life (HR-QOL) improved in the Pre-GnRHa group at 12 months and 24 months (mean difference 2.09/100, 95% CI, 0.27-3.92, P=0.025) and (mean difference 2.85/100, 95% CI 0.55-5.16, P=0.015). Pre-operative use of GnRHa has been associated with a higher incidence of perioperative and late complications, including significantly increased odds of colostomy, pelvic hematoma and abcess formation. There is need of careful patient counselling and further prospective research to clarify the pre-operative use of GnRHa in rectovaginal/colorectal endometriosis. There is need of caution use of pre-operative GnRHa in deep rectovaginal/colorectal endometriosis surgery due to increased association of the risks of complications such as colostomy, pelvic haematoma and abcess. Despite long-term improvement in HR-QOL, there is need for careful patient selection and counselling.

IntroductionPatients undergoing colorectal surgery for symptomatic deep endometriosis may experience postoperative impairment of gastrointestinal function. However, there is limited information on long‐term follow‐up of this surgical sequela. We aimed to analyze 5‐year postsurgical outcomes of gastrointestinal function in these patients, reflected by lower anterior resection syndrome (LARS) scores and gastrointestinal quality of life index (GIQLI).Material and MethodsThis prospective study included patients who either underwent nerve‐vessel‐sparing segmental resection (NVSSR) or full‐thickness discoid resection (FTDR) for symptomatic colorectal deep endometriosis from April 2017 to May 2022 at two tertiary referral centers. As published previously, gastrointestinal function was evaluated by LARS and GIQLI scores pre‐ and postsurgically (postoperative visit 1) and was now re‐evaluated (postoperative visit 2) to gain information on long‐term outcomes.ResultsOut of 121 patients, 92 were eligible for the final analysis at postoperative visit 2. The mean follow‐up interval was 58.5 ± 17.9 months in the NVSSR group and 61.6 ± 10.7 months in the FTDR group. As published previously, presurgical LARS‐like symptoms were observed in 42/92 (45.7%) of patients, including 37/76 (48.7%) in the NVSSR group and 5/16 (31.3%) in the FTDR group. Compared to preoperative LARS scores, patients in the NVSSR group showed a significant reduction of LARS scores at long‐term postoperative visit 2 (p = <0.001), with LARS scores remaining stable over postoperative visit 1 and visit 2 (p = 0.09) at 5 years postoperatively. In women following FTDR, presurgical and long‐term postoperative visit 2 LARS scores remained statistically unchanged (p < 0.73), with worsening of LARS scores between postoperative visit 1 and visit 2 (p = 0.02). In contrast, significant improvement of GIQLI was observed between the preoperative visit and postoperative visit 2 at 5 years follow‐up in both NVSSR and FTDR groups (p ≤ 0.001 and p = 0.001, respectively).ConclusionsCompared to presurgical values, long‐term gastrointestinal function reflected by LARS scores remains improved following NVSSR, whereas it remains unchanged following FTDR. However, when GIQLI is applied as patient‐reported outcome measurement (PROM), patients show permanent, long‐term improvement of gastrointestinal function following either NVSSR or FTDR for symptomatic colorectal endometriosis.

Various surgical techniques for the treatment of colorectal endometriosis have been described, and the benefit of a preventive stoma remains unclear. The aim of our study is to evaluate the risk of complications in patients who underwent surgery for colorectal endometriosis without a policy of preventive stoma. Retrospective cohort study of 97 consecutive patients treated for colorectal endometriosis in an expert centre from January 2022 to January 2024. Complications after colorectal endometriosis surgery in patients without preventive stoma. Forty-three patients were managed by segmental resection, 20 patients by single-disc excision, 5 patients by double-disc excision and 29 patients by rectal shaving. 48 patients required vaginal suturing. We found complications in 14% of patients. Severe complications (Clavien-Dindo ≥3) were encountered in 8.24% of patients. 3.09% developed a rectovaginal fistula. Patients with a colorectal endometriosis nodule larger than 3 cm had more complications than patients with smaller nodules (57.1% vs. 42.9% of total complications), with a P-value close to the statistical significance. Surgery for colorectal endometriosis performed in high-volume centres by expert surgeons leads to a reduction in the risk of postoperative complications. In our study, we did not perform routine preventive stoma formation, and we did not find an increase in postoperative complications compared to the literature. This study provides data on the risk of postoperative complications in patients undergoing surgery for colorectal endometriosis without a preventive stoma policy.

680 Clinicopathologic Features of Colorectal Endometriosis: Pre-operative Diagnostic Pitfalls

To define the risk factors of post-operative voiding dysfunction according to the type of surgical procedure performed. A systematic review through PubMed, the Cochrane Library, and Web of Science databases was performed. The Medical Subject Headings terms aimed for English articles about colorectal endometriosis surgery and voiding dysfunction published until December 26, 2022 were used. The primary outcome was the occurrence of post-operative voiding dysfunction. Secondary outcome was the presence of a persistent voiding dysfunction at 1month. MeSH terms included ''deep endometriosis'', ''surgery'', or ''voiding dysfunction''. Two reviewers (AM, PE) assessed the quality of each article independently. A Study Quality Assessment Tool was used to provide rating of the quality of the included studies. 22 studies were included in the final analysis. Rectal shaving was associated with less voiding dysfunction than segmental resection (OR 0.33; 95%CI [0.20: 0.54]; I2 = 0%; p < 10-3). No difference was found between rectal shaving and discoid excision (OR 0.44; 95%CI [0.07: 2.84]; I2 = 55%; p = 0.39), nor between discoid excision and segmental resection (OR 0.44; 95%CI [0.18: 1.09]; I2 = 49%; p = 0.08). Conservative surgery (i.e., shaving and discoid) was associated with less voiding dysfunction than radical surgery (i.e., segmental resection) (OR 0.37; 95%CI [0.25: 0.55]; I2 = 0%; p < 10-3). Regarding persistent voiding dysfunction, rectal shaving and discoid excision were less associated with voiding dysfunction than segmental resection (respectively, OR 0.30; 95%CI [0.14: 0.66]; I2 = 0%; p = 0.003 and OR 0.13; 95%CI [0.03: 0.57]; I2 = 0%; p = 0.007). Conservative bowel procedures are associated with lower rates of persistent post-operative voiding dysfunction and should be considered first when possible.Trial registration: Our meta-analysis was registered under the PROSPERO number: CRD42023395356.

Aim. Analysis of the composition of intestinal microbiota in patients with endometriosis and determination of the potential value of fecal biomarkers in the diagnosis of the disease. Design. Сross-sectional, single-center clinical study. Materials and methods. The clinical and anamnestic data of 260 women with endometriosis (mean age 28 (25; 33) years) were analyzed. A comparison group of 130 age-matched women without signs of genital endometriosis was selected to study symptoms and comorbid conditions of endometriosis. In order to measure the concentrations of fecal markers, 56 women of the main group and 21 of the comparison group were randomized, fecal samples of 37 patients with endometriosis and 22 women of the comparison group were selected for microbiological examination. Microbiological examination of fecal samples was performed by culture and quantitative real-time polymerase chain reaction (PCR) methods, and the concentrations of fecal markers (calprotectin, hemoglobin, transferrin) were estimated by the HTSA Plus immunochemical method in the same biological material. Results. Every 4th patient with endometriosis had complaints of dyschezia (68/260, 26.2%), and more than 60% reported changes in stool character during menstruation in the form of loosening or constipation (161/260, 61.9%). Analysis of gastrointestinal tract (GIT) pathology showed that 77 (29.6%) patients had concomitant organic GIT diseases, i. e. 1.4 times more often than in the comparison group, 60 (23,1%) had irritable bowel syndrome (IBS). The presence of complaints of stool changes during menstruation increased the chances of diagnosing endometriosis 2-fold, concomitant IBS — 5-fold, and dyschezia more than 16-fold. Every 2nd patient with endometriosis (27/56, 48.2%) had a fecal calprotectin concentration greater than reference values, which was also positively correlated with symptoms of intestinal dysbiosis (r = 0.397, p = 0.0025). Analysis of the composition of the intestinal microbiota showed a decrease in species richness, an increase in the frequency and titer of opportunistic microorganisms and a decrease in the colonization of symbiont bacteria in endometriosis. The realtime PCR method had advantages for additional detection of complexly cultured microorganisms; a decrease in the titer of symbiont bacteria of the Clostridium leptum gr. cluster (p = 0.02808), Faecalibacterium prausnitzii (p = 0.03635) and Akkermansia muciniphila (p = 0.05297), microorganisms of the family of the genus Desulfovibrio (p = 0.04852) was detected. Conclusion. An important stage of clinical and anamnestic examination of patients with endometriosis, in addition to the detection of IBS, is the assessment of the presence of organic pathology of the gastrointestinal tract and a number of gastrointestinal symptoms, which can increase the chances of diagnosing endometriosis up to 16 times. Studying the composition of the intestinal microbiota in endometriosis is a promising direction, it is advisable to comprehensively determine the microbial composition by culture and quantitative real-time PCR methods using an extended multiplex panel. Measurement of faecal marker levels seems to be a promising but insufficiently studied method for non-invasive diagnosis of endometriosis, which requires additional studies with a larger sample of patients with colorectal endometriosis. Keywords: endometriosis, intestinal microbiota, culturomics, real-time polymerase chain reaction, faecal calprotectin.

Гетеротопическая беременность у пациентки после оперативного лечения колоректального эндометриоза

Total Laparoscopic Segmental Resection with Transanal Natural Orifice Specimen Extraction for Treatment of Colorectal Endometriosis: Descriptive Analysis from the TrEnd Study Database

Background/Objectives: Deep infiltrating endometriosis has been linked to worsened maternal and neonatal outcomes. However, reports regarding bowel endometriosis are still scanty. We aimed to evaluate pregnancy, delivery, and newborn adverse outcomes in women after laparoscopic-assisted surgery for bowel endometriosis. Methods: A single-center retrospective cohort study was conducted at a tertiary-care university hospital. From January 2015 to December 2021, pregnant women who were diagnosed and treated for bowel endometriosis were matched using a 1:3 ratio with pregnant women with no history of endometriosis. Patients were matched using the Cox proportional hazards model to determine parity, age, BMI and gestational age-adjusted relative risk (aRR) with a 95% confidence interval (CI). Co-primary outcomes were the incidence of labor abnormalities and cesarean section (CS) rate. Co-secondary outcomes were incidence of complications related to pregnancy, delivery, and newborn. Results: A total of 71 pregnancies among women treated for bowel endometriosis and 213 from healthy controls were included. Patients requiring IVF/ET for getting pregnant were in the bowel endometriosis group relative to controls (43.7% vs. 11.7%; p &lt; 0.001). Increased risk of labor abnormalities was present for bowel endometriosis relative to controls (21.1% vs. 17.4%; p = 0.040; aRR 1.39 [95% CI 1.06–2.05]). Risk of non-cephalic fetal presentation (14.1% vs. 6.1%; p = 0.016; aRR 3.08 [95% CI 2.03–4.68]), CS rate (43.7% vs. 24.9%; p = 0.003; aRR 1.75 [95% CI 1.23–2.49]), and emergent CS rate (19.7% vs. 8.5%; p = 0.009; aRR 2.21 [95% CI 1.55–3.16]) were significantly higher in women treated for colorectal endometriosis compared with controls. Moreover, placenta previa (9.9% vs. 0.0%; p &lt; 0.001; aRR 21.82 [95% CI 2.19–116.40]), second-trimester hemorrhage (5.6% vs. 0.9%; p = 0.017; aRR 6.00 [95% CI 1.12–32.06]), postpartum hemorrhage (15.5% vs. 3.3%; p &lt; 0.001; aRR 4.71 [95% CI 1.90–11.70]), and the need for transfusion during labor (5.6% vs. 0.5%; p = 0.004; aRR 12.00 [95% CI 1.36–105.60]) were increased in treatments vs. controls. Concerning neonatal outcomes, an increased risk for neonatal intensive care unit admission was seen in postsurgical endometriotic women relative to healthy controls (26.0% vs. 6.9%; p &lt; 0.001; aRR 3.75 [2.04–3.86]). Conclusions: Women treated for bowel endometriosis seem more exposed to adverse pregnancy and neonatal outcomes relative to healthy controls. However, additional prospective and comparative studies are needed to validate the available evidence.

This study aims to examine the effect of full thickness discoid resection (FTDR) and modified, limited nerve-vessel sparing segmental bowel resection (NVSSR) in symptomatic patients with low rectal deep endometriosis (DE) within 7 cm from the anal verge. Presurgical and postsurgical evaluation of gastrointestinal (GI) function reflected by low anterior resection syndrome (LARS) and gastrointestinal function-related quality of life index (GIQLI) scores, complication rates, pain scores/visual analog scale (VAS) and endometriosis health profile (EHP-30) was performed. In this prospective multicenter cohort study, 63premenopausal patients with symptomatic low (within 7 cm from the anal verge) colorectal endometriosis, undergoing low modified limited nerve vessel sparing rectal segmental bowel resection (NVSSR) and full thickness discoid resection (FTDR) were evaluated. Presurgery and postsurgery lower anterior resection syndrome (LARS) scores, gastrointestinal function-related quality of life index (GIQLI), pain symptoms, endometriosis health profile (EHP-30) parameters compared between two groups. Out of 63women, 49(77.8%) underwent NVSSR while 14(22.2%) underwent FTDR. LARS-like symptoms were observed presurgically in 24/63 (38.1%) patients. Postsurgical LARS was observed in 14/63 (22.2%) of the patients (10/49, 20.4% in NVSSR vs.4/14, 28.5% in the FTDR group). The LARS-like symptoms significantly decreased following surgery in the FTDR group (p = 0.049) and showed atrend for decrease in the NVSSR group (p = 0.077). Postsurgical de novo LARS was only observed in 5/63 (8%) of the patients (NVSSR 4/49, 8.1%, FTDR 1/14, 7.1%). Postsurgical GIQLI scores improved in both groups (p < 0.001) with comparable changes in the NVSSR and FTDR cohorts (p = 0.490). Postoperative gradeIII complication rates between NVSSR and FTDR did not vary significantly (6/49, 12.2% vs.3/14, 21.4% p = 0.26). Pain/VAS scores and EHP-30 scores significantly decreased after amean follow-up of 29.6 ± 11 months and 30.6 ± 11months in the NVSSR and FTDR groups, respectively (EHP-30; p < 0.001; dysmenorrhea, dyspareunia, dyschezia all p < 0.05 for both cohorts). When comparing low colorectal surgery by either NVSSR or FTDR in ahigh-risk group for surgical complications, both techniques confer improvement of GI function reflected by LARS and GIQLI with non-significant differences in major complication rates, reduced pain and EHP-30 scores.

Colorectal endometriosis – a challenging, often overlooked cause of colorectal pathology: a clinicopathological review of 114 cases

Objective: To organize the experience and international knowledge in the surgical management and staging of colorectal endometriosis, with a management proposal in stages. Method: An extensive non-systematic review of the literature was carried to organize the disease in stages (limited, intermediate and advanced) according to a scoring system, which considers the characteristics of the endometrioma, the personal history and surgical findings. We tested the proposed staging in a retrospective group of patients. Results: From January 2017 to April 2023, we collected 19 patients with a confirmed diagnosis of colorectal endometriosis, treated laparoscopically, by the same group of surgeons, in whom we found a strong correlation between the stage of the disease and the presence of complications that required reinterventions. Conclusions: We suggest a sequence of colorectal surgical management in stages according to the staging of the disease and we hope that this work will be followed by joint efforts to test it prospectively in order to compare results between hospital centers and make planned decisions.