Colorectal Resection For Endometriosis Research Articles

An analysis of body mass index and the risk of postoperative complications following colorectal resection for endometriosis

An analysis of body mass index and the risk of postoperative complications following colorectal resection for endometriosis

Colorectal resection in endometriosis patients: correlation between histopathological findings and postoperative outcome

IntroductionEndometriosis is associated with a high number of chronic pelvic pain and reduced quality of life. Colorectal resections in case of bowel involvement of endometriosis are associated with an unneglectable morbidity in young and healthy patients. There is no linear correlation established between the degree of symptoms and stage of endometriosis. The aim of this study was to correlate the histological findings to preoperative pain scores in colorectal resected patients with endometriosis.MethodsTwenty-five patients who underwent laparoscopic colorectal resection for endometriosis between 2014 and 2019 were included in this retrospective study. Pain level was assessed preoperatively and postoperatively via phone call in May 2020. Histopathology was correlated to preoperative symptoms and postoperative outcome.ResultsAverage follow-up time was 38.68 months (± 19.92). Preoperative VAS-score was 8.32 (± 1.70). We observed a significant reduction of pain level in all patients after surgery (p ≤ 0.005). Pain levels were equal regarding the presence of satellite spots and various degrees of infiltration depth. The resection margins were clear in all patients. Postoperative complications occurred in 6 cases (24%) and anastomotic leakage was observed in 3 patients (12%). Average VAS-score at time of follow-up was 1.70 (± 2.54).ConclusionOur data demonstrate that adequate colorectal resection leads to reduction of pain and an increase of quality of life irrespective of histopathological findings. An experienced team is necessary to improve intraoperative outcome and to reduce postoperative morbidity in case of complication.

Prevesical peritoneum interposition to prevent risk of rectovaginal fistula after en bloc colorectal resection with hysterectomy for endometriosis: Results of a pilot study

ObjectiveTo evaluate the risk of rectovaginal fistula after en bloc hysterectomy and colorectal resection (H-CR) for endometriosis using prevesical peritoneum interposition. Study DesignA retrospective study conducted at Tenon University Hospital, expert center in endometriosis, from June 2016 to June 2018. Patients undergoing H-CR with prevesical peritoneum interposition without protective defunctioning stoma were included. ResultsOf the 160 patients who underwent surgery with colorectal resection for endometriosis during the study period, 27 had H-CR (15 with segmental and 12 with discoïd colorectal resection) and were included. The median age (range) was 45 years (41–47.5). Eight patients (13 %) were nulliparous. All procedures were performed by laparoscopy. Parametrial resection was performed in 14 cases (52 %). Associated bowel procedures were ileocecal resection (n = 5) and appendectomy (n = 2). Median follow-up (range) was 14.6 months (10.5–20.2). Nine (33.3 %) patients experienced intra- or postoperative complications including one grade I, four grade II, two grade IIIA and two grade IIIB complications (Clavien-Dindo classification). Seven patients (26 %) experienced postoperative voiding dysfunction. One suspicion of rectovaginal fistula associated with pelvic abscess was diagnosed 4 weeks after surgery but not confirmed during a second operation. ConclusionDespite the small sample size, the present pilot study supports the practice of prevesical peritoneum interposition to limit the risk of rectovaginal fistula in patients who undergo H-CR for deep endometriosis.

Laparoscopic surgery for deep infiltrating endometriosis (DIE) - clinical management and outcome in a multidisciplinary center

Endometriosis is a benign disease with highly variable symptoms. The adequate treatment for symptomatic disease requires complete resection of all lesions. In advanced stages, bowel involvement is common. However, indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The aim of this study was to assess the feasibility of complete laparoscopic management of symptomatic deep pelvic endometriosis in a new multidisciplinary center in Romania. We included and retrospectively evaluated 74 patients treated for symptomatic deep infiltrating endometriosis in our institution between 2014 and 2015. In the majority of patients (97.3%), radical resection was achieved entirely using a minimally invasive surgical technique. Complications occurred in only 2 cases with anastomotic leakage in 1 patient and a rectovaginal fistula in another patient. A well-trained interdisciplinary team can perform the laparoscopic treatment of deep infiltrating endometriosis with low incidence of major complications and good clinical outcome.

Protective Ileostomy in Colorectal Resection for Endometriosis: Is It Truly Protective?

Protective Ileostomy in Colorectal Resection for Endometriosis: Is It Truly Protective?

Long-term symptoms, quality of life, and fertility after colorectal resection for endometriosis: extended analysis of a randomized controlled trial comparing laparoscopically assisted to open surgery.

To evaluate the long-term symptoms, quality of life (QOL), and fertility after colorectal resection for endometriosis. Extended analysis of a randomized controlled trial including 52 patients with colorectal endometriosis, comparing laparoscopically assisted to open colorectal resection. All included patients were invited to complete questionnaires evaluating the presence and intensity of symptoms and QOL using the SF-36 and fertility at a mean (SD) follow-up of 50.7 (13.8) months. We compared symptoms intensity and QOL before and after surgery at short- (mean follow-up of 19 months) and long-term (mean follow-up of 51 months). Persistent improvement in QOL was noted after surgery without differences between short and long term. Self-catheterization >6 months was the sole factor decreasing the long-term QOL (P = 0.02). No difference in symptoms and QOL was noted according to the route. Among the 28 patients (53.8%) wishing to conceive, 12 (42.9%) conceived within a mean (SD) time of 17 (13) months. No difference in fertility including pregnancy after IVF was noted between the routes, but spontaneous pregnancy occurred only after laparoscopy (P = 0.016). Symptoms and QOL improvements after colorectal resection last for over 4 years without difference between the routes. Thank to a lower intra- and postoperative complications and higher spontaneous pregnancy rate, laparoscopic colorectal resection should be the first surgical approach.

Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis

Study ObjectiveTo evaluate the role of protective defunctioning stoma (PDS) on the occurrence of digestive tract complications after colorectal resection to treat endometriosis. DesignProspective cohort study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsAll patients undergoing segmental colorectal resection to treat colorectal endometriosis with and without PDS between 2003 and 2011 at Tenon University Hospital, Paris, France. Measurements and Main ResultsPatients were assessed at 1, 6, and 12 months postoperatively and each year thereafter. Median follow-up was 60 months. Of 198 patients included for analysis, 53 (27%) had PDS. Overall, 15 (7.5%) digestive tract complications occurred: 9 (4.5%) rectovaginal fistulas and 6 (3%) anastomotic leakages. All rectovaginal fistulas occurred in patients with a low colorectal anastomosis (p < .001) and 88% (8 of 9) in patients with a partial colpectomy (p < .001). PDS was associated with a decrease in the number of rectovaginal fistulas in women undergoing partial colpectomy and low colorectal resection from 27% to 15%, without reaching significance (p = .4). No anastomotic leakage occurred in patients with PDS. ConclusionOur results support that PDS can be omitted in patients with mid-colorectal anastomosis without partial colpectomy. In patients requiring partial colpectomy or partial colpectomy plus low colorectal anastomosis, PDS remains questionable.

Early Postoperative Outcomes After Laparoscopic Segmental Colorectal Resection for Endometriosis: The Impact of Surgical Experience

Early Postoperative Outcomes After Laparoscopic Segmental Colorectal Resection for Endometriosis: The Impact of Surgical Experience

Urinary dysfunction after colorectal resection for endometriosis: results of a prospective randomized trial comparing laparoscopy to open surgery

To evaluate urinary symptoms before and after colorectal resection for endometriosis using validated questionnaires. We randomly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection. The median follow-up was 19 months. Urinary symptoms were evaluated using the International Prostate Score Symptom and the Bristol Female Low Urinary Tract Symptoms questionnaires. Dysuria was observed in 29% of cases postoperatively. Using Bristol Female Low Urinary Tract Symptoms and International Prostate Score Symptom scores, an alteration was observed for voiding symptoms (P = .01 and P = .006, respectively). No difference was observed between the laparoscopy and the open surgery group. An alteration of the International Prostate Score Symptom voiding symptoms was observed in the group that did not undergo nerve sparing surgery (P = .048). An alteration of the International Prostate Score Symptom voiding symptoms was observed for patients who underwent vaginal resection (P = .01) and parametrial resection (P = .02). Our findings confirm that colorectal resection for endometriosis is a source of urinary dysfunction whatever the surgical route.

Post-operative digestive symptoms after colorectal resection for endometriosis

Post-operative digestive symptoms after colorectal resection for endometriosis

Reply: Post-operative digestive symptoms after colorectal resection for endometriosis

Reply: Post-operative digestive symptoms after colorectal resection for endometriosis