Resection Of Endometriosis Research Articles

Fertility outcomes after laparoscopic partial bladder resection for deep endometriosis: Retrospective analysis from two expert centres and review of the literature

ObjectiveTo evaluate fertility outcomes after laparoscopic partial bladder resection in women with bladder endometriosis and to review the literature. Study designA retrospective study conducted at two tertiary referral centres –Tenon University Hospital and Poissy University Hospital (Canadian Task Force Classification Level II-2)–from July 2006 to November 2015.Patients with bladder endometriosis who underwent either laparoscopic partial bladder resection (PBR) alone for those without posterior endometriotic lesions (PBR group) or both laparoscopic PBR and associated posterior deep infiltrating endometriosis (DIE) resection (PBR-PDIE group) were included. Pregnancy and live birth rates according to prior infertility, and associated posterior DIE resection were analysed. ResultsThirty-four patients were included; 15 in the PBR group and 19 in the PBR-PDIE group. The median age (range) was 31 years (25–37), Seventeen patients (50%) had prior infertility. The median follow-up after bladder resection was 60.6 months (12–116). Overall, of the 25 (73.5%) patients who wished to conceive, 17 (68%) achieved pregnancies resulting in a live birth rate of 76.4%. Among the 17 patients with prior infertility, nine (52.9%) conceived. Overall, eight patients (53.3%) in the PBR group conceived and nine (47.3%) in the PBR-PDIE group (difference not significant). ConclusionThe present study demonstrates that laparoscopic PBR results in a high pregnancy rate in patients with prior infertility as well as in those with associated posterior DIE suggesting that surgery could be an acceptable alternative to first-line assisted reproductive technology.

Comparison of Laparoscopic Discoid Resection and Segmental Resection for Colorectal Endometriosis Using a Propensity Score Matching Analysis

Study ObjectiveOur primary endpoint was to compare the intra- and postoperative complications, whereas secondary endpoints were the occurrence of voiding dysfunction and evaluation of the quality or life of segmental and discoid resection in patients with colorectal endometriosis. DesignRetrospective study (Canadian Task Force classification II-2). SettingTenon University Hospital in Paris. PatientsThirty-one 31 patients who underwent a conservative surgery and 31 patients who underwent. InterventionsThe 2 groups were compared using propensity score matching (PSM) analysis, with a median follow-up of 247 days (8.2 months). Measurements and Main ResultsDiscoid colorectal resection was associated with a shorter operating time (155 vs 180 minutes, p = .03) and hospital stay (7 vs 8 days, p = .002) than segmental colorectal resection; however, a similar intra- and postoperative complication rate was found. A higher rate of postoperative voiding dysfunction was observed in the segmental resection group (19% vs 45%, p = .03) as well as duration of voiding dysfunction requiring bladder self-catheterization longer than 30 days (0 vs 22%, p = .005). ConclusionOur PSM analysis suggests the advantages of discoid resection because it results in a similar surgical complication rate to segmental resection but with advantages in operating time, hospital stay, and voiding dysfunction.

Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis.

Can live birth be accurately predicted following surgical resection of moderate-severe (Stage III-IV) endometriosis? Live births can accurately be predicted with the endometriosis fertility index (EFI), with adnexal function being the most important factor to predict non-assisted reproductive technology (non-ART) fertility or the requirement for ART (www.endometriosisefi.com). Fertility prognosis is important to many women with severe endometriosis. Controversy persists regarding optimal post-operative management to achieve pregnancy and the counselling of patients regarding duration of conventional treatments before undergoing ART. The EFI is reported to correlate with expectant management pregnancy rate, although external validation has been performed without specifically addressing fertility in women with moderate and severe endometriosis. Retrospective cohort study of 279 women from September 2001 to June 2016. We included women undergoing laparoscopic resection of Stage III-IV endometriosis who attempted pregnancy post-operatively. The EFI was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan-Meier model, log rank test and Cox regression were used for analyses. The follow-up rate was 84% with a mean duration of 4.1 years. A total of 147 women (63%) had a live birth following surgery, 94 of them (64%) without ART. The EFI was highly associated with live births (P < 0.001): for women with an EFI of 0-2 the estimated cumulative non-ART live birth rate at five years was 0% and steadily increased up to 91% with an EFI of 9-10, while the proportion of women who attempted ART and had a live birth, steadily increased from 38 to 71% among the same EFI strata (P = 0.1). A low least function score was the most significant predictor of failure (P = 0.003), followed by having had a previous resection (P = 0.019) or incomplete resection (P = 0.028), being older than 40 compared to <35 years of age (P = 0.027), and having leiomyomas (P = 0.037). The main limitation of this study is its retrospective design. Imprecision was higher with low EFI due to smaller sample size in this subgroup. Finally, the EFI is somewhat subjective and could be prone to intra- and inter-observer variations. Women with a high EFI score have excellent fertility prognosis and may be advised to try to become pregnant with timed intercourse compared to women with a low score, for which prompt referral to ART seems more reasonable. Other prognostic factors can be used to guide the management of women with an intermediate EFI score. These data follow women over many years post-resection and represent longitudinal fertility data rarely demonstrated in such a cohort. The location and impact of lesions on the ability of the adnexa to function seems crucial for the fertility prognosis and should be further investigated. This study was funded by the GRACE Research funds. S.M.-L. is the recipient of a Training Award from the Fonds de Recherche Quebec-Sante. D.A. is the primary author of the Endometriosis Fertility Index. All authors have no conflicts of interest to declare. N/A.

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

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.

The Outcome on Conservative Surgical Treatment of Adenomyosis

Objective: To understand the outcome on conservative surgical&#x0D; treatment of adenomyosis.&#x0D; &#x0D; Methods: A retrospective cohort study followed for 2 years from&#x0D; 2010 to 2012 of women with adenomyosis were diagnosed by&#x0D; transvaginal sonography and confirmed histologically. Subjects divided&#x0D; into women who were treated by adenomyosis resection&#x0D; (with/without Osada’s technique) and who were underwent hysterectomy.&#x0D; &#x0D; Results: After the surgery, as many as 40 patients (81.63%) did not&#x0D; feel any pain (VAS 0), and 9 patients (18.37%) still felt pain. For the&#x0D; fertility outcome, we had 8 patients (20.51%) getting pregnant naturally&#x0D; without any fertility intervention. Two patients (5.13%) had&#x0D; successfully conceived by IVF. According to the type of surgery, from&#x0D; 8 natural pregnancy, 7 patients (87.50%) was underwent conventional&#x0D; resection of adenomyosis and 1 patients (12.50%) underwent&#x0D; Osada’s procedures. Two patients who were conceived by IVF, both&#x0D; of them were underwent Osada’s resection.&#x0D; &#x0D; Conclusion: Adenomyosis resection both conservative or Osada’s&#x0D; procedures actually has a better outcome for relieving pain; therefore,&#x0D; some patients can still have a child.&#x0D; &#x0D; Keywords: adenomyosis resection, conventional resection, infertility,&#x0D; Osada’s procedure

When endometriosis is the barrier for fertility.

When endometriosis is the barrier for fertility.

Identification and Resection of Endometriosis Using Indocyanine Green [26D

INTRODUCTION: Endometriosis is a common cause of nonspecific pelvic symptoms, typically diagnosed through laparoscopic biopsies. An innovative technique utilizing indocyanine green (ICG), a dye that fluoresces in areas of increased vascularity such as endometriotic lesions, is used to diagnose normal-appearing, “clear” lesions of endometriosis. These lesions would have otherwise been missed by conventional laparoscopy. METHODS: A retrospective chart review and analysis included all patients on whom ICG was used from July 2014 to August 2016. Preoperative symptoms and postoperative localization of lesions were analyzed using the Fisher Exact test. Preoperative symptoms included abnormal uterine bleeding, pelvic pain, fibroids, and dyspareunia. Postoperative localization included lesions in the ovary, cul-de-sacs, vesicouterine peritoneum, pelvic peritoneum, uterosacral ligaments, and uterine serosa. RESULTS: Of 30 patients undergoing laparoscopic excision of endometriosis using ICG, twenty-one with positive fluorescence had endometriosis confirmed on pathology; eight with no ICG fluorescence had negative pathology results; and one patient had fluorescence with no identifiable endometriosis. This statistically indicates a positive predictive value of 95% with a sensitivity of 100%. The preoperative symptoms analyzed were not statistically significant for endometriosis, but clear lesions present in pelvic and vesicouterine peritoneum were statistically significant for endometriosis (p=0.001 and 0.01, respectively). CONCLUSION: Use of ICG fluorescence led to pathology-proven diagnosis in 29 of 30 patients. ICG is an inexpensive, non-toxic dye whose application could help change how endometriosis is diagnosed with minimal risk to patients. Future studies would benefit from larger patient recruitment by adding power to the analysis.

Five-Year Follow-Up After Laparoscopic Large Nerve Resection for Deep Infiltrating Sciatic Nerve Endometriosis

ObjectiveTo report neurologic follow-up of patients after laparoscopic large resection of deep infiltrating endometriosis of the sciatic nerve. DesignProspective clinical case series. SettingTertiary referral unit specializing in advanced gynecologic surgery and neuropelveology. PatientsAll data for patients who underwent laparoscopic surgery for endometriosis of the sciatic nerve between 2004 and 2016 (n = 259) were documented prospectively. In this study, patients who underwent a large resection of the sciatic nerve (>30% of the nerve) and were followed for at least 5 years were evaluated (n = 46). All patients presented preoperatively with incapacity for normal gait and foot drop. All were suffering from intractable and constant neuropathic sciatic pain (visual analog scale [VAS] score of 9 to 10 despite strong pain medicine), with sensorimotor disorders of the affected leg. InterventionsLaparoscopic large resection of endometriosis of the sciatic nerve. Measurements and Main ResultsAll procedures were performed by laparoscopy. Postoperative management included medical treatment with neuroleptic agents and intensive physiotherapy. At the 5-year follow-up, all patients reported significant pain reduction, with a median VAS score of 2.1 (range, 0 to 3) and recovery of normal gait, including the ability to climb stairs. ConclusionIn deep infiltrating intraneural endometriosis of the sciatic nerve, patients present with motor disorders before and after surgical resection. The average VAS score was reduced from 9.33 preoperatively to 1.25 at a 3-year follow-up. When full resection of endometriosis including nerve resection is completed, sciatic nerve function recover, but recovery of a normal gait may take at least 3 years and intensive physiotherapy.

Complications of colorectal resection for endometriosis.

Based on a review of the current literature, we will discuss early and late (more than three months postoperative) complications associated with surgery for colorectal endometriosis resection. The most common surgical complications are: rectovaginal fistulae, anastomotic leakages and abscesses. Postoperative bleeding occurs rarely but has also been reported; and usually requires blood transfusion without surgical interventions. The selection of patients for surgery requires a multidisciplinary approach and complete preoperative imaging work-up by an experienced physician. The surgical procedure is challenging, including resection of all extrarectal DIE lesions, often in a context of patients who already underwent operations. Considering the major complications that may occur, there are three frequently observed risk factors. First is the opening of the vagina at the time of the bowel surgical procedure. However, this is a matter of debate, and experts commonly open the vagina during the procedure, as appropriate, without increasing the rate of complications. Second is excessive use of electrocoagulation, which increases the risk of rectovaginal fistulae and abscesses, due to the risk of necrosis of the posterior vaginal cuff. Third is surgical treatment of low rectal lesions (5-8 cm from the anal verge), which increases the risk of anastomotic leaks. In addition, we refuse to consider functional postoperative complications that affect gastrointestinal and sexual function, as minor complications. These can have a severe impact on the quality of life of young women. Further research is needed to prevent and treat such complications.

Magnetic Resonance Colonography May Predict the Need for Bowel Resection in Colorectal Endometriosis.

Purpose To define if MRI findings in patients with deep pelvic endometriosis (DPE) may be predictive for the need of bowel resection. Material and Methods A retrospective survey of 196 pelvic MRIs of women who received laparoscopic procedures for DPE was carried out. A pelvic MRI was performed in all patients: it consisted in T2w-TSE sequences in axial, sagittal, and coronal planes and T1w and THRIVE sequences in the axial plane; the exam was completed by MR-Colonography. Intestinal lesions were measured in short and long axis and the degree of stenosis was established. A multivariate logistic regression was used to identify the predictors of intestinal resection. Results 57/196 patients received an intestinal resection. Multivariate logistic regression demonstrated a predictive value of short axis (Odds-Ratio = 2.29, p = 0.011) and stenosis (Odds-Ratio = 1.20, p = 0.003). ROC analysis showed that a cut-off value of 11 mm for the short axis and 30% for the stenosis may correctly classify, respectively, 96,94% (sensitivity 92,9% and specificity 98,56%) and 97,96% (sensitivity 94,74% and specificity 99,3%) of the cases. Conclusion The presence of an endometriotic rectal nodule > 11 mm in short axis causing a stenosis > 30% in pelvic MRI reliably predicts the need of a rectal resection.

La résection de l’endométriose profonde sans atteinte digestive améliore-t-elle les résultats de la fécondation in vitro ? Une étude retrospective

ObjectivesTo evaluate the impact of complete removal of endometriosis in case of deep infiltrative endometriosis without digestive involvement, on in vitro fertilization outcomes. MethodsRetrospective monocentric study. We included infertile women with deep infiltrative endometriosis without colorectal involvement that underwent IVF. Women were divided in two groups, following their history: “surgery” when they underwent complete endometriosis resection before IVF and “without surgery” when they underwent IVF without endometriosis removal. We analysed IVF outcomes considering pregnancy rates per cycle and cumulative pregnancy rates per patient. ResultsWe included 72 patients: 35 in the “surgery” group and 37 in the “without surgery” group. Women in the two groups were comparable in terms of baseline characteristics (age, body mass index, anti-Müllerian hormone, antral follicular count), endometriosis localizations and in vitro fertilization parameters. Cumulative pregnancy rates per patient were similar in both groups (40 % in the “surgery” group and 41 % in the “without surgery” group; P=1). Clinical pregnancy rate per cycle were also comparable groups (24 % in the “surgery” group and 28 % in the “without surgery” group; P=0.67). Surgery performed was comparable in women that became pregnant and in women that did not. Age was lower in women that became pregnant (P=0.01) and there were more pregnancy obtained in women under 35 years. ConclusionIn women with deep infiltrative endometriosis without digestive involvement, in vitro fertilization outcomes were not impacted by surgery. Therapeutic choice between IVF or surgery as first-line treatment remains thus questionable and shall be guided by other influencing factors, such as pain symptomatology, age, tubal permeability, ovarian reserve, partner's sperm characteristics and woman's choice.

Robotically Assisted Resection of Pericardial Endometriosis

Robotically Assisted Resection of Pericardial Endometriosis

Excision of a Large Adnexal Endometriotic Nodule Masquerading as Salpingitis Isthmica Nodosa

This video presents a case of deeply invasive paratubal endometriosis proximal to the uterine fundus, masquerading as salpingitis isthmica nodosa (SIN). The differential diagnosis of endometriosis is demonstrated and surgery is performed to fully resect the invasive disease while preserving tubal function. This case demonstrates the importance of complete resection of paraisthmic endometriosis for the resolution of pelvic pain and the feasibility of preserving tubal function, thereby conserving the patient’s fertility.

Abdominal wall endometriosis occurring after cesarean section: an underestimated complication

The aim of the study was to review patients characteristics, describe the exact anatomic locations and size of the endometriosis in the abdominal wall, and discuss the factors that may contribute to mesh use during abdominal wall endometriosis (AWE) resection. Materials and Methods: Patients diagnosed with AWE in their surgical scars from January 2008 to December 2014 were documented. Descriptive data was collected and analyzed. Results: A total of 95 patients with an age ranging from 26 to 48 years, with a mean age of 33.5 &#x00B1;5.0 years at the time of excision were analyzed. The mean diameter of the mass was 3.25 cm in the present series with an average of 4.97 cm in the mesh group by ultrasound. A total of 18 patients had mesh therapy for fascia defect compared with 77 non-mesh therapy patients. The size of the lesions, the mean duration of symptoms for painful mass, and level of the serum CA125 were statistically different between mesh group and non-mesh group (p p p Conclusions: The more common position for scar endometriosis may be in the adipose layer at the corner of the surgical scar. Mesh therapy should be considered before surgery when the diameter of the abdominal wall mass detected by ultrasound is more than five cm and/or when the lesions invade into rectus abdominis muscle with/without peritoneum tissues from adipose and fascia layers.

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.

Clinical analysis of efficacy and quality of life of segmental bowel resection for bowel endometriosis

To evaluate the efficacy and quality of life of segmental bowel resection for bowel endometriosis. Totally 62 symptomatic patients with bowel endometriosis undergoing segmental bowel resection were recruited. A visual analogue scale(VAS)and the 36-item short form health survey(SF-36)questionnaire were administered before and at least 1 year after surgery, respectively. Pregnancy rates were also recorded. Sixty-two patients in total underwent follow-up ranging from 12 to 74 months. All patients complained of obvious pain symptoms, including dysmenorrhea, dyspareunia, pain on defecation and chronic pelvic pain. The relief of dysmenorrhea(2.9 ± 2.2 versus 7.5 ± 2.9), dyspareunia(0.7 ± 0.5 versus 4.3 ± 2.2)and pain on defecation(1.6 ± 0.7 versus 7.3 ± 1.9)after surgery was statistically significant(all P<0.01). The scores for all 8 domains of the SF-36 questionnaire were significant improved after segmental bowel resection(all P<0.01). The complication rate was 45%(28/62), including 18 cases of urinary retention, 4 rectovaginal fistulas, 2 cases of vaginal dehiscence, and 1 case each of thrombogenesis, pelvic abscess and general peritonitis. All of the patients with complications recovered well throughout follow-up. The postoperative pregnancy rate of the previous infertile patients was 6/10. Among the 6 gestational cases, 2 had labour, 2 underwent caesarean sections, one had a spontaneous natural abortion, and one underwent uterine curettage. Segmental bowel resection could significantly relieve pain and improve quality of life for patients with bowel endometriosis.

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Aims: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis. Methods: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. Results: The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases. Conclusion: A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.

Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis

Two surgical approaches usually are used in the surgical management of deep infiltrating endometriosis of the rectum: theradical approach that mainly is based on colorectal resection and the conservative or symptom-guided approach that prioritizes conservation of the rectum. There are no data available that compare long-term functional digestive outcomes of 1 approach to the other. The purpose of this study was to compare long-term digestive outcomes in women who were treated by either rectal shaving or colorectal resection for deep endometriosis infiltrating the rectum. A retrospective comparative study was performed. All women who were treated with surgery for deep endometriosis infiltrating the rectum by either shaving or colorectal resection at the University Hospital of Rouen from January 2005 to January 2010 were enrolled. Follow-up evaluation was carried out fora minimum of 5 years. Postoperative evaluation of digestive symptoms was performed by 4 standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott-Symptom score for constipation, the Wexner score for anal continence, and the Bristol Stool Score. Symptoms that were related to endometriosis, fertility, and disease recurrence were obtained from a specific questionnaire. A total of 77 women were included. Three women were lost to follow up (3.9%), and 3 were treated by disc excision (3.9%). The mean follow-up time was 80±19 months. Forty-six women underwent conservative rectal shaving, and 25 women underwent colorectal resection. Patient characteristics and the severity of the disease were comparable in both groups. Patients who were treated by rectal shaving had significantly better Gastrointestinal Quality of Life Index values, lower Knowles-Eccersley-Scott-Symptom scores for postoperative constipation, and better anal continence. No statistically significant differences were revealed for postoperative pelvic pain. Rectal recurrence occurred in 8.7% of patients who were treated by conservative surgery: 4.3% underwent secondary colorectal resection and 4.3% were treated secondarily by rectal shaving. Consequently, avoiding a recurrence for merely 1 patient would have required 11 patients to undergo colorectal resection instead of shaving. Our data suggest that, in patients who are treated for rectal endometriosis, colorectal resection does not improve long-term postoperative functional outcomes when compared with rectal shaving.

Medium to long-term gastrointestinal outcomes following disc resection of the rectum for treatment of endometriosis using a validated scoring questionnaire.

To assess the gastrointestinal functional outcomes and symptoms of low anterior resection syndrome after disc resection for deeply infiltrative endometriosis (DIE) using a validated scoring system. Retrospective study to assess the gastrointestinal functional outcomes after rectal disc resection for DIE using a validated scoring system. University tertiary referral centre. Women who underwent disc resection for endometriosis at Royal Hospital for Women and Prince of Wales Private Hospital between January 2012 and December 2013 were included. Low anterior resection syndrome (LARS) score using a validated questionnaire. Forty-one women met the inclusion criteria. The mean age was 40±10years (range 22-75years). All procedures were performed laparoscopically. Eleven women (27%) underwent a hysterectomy in addition to rectal disc resection and endometriosis surgery. Mean operative time for the entire cohort was 158±64minutes, and mean length of hospital stay was 5±2days. Completed questionnaires were received from 31 women, a response rate of 76%. The mean length of follow-up was 17±10months (range 3-34months). The LARS scores ranged from 0 to 34 (median 15, interquartile range 0-24). Eight women (26%) had a LARS score of 0. Nineteen women (61%) had a LARS score less than 21 (the threshold for LARS). Conservative treatment of DIE with rectal disc resection is safe and feasible and is associated with mild gastrointestinal dysfunction in the medium to long term.

Rates, trends, and short-term outcomes of colorectal resections for endometriosis: An ACS-NSQIP review

BackgroundThere is a paucity of literature regarding rates, trends, and outcomes of women with endometriosis undergoing elective colorectal resections in the United States. It was been suggested that endometriosis requiring colorectal resection is well suited for minimally invasive surgery. Materials and methodsThe American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was searched from 2005 to 2014 for all elective colorectal resections performed for endometriosis. The proportion of resections was compared over time using a Cochran-Armitage test for trend. Univariate comparisons were made between patients with laparoscopic vs open resections. ResultsA total of 101,686 women underwent elective colorectal resections, of which 268 (0.26%) were performed for endometriosis. The proportion of endometriosis as the indication for resection increased over time (R2 = 0.77). Mean age was 42.9 ± 8.4 years with 72.8% non-Hispanic white. Median body mass index was 25.8 [interquartile range: 23.0, 31.5]. Overall, patients were healthy (82.8% American Society of Anesthesiologists classification I or II). Median length of stay was 4 [3, 6] days and 14.2% suffered any complication, with 9.0% having a minor complication and 7.1% having a major complication. There were no 30-day mortalities. The majority of cases (97.4%) were performed by a general/colorectal surgeon and the remainder by gynecologists. Forty-five (16.8%) underwent concurrent hysterectomy. Comparing open (n = 124) to laparoscopic approaches (n = 144) revealed no differences other than a longer length of stay (5 vs 4 days, p < 0.001) and operative time (180.5 vs 138.5 min, p = 0.02) in the open group. ConclusionsEndometriosis is a rare but increasing indication for elective colorectal resection at participating hospitals. The short-term outcomes after colorectal resection in this young and healthy population are acceptable and our data suggests that minimally invasive surgery should be considered in these patients.