{"paper_id":"eb59387f-a505-41de-a625-8aebdb873a78","body_text":"Abstract\nPurpose\n“Endometriosis” is defined such as the presence of endometrial glands and stroma outside the uterine cavity. This ectopic condition may develop as deeply infiltrating endometriosis (DIE) when a solid mass is located deeper than 5 mm underneath the peritoneum including the intestinal wall. The ideal surgical treatment is still under search, and treatment may range from simple shaving to rectal resection. The aim of the present systematic review is to report and analyze the postoperative outcomes after rectosigmoid resection for endometriosis.\nMethods\nWe performed a systematic review according to Meta-analysis of Observational Studies in Epidemiology guidelines. The search was carried out in the PubMed database, using the keywords: “rectal resection” AND “endometriosis” and “rectosigmoid resection” AND “endometriosis.” The search revealed 380 papers of which 78 were fully analyzed.\nResults\nThirty-eight articles published between 1998 and 2017 were included. Three thousand seventy-nine patients (mean age 34.28 ± 2.46) were included. Laparoscopic approach was the most employed (90.3%) followed by the open one (7.9%) and the robotic one (1.7%). Overall operative time was 238.47 ± 66.82. Conversion rate was 2.7%. In more than 80% of cases, associated procedures were performed. Intraoperative complications were observed in 1% of cases. The overall postoperative complications rate was 18.5% (571 patients), and the most frequent complication was recto-vaginal fistula (74 patients, 2.4%). Postoperative mortality rate was 0.03% and mean hospital stay was 8.88 ± 3.71 days.\nConclusions\nDespite the large and extremely various number of associated procedures, rectosigmoid resection is a feasible and safe technique to treat endometriosis.\nSimilar content being viewed by others\nChange history\n09 July 2018\nThe authors of the published version of this article missed to add the second affiliation of Mostafa Shalaby. The new affiliation is now added and presented correctly in this article. The remainder of the article remains unchanged.\nReferences\nVercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol 10(5):261–275. https://doi.org/10.1038/nrendo.2013.255\nKamergorodsky G, Lemos N, Rodrigues FC, Asanuma FY, D'Amora P, Schor E, Girão MJ (2015 Aug) Evaluation of pre- and post-operative symptoms in patients submitted to linear stapler nodulectomy due to anterior rectal wall endometriosis. Surg Endosc 29(8):2389–2393. https://doi.org/10.1007/s00464-014-3945-4\nRiiskjær M, Forman A, Kesmodel US, Andersen LM, Ljungmann K, Seyer-Hansen M (2017) Diagnostic value of serial measurement of C-reactive protein in the detection of a surgical complication after laparoscopic bowel resection for endometriosis. Gynecol Obstet Investig 82(4):410–416. https://doi.org/10.1159/000447513\nRoman H, Abo C, Huet E, Bridoux V, Auber M, Oden S, Marpeau L, Tuech JJ (2015) Full-thickness disc excision in deep endometriotic nodules of the rectum: a prospective cohort. Dis Colon rectum Oct 58(10):957–966. https://doi.org/10.1097/DCR.0000000000000447\nStroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012\nLo CK, Mertz D, Loeb M (2014) Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol 14:45. https://doi.org/10.1186/1471-2288-14-45\nHozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13\nUrbach DR, Reedijk M, Richard CS, Lie KI, Ross TM (1998) Bowel resection for intestinal endometriosis. Dis Colon Rectum Sep 41(9):1158–1164\nDarai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol Feb 192(2):394–400\nCampagnacci R, Perretta S, Guerrieri M, Paganini AM, De Sanctis A, Ciavattini A, Lezoche E. (2005). Laparoscopic colorectal resection for endometriosis. Surg Endosc 19(5):662–664\nAbrao MS, Sagae UE, Gonzales M, Podgaec S, Dias JA Jr. (2005). Treatment of rectosigmoid endometriosis by laparoscopically assisted vaginal rectosigmoidectomy. Int J Gynaecol Obstet;91(1):27–31\nDubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E (2006) Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 21(5):1243–1247\nRibeiro PA, Rodrigues FC, Kehdi IP, Rossini L, Abdalla HS, Donadio N, Aoki T (2006) Laparoscopic resection of intestinal endometriosis: a 5-year experience. J Minim Invasive Gynecol 13(5):442–446\nSeracchioli R, Poggioli G, Pierangeli F, Manuzzi L, Gualerzi B, Savelli L, Remorgida V, Mabrouk M, Venturoli S (2007) Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG 114(7):889–895\nZanetti-Dällenbach R, Bartley J, Müller C, Schneider A, Köhler C (2008) Combined vaginal-laparoscopic-abdominal approach for the surgical treatment of rectovaginal endometriosis with bowel resection: a comparison of this new technique with various established approaches by laparoscopy and laparotomy, 22. Surg Endosc (4):995–1001\nGhezzi F, Cromi A, Ciravolo G, Rampinelli F, Braga M, Boni L (2008) A new laparoscopic-transvaginal technique for rectosigmoid resection in patients with endometriosis. Fertil Steril Nov 90(5):1964–1968. https://doi.org/10.1016/j.fertnstert.2007.09.002\nMinelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 144(3):234–239; discussion 239. https://doi.org/10.1001/archsurg.2008.555\nDe Nardi P, Osman N, Ferrari S, Carlucci M, Persico P, Staudacher C (2009) Laparoscopic treatment of deep pelvic endometriosis with rectal involvement. Dis Colon Rectum 52(3):419–424. https://doi.org/10.1007/DCR.0b013e318197d716\nBracale U, Azioni G, Rosati M, Barone M, Pignata G (2009) Deep pelvic endometriosis (Adamyan IV stage): multidisciplinary laparoscopic treatments. Acta Chir Iugosl 56(1):41–46\nKim JS, Hur H, Min BS, Kim H, Sohn SK, Cho CH, Kim NK (2009) Intestinal endometriosis mimicking carcinoma of rectum and sigmoid colon: a report of five cases. Yonsei Med J 50(5):732–735. https://doi.org/10.3349/ymj.2009.50.5.732\nKössi J, Setälä M, Enholm B, Luostarinen M (2010) The early outcome of laparoscopic sigmoid and rectal resection for endometriosis. Colorectal Dis 12(3):232–235. https://doi.org/10.1111/j.14631318.2009.01923.x\nDousset B, Leconte M, Borghese B, Millischer AE, Roseau G, Arkwright S, Chapron C (2010) Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg May 251(5):887–895. https://doi.org/10.1097/SLA.0b013e3181d9722d\nDaraï E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251(6):1018–1023. https://doi.org/10.1097/SLA.0b013e3181d9691d\nRoman H, Rozsnayi F, Puscasiu L, Resch B, Belhiba H, Lefebure B, Scotte M, Michot F, Marpeau L, Tuech JJ. (2010). Complications associated with two laparoscopic procedures used in the management of rectal endometriosis. JSLS. Apr-Jun;14(2):169–77. doi:https://doi.org/10.4293/108680810X12785289143800\nMoawad NS, Guido R, Ramanathan R, Mansuria S, Lee T (2011) Comparison of laparoscopic anterior discoid resection and laparoscopic low anterior resection of deep infiltrating rectosigmoid endometriosis. JSLS 15(3):331–338. https://doi.org/10.4293/108680811X13125733356431\nLim PC, Kang E, do Park H (2011) Robot-assisted total intracorporeal low anterior resection with primary anastomosis and radical dissection for treatment of stage IV endometriosis with bowel involvement: morbidity and its outcome. J Robot Surg 5(4):273–278. https://doi.org/10.1007/s11701-011-0272-9\nRuffo G, Sartori A, Crippa S, Partelli S, Barugola G, Manzoni A, Steinasserer M, Minelli L, Falconi M (2012) Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results. Surg Endosc 26(4):1035–1040. https://doi.org/10.1007/s00464-011-1991-8\nCeccaroni M, Clarizia R, Bruni F, D'Urso E, Gagliardi ML, Roviglione G, Minelli L, Ruffo G (2012) Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. Surg Endosc 26(7):2029–2045. https://doi.org/10.1007/s00464-012-2153-3\nVitobello D, Fattizzi N, Santoro G, Rosati R, Baldazzi G, Bulletti C, Palmara V (2013) Robotic surgery and standard laparoscopy: a surgical hybrid technique for use in colorectal endometriosis. J Obstet Gynaecol Res 39(1):217–222. https://doi.org/10.1111/j.1447-0756.2012.01891.x\nKössi J, Setälä M, Mäkinen J, Härkki P, Luostarinen M (2013) Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis 15(1):102–108. https://doi.org/10.1111/j.1463-1318.2012.03111.x\nNeme RM, Schraibman V, Okazaki S, Maccapani G, Chen WJ, Domit CD, Kaufmann OG, Advincula AP (2013) Deep infiltrating colorectal endometriosis treated with robotic-assisted rectosigmoidectomy. JSLS 17(2):227–234. https://doi.org/10.4293/108680813X13693422521836\nCassini D, Cerullo G, Miccini M, Manoochehri F, Ercoli A, Baldazzi G (2014) Robotic hybrid technique in rectal surgery for deep pelvic endometriosis. Surg Innov 21(1):52–58. https://doi.org/10.1177/1553350613487804\nFleisch MC, Hepp P, Kaleta T, Schulte A, Esch J, Rein D, Fehm T, Beyer I (2014) Feasibility and first long-term results after laparoscopic rectal segment resection and vaginal specimen retrieval for deep infiltrating endometriosis. Arch Gynecol Obstet 289(6):1241–1247. https://doi.org/10.1007/s00404-014-3146-3\nMangler M, Herbstleb J, Mechsner S, Bartley J, Schneider A, Köhler C (2014) Long-term follow-up and recurrence rate after mesorectum-sparing bowel resection among women with rectovaginal endometriosis. Int J Gynaecol Obstet 125(3):266–269. https://doi.org/10.1016/j.ijgo.2013.12.010\nEnglish J, Sajid MS, Lo J, Hudelist G, Baig MK, Miles WA (2014) Limited segmental rectal resection in the treatment of deeply infiltrating rectal endometriosis: 10 years’ experience from a tertiary referral unit. Gastroenterol Rep (Oxf) 2(4):288–294. https://doi.org/10.1093/gastro/gou055\nAkladios C, Messori P, Faller E, Puga M, Afors K, Leroy J, Wattiez A (2015) Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? J Minim Invasive Gynecol 22(1):103–109. https://doi.org/10.1016/j.jmig.2014.08.001\nTarjanne S, Heikinheimo O, Mentula M, Härkki P (2015) Complications and long-term follow-up on colorectal resections in the treatment of deep infiltrating endometriosis extending to bowel wall. Acta Obstet Gynecol Scand 94(1):72–79. https://doi.org/10.1111/aogs.12515\nRausei S, Sambucci D, Spampatti S, Cassinotti E, Dionigi G, David G, Ghezzi F, Uccella S, Boni L (2015) Laparoscopic treatment of deep infiltrating endometriosis: results of the combined laparoscopic gynecologic and colorectal surgery. Surg Endosc 29(10):2904–2909. https://doi.org/10.1007/s00464-014-4018-4\nMilone M, Vignali A, Milone F, Pignata G, Elmore U, Musella M, De Placido G, Mollo A, Fernandez LM, Coretti G, Bracale U, Rosati R. (2015). Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications. World J Gastroenterol;21(47):13345–13351. doi:https://doi.org/10.3748/wjg.v21.i47.13345\nMalzoni M, Di Giovanni A, Exacoustos C, Lannino G, Capece R, Perone C, Rasile M, Iuzzolino D (2016) Feasibility and safety of laparoscopic-assisted bowel segmental resection for deep infiltrating endometriosis: a retrospective cohort study with description of technique. J Minim Invasive Gynecol 23(4):512–525. https://doi.org/10.1016/j.jmig.2015.09.024\nRoman H, Hennetier C, Darwish B, Badescu A, Csanyi M, Aziz M, Tuech JJ, Abo C (2016) Bowel occult microscopic endometriosis in resection margins in deep colorectal endometriosis specimens has no impact on short-term postoperative outcomes. Fertil Steril 105(2):423–9.e7. https://doi.org/10.1016/j.fertnstert.2015.09.030\nRiiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US, Forman A, Seyer-Hansen M (2016) Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG 123(8):1360–1367. https://doi.org/10.1111/1471-0528.13975\nRoman H, Milles M, Vassilieff M, Resch B, Tuech JJ, Huet E, Darwish B, Abo C. (2016). Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol;215(6):762.e1–762762.e9. doi:https://doi.org/10.1016/j.ajog.2016.06.055\nVlek SL, Lier MCI, Koedam TWA, Melgers I, Dekker JJML, Bonjer JH, Mijatovic V, Tuynman JB (2017) Transanal minimally invasive rectal resection for deep endometriosis: a promising technique. Colorectal Dis 19(6):576–581. https://doi.org/10.1111/codi.13569\nRenner SP, Kessler H, Topal N, Proske K, Adler W, Burghaus S, Haupt W, Beckmann MW, Lermann J (2017) Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 295(5):1277–1285. https://doi.org/10.1007/s00404-017-4360-6\nMoher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007\nClavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196\nKalogera E, Nitschmann CC, Dowdy SC, Cliby WA, Langstraat CL. (2017). A prospective algorithm to reduce anastomotic leaks after rectosigmoid resection for gynecologic malignancies. Gynecol Oncol 2017;144(2):343–347. doi: https://doi.org/10.1016/j.ygyno.2016.11.032\nAbo C, Moatassim S, Marty N, Saint Ghislain M, Huet E, Bridoux V, Tuech JJ, Roman H (2018) Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril 2018 109(1):172–178.e1. https://doi.org/10.1016/j.fertnstert.2017.10.001\nAfors K, Centini G, Fernandes R, Murtada R, Zupi E, Akladios C, Wattiez A (2016) Segmental and Discoid Resection are Preferential to Bowel Shaving for Medium-Term Symptomatic Relief in Patients With Bowel Endometriosis. J Minim Invasive Gynecol 2016 23(7):1123–1129. https://doi.org/10.1016/j.jmig.2016.08.813\nRoman H, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Daraï E, Collinet P, Tuech JJ (2018) Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod 33(1):47–57. https://doi.org/10.1093/humrep/dex336\nRex JC Jr, Khubchandani IT (1992) Rectovaginal fistula: complication of low anterior resection. Dis Colon Rectum 35(4):354–356\nKosugi C, Saito N, Kimata Y, Ono M, Sugito M, Ito M, Sato K, Koda K, Miyazaki M (2005) Rectovaginal fistulas after rectal cancer surgery: incidence and operative repair by gluteal-fold flap repair. Surgery 137(3):329–336\nAntonsen HK, Kronborg O (1987) Early complications after low anterior resection for rectal cancer using the EEA stapling device. A prospective trial Dis Colon rectum 30(8):579–583\nArbman G (1993) Rectovaginal fistulas and the double-stapling technique. Dis Colon Rectum 36(3):310–311\nBaran JJ, Goldstein SD, Resnik AM (1992) The double-staple technique in colorectal anastomosis: a critical review. Am Surg 58(4):270–272\nFleshner PR, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1992) Anastomotic-vaginal fistula after colorectal surgery. Dis Colon Rectum 35(10):938–943\nNakagoe T, Sawai T, Tuji T, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H (1999) Avoidance of rectovaginal fistula as a complication after low anterior resection for rectal cancerusing a double-stapling technique. J Surg Oncol 71(3):196–197\nSugarbaker PH (1996) Rectovaginal fistula following low circular stapled anastomosis in women with rectal cancer. J Surg Oncol 61(2):155–158\nTsutsumi N, Yoshida Y, Maehara Y, Kohnoe S (2007) Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer. Hepatogastroenterology 54(78):1682–1683\nWatanabe J, Ota M, Kawaguchi D, Shima H, Kaida S, Osada S, Kamimukai N, Kamiya N, Ishibe A, Watanabe K, Matsuyama R, Akiyama H, Ichikawa Y, Oba M, Endo I (2015) Incidence and risk factors for rectovaginal fistula after low anterior resection for rectal cancer. Int J Colorectal Dis 30(12):1659–1666. https://doi.org/10.1007/s00384-015-2340-5\nPaun BC, Cassie S, MacLean AR, Dixon E, Buie WD (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251(5):807–818. https://doi.org/10.1097/SLA.0b013e3181dae4ed\nFujita F, Torashima Y, Kuroki T, Eguchi S (2014) Risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surg Today 44(9):1595–1602. https://doi.org/10.1007/s00595-013-0685-3\nHayden DM, Mora Pinzon MC, Francescatti AB, Saclarides TJ (2014) Patient factors may predict anastomotic complications after rectal cancer surgery: anastomotic complications in rectal cancer. Ann Med Surg (Lond) 4(1):11–16. https://doi.org/10.1016/j.amsu.2014.12.002\nPaganini AM, Balla A, Quaresima S, D'Ambrosio G, Bruzzone P, Lezoche E (2015) Tricks to decrease the suture line dehiscence rate during endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM). Surg Endosc 29(5):1045–1050. https://doi.org/10.1007/s00464-014-3776-3\nKobayashi M, Mohri Y, Ohi M, Inoue Y, Araki T, Okita Y, Kusunoki M (2014) Risk factors for anastomotic leakage and favorable antimicrobial treatment as empirical therapy for intra-abdominal infection in patients undergoing colorectal surgery. Surg Today 44(3):487–493. https://doi.org/10.1007/s00595-013-0575-8\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of interest\nAndrea Balla, Silvia Quaresima, José D. Subiela, Mostafa Shalaby, Giuseppe Petrella, and Pierpaolo Sileri have no conflicts of interest or financial ties to disclose.\nRights and permissions\nAbout this article\nCite this article\nBalla, A., Quaresima, S., Subiela, J.D. et al. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 33, 835–847 (2018). https://doi.org/10.1007/s00384-018-3082-y\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00384-018-3082-y","source_license":"CC0","license_restricted":false}