Endometriosis in Reproductive Years: Surgical Management of Colorectal Endometriosis

Surgical management of rectal endometriosis may employ two approaches: (i) conservative, with the preservation of overall rectal shape by either shaving or disc excision and (ii) radical, by segmental colorectal resection. There are numerous retrospective case series, a few comparative cohorts with prospective recording of data, as well as a randomized trial comparing the two approaches. The technique of segmental resection and disc excision is standardized, while that of shaving is surgeon-dependent, when related to the depth and the completeness of the excision. In outline, postoperative complications, such as bowel fistula or pelvis abscess, are more frequent when rectal lumen is opened and rectal wall sutured, which explain higher postoperative risk of complications in women managed by disc excision when compared to those undergoing shaving. Conversely, the long-term risk of local rectal recurrences seems increasing from segmental resection and disc excision to shaving. The risk of the stenosis of bowel lumen is specifically associated with segmental resection and represents a clinically relevant narrowness of colorectal anastomosis. The feasibility of each technique is still debated: for numerous authors, rectal shaving is less or not feasible in very large and deep infiltrating nodules responsible for lumen stenosis; disc excision, particularly when it employs transanal stapler, is technically challenging in nodules involving the rectum over 4–5 cm in length; segmental resection is feasible in all cases; however it seems excessive in small nodules responsible for limited infiltration of rectal wall. As regards postoperative functional outcomes, they appear not being significantly different in women undergoing conservative versus radical approaches, suggesting that rectal shape is not the unique factor conditioning bowel function. In conclusion, to date, there is insufficient evidence to strongly recommend one technique over others. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others Change history 10 September 2022 Correction to:

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