A peroperative analysis of rectal vascularization after the shaving technique: an innovative method to avoid fistula?

This reflections piece discusses the peroperative management of rectovaginal septal deep endometriotic lesions with muscular layer infiltration and focuses on an approach for assessing rectal vascularization after rectal shaving using indocyanine green (ICG), as proposed in a preliminary study (INDIE). It describes the rationale that reduced rectal wall vascularization could reflect thermal or ischemic damage that may contribute to postoperative fistula, while noting limitations such as difficulty excluding thermal injury during monopolar electrocautery and the possibility of fistula from misdiagnosed microperforation or underestimated lesion thickness. The author argues that peroperative imaging and careful attention to bowel muscularis involvement, distance to the anal verge, and presurgical assessment determine the appropriateness of shaving versus alternative procedures, while also raising questions about surgical decision-making if vascularization decreases at the end of surgery. This paper is centrally about endometriosis — it analyzes and contextualizes ICG-based evaluation of rectal vascularization following rectal shaving for deep infiltrating endometriosis of the bowel.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works