Diverting stoma-related complications following colorectal endometriosis surgery: a 163-patient cohort

Bonin E, Elodie Bonin, Valérie Bridoux, Bridoux V, Rachid Chati, Chati R, Kermiche S, Sabrina Kermiche, Julien Coget, J Coget, Coget J, Jean‐Jacques Tuech, Jean Jacques Tuech, Tuech JJ, Horace Roman
European journal of obstetrics, gynecology, and reproductive biology · 2018 · vol. 232 , pp. 46–53 · doi:10.1016/j.ejogrb.2018.11.008 · PMID:30468983 · W2900026602
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This study investigated complications related to diverting stomas used in colorectal endometriosis surgeries, analyzing data from 163 patients.

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Abstract

ObjectiveDeep endometriosis may simultaneously infiltrate the vagina and the rectosigmoid, which associated resection may increase the risk of postoperative complications. Among these complications, rectovaginal fistula is one of the worst. To reduce the risk of rectovaginal fistula and related complications, surgeons may employ diverting stoma. The literature is rich in data concerning the usefulness of stoma in patients managed for low rectal cancer. However, extrapolation of these data to patients managed for rectal endometriosis is disputable. For this reason, there are no guidelines on the role of stoma in preventing rectovaginal fistula in patients managed for colorectal endometriosis. The objective of our study was to assess the risk of complications related to the use of stoma in patients managed for colorectal endometriosis.Study designA retrospective comparative study has been performed using data prospectively recorded in the CIRENDO database. 163 consecutive women with colorectal endometriosis who had temporary stoma have been enrolled at the University Hospital of Rouen, from June 2009 to December 2016. The main outcome was stoma-related complications rate using Clavien-Dindo classification. No women were lost to follow-up.ResultsAmong the 163 women, 158 (96.9%) had a primary diverting stoma and 5 women (3.1%) with an immediate post-surgical bowel fistula had a secondary diverting stoma. Stoma involved the ileum in 28 women (17.2%) and the colon in 135 (82.8%). Surgical management of the rectosigmoid junction was rectal shaving in 2 women (1.2%), disc excision in 62 (38%), colorectal resection in 87 (53.4%), and combined rectal disc excision and sigmoid colon segmental resection in 12 (7.4%). Clavien Dindo I stoma-related complications occurred in 38 patients (23.3%) and were related to abnormal healing of stoma scar. Most Clavien-Dindo II complications were wound or urinary infections following stoma closure. Clavien Dindo III complications occurred in 14 patients (8.6%) and were related to leakage, hemoperitoneum, hernia of the abdominal wall, subcutaneous abscess and bowel obstruction syndrome.ConclusionSpecific complications may occur directly related to the use of stoma in the surgery of deep endometriosis of the rectosigmoid. The risk of these complications should be taken into account and full preoperative information should be provided to patients and their family.

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Digestive System Surgical Procedures Endometriosis Rectal Diseases Adult Colonic Diseases Databases, Factual Digestive System Surgical Procedures Endometriosis Female Humans Postoperative Complications Postoperative Complications Rectal Diseases Retrospective Studies

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