Posterior rectal pouch after large full-thickness disc excision of deep endometriosis infiltrating the low/mid rectum and relationship with digestive functional outcome

Perrine d’Avout-Fourdinier, Perrine d'Avout-Fourdinier, d'Avout-Fourdinier P, Lempicka M, Marta Lempicka, André Gilibert, Gilibert A, Céline Savoye‐Collet, Céline Savoye-Collet, Savoye-Collet C, Loïc Marpeau, Loı̈c Marpeau, Marpeau L, Hennetier C, Clotilde Hennetier, Tuech JJ, Jean-Jacques Tuech, Jean–Jacques Tuech, Roman H, Horace Roman
Journal of gynecology obstetrics and human reproduction · 2020 · vol. 49(7) , pp. 101792 · doi:10.1016/j.jogoh.2020.101792 · PMID:32439615 · W3028103574
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This study described the MRI appearance of posterior rectal pouches after rectal endometriosis excision, finding no correlation with functional digestive outcomes one year post-surgery.

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Abstract

IntroductionThe aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms.Material and methodsSingle center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence.ResultsEighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = -0.24, 95%CI -0.51-0.69, p = 0.44).ConclusionLarge disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.

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Condition tags

endometriosis

MeSH descriptors

Digestive System Diseases Digestive System Surgical Procedures Endometriosis Postoperative Complications Rectal Diseases Rectum Digestive System Diseases Digestive System Surgical Procedures Endometriosis Endometriosis Endometriosis Female France Humans Magnetic Resonance Imaging Postoperative Complications Postoperative Complications Quality of Life Rectal Diseases Rectal Diseases

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