Management of deep infiltrating endometriosis of the rectum: Is a systematic temporary stoma relevant?

N Ledu, Ledu N, Nzeba K Ledu, Rubod C, C. Rubod, Piessen G, G Piessen, Guillaume Piessen, Roman H, H. Roman, Horace Roman, Collinet P, P Collinet, Pierre Collinet
Journal of gynecology obstetrics and human reproduction · 2017 · vol. 47(1) , pp. 1–7 · doi:10.1016/j.jogoh.2017.10.005 · PMID:29097291 · W2766996516
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This paper investigates the relevance of systematically using a temporary stoma for managing deep rectal endometriosis.

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Abstract

Study objectiveTo assess the value of performing a protective stoma in patients operated for rectal endometriosis.Material and methodsFrom June 2009 to December 2011, 47 patients were operated for rectal endometriosis by segmental or discoid resection in 4 different centers. Two groups were formed: one with protective stoma (group S), n=33 and one without protective stoma (group NS), n=14. Data were collected from the CIRENDO database.Measurements and main resultsPostoperative complication rate of group NS was 57% against 48% in group S (P=0.75). There was an increasing trend of the rate of anastomotic leakage in group S as compared to group NS: 21% against 3% (P=0.073). All 3 patients of group NS with an anastomotic leakage were reoperated and the group S patient had medical treatment. In a center, digestive operative time was not necessarily performed in association with a gastrointestinal surgeon. All patients in group S had a restoration of continuity in about 3 months. Two of them had dilation of anastomotic stricture and 3 others showed a transient postoperative ileus during this recovery. Quality of life was assessed by the MOS SF-36 and significantly improved in both groups thanks to the intervention.ConclusionTemporary digestive stoma in patients operated for rectal endometriosis has to be considered because in our study, it seems reducing complications such as anastomotic leakage. This must be confirmed with studies with larger numbers.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Digestive System Surgical Procedures Endometriosis Outcome Assessment, Health Care Postoperative Complications Rectal Diseases Surgical Stomas Adult Anastomotic Leak Anastomotic Leak Case-Control Studies Digestive System Surgical Procedures Digestive System Surgical Procedures Endometriosis Female Humans Postoperative Complications Rectal Diseases Reoperation Young Adult

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