Multiple Nodule Removal by Disc Excision and Segmental Resection in Multifocal Colorectal Endometriosis

Jenny-Claude Millochau, Millochau JC, Emanuela Stochino-Loi, Stochino-Loi E, Basma Darwish, Darwish B, Abo C, Carole Abo, J Coget, Coget J, Julien Coget, Rachid Chati, Chati R, Jean-Jacques Tuech, Tuech JJ, Jean–Jacques Tuech, Horace Roman
Journal of Minimally Invasive Gynecology · 2017 · vol. 25(1) , pp. 139–146 · doi:10.1016/j.jmig.2017.09.007 · PMID:28893658 · W2752363840
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This paper describes a surgical technique involving disc excision and segmental resection for removing multiple nodules of colorectal endometriosis.

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Abstract

STUDY OBJECTIVE: To report postoperative outcomes after dual digestive resection for deep endometriosis infiltrating the rectum and the colon. DESIGN: A retrospective study using data prospectively recorded in the CIRENDO database (Canadian Task Force classification II-2). SETTING: A university tertiary referral center. PATIENTS: Twenty-one patients managed for multiple colorectal deep endometriosis infiltrating nodules. INTERVENTIONS: Concomitant disc excision and segmental resection of both the rectum and sigmoid colon. MEASUREMENTS AND MAIN RESULTS: The assessment of postoperative outcomes was performed. Rectal nodules were managed by disc excision and segmental resection in 20 patients and 1 patient, respectively. Sigmoid colon nodules were removed by short segmental resection and disc excision in 15 and 6 patients, respectively. The rectal nodule diameter was between 1 and 3 cm and over 3 cm in 33% and 67% of patients, respectively. Associated vaginal infiltration requiring vaginal excision was recorded in 76.2% of patients. The mean diameter of the rectal disc removed averaged 4.6 cm, and the mean height of the rectal suture was 5.8 cm. The length of the sigmoid colon specimen and the height of the anastomosis were 7.3 cm and 18.5 cm, respectively. The mean operative time was 290 minutes, and the mean postoperative follow-up averaged 30 months. Clavien-Dindo 3 complications occurred in 28% of patients, including 4 with rectal fistulae (19%). The pregnancy rate was 67% among patients with pregnancy intention. CONCLUSION: Our data suggest that combining disc excision and segmental resection to remove multiple deep endometriosis nodules infiltrating the rectum and the sigmoid colon can preserve the healthy bowel located between 2 consecutive nodules. However, the rate of postoperative complications is high, particularly in patients with large low rectal nodules.

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Digestive System Surgical Procedures Endometriosis Rectal Diseases Adult Adult Colonic Diseases Colonic Diseases Colonic Diseases Colon, Sigmoid Colon, Sigmoid Colon, Sigmoid Colon, Sigmoid Digestive System Surgical Procedures Digestive System Surgical Procedures Digestive System Surgical Procedures Digestive System Surgical Procedures Endometriosis Endometriosis Endometriosis

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (36)

Cited by (29)

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License: CC0 · commercial use OK