Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study

Sophia Braund, Braund S, Clotilde Hennetier, Hennetier C, Clemence Klapczynski, Klapczynski C, Clémence Klapczynski, Scattarelli A, Antoine Scattarelli, J Coget, Coget J, Julien Coget, Valérie Bridoux, Bridoux V, Jean Jacques Tuech, Tuech JJ, Jean‐Jacques Tuech, Horace Roman
Journal of Minimally Invasive Gynecology · 2020 · vol. 28(1) , pp. 50–56 · doi:10.1016/j.jmig.2020.04.034 · PMID:32360656 · W3022234785
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This retrospective study found that segmental resection for rectosigmoid endometriosis resulted in postoperative stenosis in 8.6% of patients, whereas disk excision did not, with a diverting stoma identified as a risk factor for stenosis after segmental resection.

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This retrospective study evaluated the prevalence and risk factors of postoperative bowel stenosis in 431 patients undergoing surgery for deep infiltrating endometriosis of the rectosigmoid. Comparing disk excision (DE) and segmental resection (SR), the researchers found that stenosis occurred in 8.6% of SR patients but in none of the DE patients, with a diverting stoma identified as the sole independent risk factor for stenosis following SR. The authors note that while dilatation was the primary treatment for stenosis, it carried risks of injury and subsequent fistula formation in rare cases. This paper is centrally about endometriosis — specifically laparoscopic surgical management and complications associated with deep infiltrating rectosigmoid lesions.

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Abstract

STUDY OBJECTIVE: To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR). DESIGN: Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database. SETTING: University tertiary referral center. PATIENTS: Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study. INTERVENTIONS: Laparoscopic SR or DE. MEASUREMENTS AND MAIN RESULTS: One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR. CONCLUSION: Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma.
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Abstract

Study Objective: To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR). Design: Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database. Setting: University tertiary referral center. Patients: Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study. Interventions: Laparoscopic SR or DE. Measurements and Main Results: One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR. Conclusion: Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma. | Original language | English | |---|---| | Journal | Journal of minimally invasive gynecology | | Volume | 28 | | Issue | 1 | | Pages (from-to) | 50-56 | | Number of pages | 7 | | ISSN | 1553-4650 | | DOIs | | | Publication status | Published - Jan 2021 |

Keywords

- Bowel stenosis - Deep endometriosis - Postoperative complications - Stoma Fingerprint Dive into the research topics of 'Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Colonic Diseases Constriction, Pathologic Endometriosis Postoperative Complications Rectal Diseases Adult Colonic Diseases Constriction, Pathologic Endometriosis Female Humans Rectal Diseases Retrospective Studies

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