Effect of Retaining the Uterus During Anterior Resection for Rectosigmoid Bowel Endometriosis

Keisuke Tanaka, E Ballard, Damien Petersen, Akwasi Amoako, Akram Khalil, David Baartz
In: Journal of Gynecologic Surgery · 2020 · vol. 37(1) , pp. 6–9 · doi:10.1089/gyn.2020.0101 · W3083210492
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Anterior resection for rectosigmoid endometriosis effectively resolved pain, with similar complication rates whether the uterus was retained or removed, though 24.2% reported altered bowel habits.

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Abstract

Objective: The goal of this research was to report the efficacy and morbidity of anterior resection for rectosigmoid bowel endometriosis and to compare outcomes between women who underwent hysterectomy and those who did not. Materials and Methods: This was a retrospective cohort study of women who underwent anterior resection for endometriosis at an Australian tertiary center within 5 years, from January 2013 to December 2017. Results: During the study period, 33 women underwent anterior resection. Of these patients, 17 underwent hysterectomy and 16 retained their fertility. There were 32 laparoscopic cases, 3 of which were converted to laparotomy, and 1 case was intended to be managed with a laparotomy. The length of stays (LOS) ranged from 4 to 32 days (mean: 8 days). Postoperative complications included voiding dysfunction requiring temporary self-catheterization (9.1%), anastomotic leaks (6.1%), ileus managed conservatively (6.1%), readmission for conservative management of gastrointestinal symptoms (6.1%), and pancreatitis (3%). All women with or without hysterectomy reported either complete resolution of or reduced pain symptoms at follow-up appointments, 8 women (24.2%) reported altered bowel habits, for which 2 women underwent colonoscopy with normal findings. All women with altered bowel habits were managed conservatively. Retaining the uterus did not affect the postoperative complication rate. Conclusions: Anterior resection for bowel endometriosis was effective for addressing endometriosis-related pain. However, 24.2% of women developed altered bowel habits and 6.1% of cases were complicated with anastomotic leaks associated with extended LOS. The incidence of surgical morbidity for bowel procedures poses a therapeutic dilemma. A rationale behind the management plan for each patient and careful preoperative counseling is essential.

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Condition tags

endometriosisbowel_endometriosis

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