Prevesical peritoneum interposition to prevent risk of rectovaginal fistula after en bloc colorectal resection with hysterectomy for endometriosis: Results of a pilot study

Boudy AS, Anne‐Sophie Boudy, Anne-Sophie Boudy, Elie Vesale, Vesale E, Elie Vésale, Alexandra Arfi, Arfi A, Clementine Owen, Owen C, C. A. Owen, Jayot A, Aude Jayot, Zilberman S, Sonia Zilberman, Sofiane Bendifallah, Bendifallah S, Émile Daraï, Darai E, Emile Darai
Journal of gynecology obstetrics and human reproduction · 2019 · vol. 49(2) , pp. 101649 · doi:10.1016/j.jogoh.2019.101649 · PMID:31760180 · W2991611329
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This pilot study investigated the use of prevesical peritoneum interposition during en bloc colorectal resection with hysterectomy for endometriosis to assess its effectiveness in preventing rectovaginal fistula.

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Abstract

ObjectiveTo evaluate the risk of rectovaginal fistula after en bloc hysterectomy and colorectal resection (H-CR) for endometriosis using prevesical peritoneum interposition.Study designA retrospective study conducted at Tenon University Hospital, expert center in endometriosis, from June 2016 to June 2018. Patients undergoing H-CR with prevesical peritoneum interposition without protective defunctioning stoma were included.ResultsOf the 160 patients who underwent surgery with colorectal resection for endometriosis during the study period, 27 had H-CR (15 with segmental and 12 with discoïd colorectal resection) and were included. The median age (range) was 45 years (41-47.5). Eight patients (13 %) were nulliparous. All procedures were performed by laparoscopy. Parametrial resection was performed in 14 cases (52 %). Associated bowel procedures were ileocecal resection (n = 5) and appendectomy (n = 2). Median follow-up (range) was 14.6 months (10.5-20.2). Nine (33.3 %) patients experienced intra- or postoperative complications including one grade I, four grade II, two grade IIIA and two grade IIIB complications (Clavien-Dindo classification). Seven patients (26 %) experienced postoperative voiding dysfunction. One suspicion of rectovaginal fistula associated with pelvic abscess was diagnosed 4 weeks after surgery but not confirmed during a second operation.ConclusionDespite the small sample size, the present pilot study supports the practice of prevesical peritoneum interposition to limit the risk of rectovaginal fistula in patients who undergo H-CR for deep endometriosis.

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Condition tags

endometriosis

MeSH descriptors

Colectomy Colonic Diseases Endometriosis Hysterectomy Peritoneum Postoperative Complications Proctectomy Rectal Diseases Rectovaginal Fistula Uterine Diseases Adult Colonic Diseases Colonic Diseases Endometriosis Female Humans Middle Aged Peritoneum Pilot Projects Postoperative Complications

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