Traitement chirurgical de l’endométriose digestive : entre l’approche limitée et radicale

Résumé L’endométriose digestive est définie par une infiltration endométriosique de la musculeuse pariétale du tube digestif et affecte 8 % à 30 % des patientes porteuses d’endométriose. Les localisations rectales et de la charnière rectosigmoïdienne sont les plus fréquentes et représentent jusqu’à 90 % de l’ensemble de ces lésions. Deux approches chirugicales existent dans la prise en charge de ces patientes que sont l’approche radicale et conservatrice. L’approche radicale a pour objectif la résection micro- et macroscopiquement complète des implants digestifs d’endométriose afin de réduire au minimum le risque de récidives digestives; elle consiste à réaliser de manière systématique des résections colorectales segmentaires et expose à un risque de séquelles fonctionnelles. L’approche conservatrice vise à réaliser chaque fois que possible des exérèses sélectives afin d’éviter les séquelles fonctionnelles, mais nécessite un traitement hormonal postopératoire pour éviter les récidives. Il n’existe à ce jour, aucune étude permettant de recommander une stratégie plutôt que l’autre. Les résultats de l’essai contrôlé randomisé ENDORE pourront prochainement apporter des informations sur les résultats fonctionnels digestifs chez les patientes opérées d’une endométriose rectale par résection colorectale ou chirurgie conservatrice. Abstract Digestive endometriosis is defined by infiltration of the muscular layer of bowel wall with endometriotic tissue. This condition affects 8 to 30% of the patients suffering from endometriosis. Rectal wall and low sigmoid are commonly affected (90% of digestive locations). Surgical approaches can be radical or conservative. 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Traitement chirurgical de l’endométriose digestive : entre l’approche limitée et radicale. Colon Rectum 10, 174–180 (2016). https://doi.org/10.1007/s11725-016-0662-2 Published: Issue date: DOI: https://doi.org/10.1007/s11725-016-0662-2 Mots clés - Endométriose digestive - Endométriose colorectale - Chirurgie - Résection segmentaire - Résection en pastille - Shaving rectal