Evaluation of pre- and post-operative symptoms in patients submitted to linear stapler nodulectomy due to anterior rectal wall endometriosis

Background The objective of this study was to evaluate the feasibility and safety of a more versatile rectosigmoid nodulectomy technique using a linear stapler.

Case series. Setting: tertiary care (reference center for endometriosis surgery). Patients: Sixty-one consecutive patients who were operated on between January 2006 and February 2013. Intervention: anterior rectal wall nodulectomy technique using sequential bites of the linear stapler. Measurements: Perioperative complications were recorded, and a condition-specific bowel dysfunction quality of life questionnaire (Rome III—Constipation) was applied pre-operatively and post-operatively during the first week of April 2013. Design classification: Canadian Task Force III

A total of 61 patients were submitted to the intervention. After a mean follow-up period of 1.83 years (.25–7.1 ± 1.97), no post-operative fistula or leakage was observed. In addition, no cases of rectal stenosis or bowel obstruction were recorded, and two patients were excluded for not answering the post-operative questionnaire. According to the Rome III questionnaire, constipation symptoms improved significantly in 12 out of 17 questions. No patient reported worsening of symptoms in question.

Linear stapler resection is a safe alternative to segmentar resection for endometriotic nodules on the anterior rectal wall. Similar content being viewed by others

De Cicco C, Schonman R, Craessaerts M, Van Cl, Ussia A, Koninckx PR (2009) Laparoscopic management of ureteral lesions in gynecology. Fertil Steril 92:1424–1427 Koninckx PR, Martin DC (1992) Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril 58:924–928 Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13:1125–1128 Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC (2007) Bowel endometriosis: presentation, diagnosis and treatment. Obstet Gynecol Surv 62:461–470 Mabrouk M, Spagnolo E, Raimondo D, D’Errico A, Caprara G, Malvi D, Catena F, Ferrini G, Paradisi R, Seracchioli R (2012) Segmental bowel resection for colorectal endometriosis: is there a correlation between histological pattern and clinical outcomes? Hum Reprod 27(5):1314–1319 Sahw RW (1992) Treatment of endometriosis. Lancet 340:1267–1271 Fanfani F, Fagotti A, Gagliardi ML, Ruffo G, Ceccaroni M, Scambia G et al (2010) Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study. Fertil Steril 94:444–449 Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L et al (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications and clinical outcome. Arch Surg 144:234–239 Mereu L, Ruffo G, Landi S, Barbieri F, Zaccoletti R, Fiaccavento A et al (2007) Laparoscopic treatment of deep endometriosis with segmental colorectal resection: short-term morbidity. J Minim Invasive Gynecol 14:463–469 Nezhat C, Nezhat F, Pennington E, Nezhat CH, Ambroze W (1994) Laparoscopic disk excision and primary repair of the anterior rectal wall for the treatment of full-thickness bowel endometriosis. Surg Endosc 8:682–685 Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 18:157–161 Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 20:2317–2320 De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P (2011) Bowel resection for deep endometriosis: a systematic review. BJOG 118:285–291 Abrao MS, Podgaec S, Dias JA Jr, Averbach M, Silva LF, de Carvalho F Marino (2008) Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol 15:280–285 Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E (2006) Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 21(5):1243–1247 Armengol-Debeir L, Savoye G, Leroi AM, Gourcerol G, Savoye-Collet C, Tuech JJ, Vassilieff M, Roman H (2011) Pathophysiological approach to bowel dysfunction after segmental colorectal resection for deep endometriosis infiltrating the rectum: a preliminary study. Hum Reprod 26(9):2330–2335 Roman H, Vassilieff M, Tuech JJ, Huet E, Savoye G, Marpeau L, Puscasiu L (2013) Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 99(6):1695–1704 Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J (2012) Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril 98(3):564–571

Authors would like to thank T. C. S. Bonetti, Ph.D. for her assistance in statistical analysis and to J. Ottolia M.D. for her assistance in the application of Rome III questionnaire. Disclosures Drs. Gil Kamergorodsky, Nucelio Lemos, Francisco C. Rodrigues, Fernando Yassuo Asanuma, Paulo D’Amora, Eduardo Schor, and Manoel J. B. C. Girão have no conflicts of interest or financial ties to disclose. Author information Authors and Affiliations Corresponding author Electronic supplementary material Below is the link to the electronic supplementary material. Supplementary material 1 (MP4 76019 kb). Rights and permissions About this article Cite this article Kamergorodsky, G., Lemos, N., Rodrigues, F.C. et al. Evaluation of pre- and post-operative symptoms in patients submitted to linear stapler nodulectomy due to anterior rectal wall endometriosis. Surg Endosc 29, 2389–2393 (2015). https://doi.org/10.1007/s00464-014-3945-4 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00464-014-3945-4