Totally intracorporeal colorectal anastomosis (TICA) versus classical mini-laparotomy for specimen extraction, after segmental bowel resection for deep endometriosis: a single-center experience

Manuel Maria Ianieri, Alessandra Nardone, Alessandra De Cicco Nardone, Pierfrancesco Greco, Antonella Carcagnì, Federica Campolo, Fabio Pacelli, Giovanni Scambia, Francesco Santullo
Archives of gynecology and obstetrics · 2024 · vol. 309(6) , pp. 2697–2707 · doi:10.1007/s00404-024-07412-6 · PMID:38512463 · W4393055874
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Totally intracorporeal colorectal anastomosis showed no significant difference in complications compared to classical mini-laparotomy for specimen extraction, but classical technique had a better gastrointestinal quality of life index after six months.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This single-center retrospective observational study enrolled 64 symptomatic women with histologically confirmed deep endometriosis who underwent laparoscopic excision with segmental bowel resection, comparing totally intracorporeal colorectal anastomosis (TICA) against a classical technique (CT) that used conventional specimen extraction and extra-abdominal anvil insertion. The authors assessed intra- and postoperative complications (within 30 days, using Clavien-Dindo) and functional outcomes at 6 months using VAS pain scores plus the KESS and GIQLI validated questionnaires. They found no significant difference between TICA and CT in complications, with pain VAS scores generally decreasing in both groups and GIQLI improving in both groups, though GIQLI was significantly smaller in the TICA group versus CT at 6 months; the paper also notes limitations inherent to its retrospective design and single-center experience. This paper is centrally about endometriosis — it evaluates surgical technique outcomes specifically after segmental bowel resection for colorectal deep endometriosis.

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Abstract

PURPOSE: The surgical approach to bowel endometriosis is still unclear. The aim of the study is to compare TICA to conventional specimen extractions and extra-abdominal insertion of the anvil in terms of both complications and functional outcomes. METHODS: This is a single-center, observational, retrospective study conducted enrolling symptomatic women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between September 2019 and June 2022. Women who underwent TICA were compared to classical technique (CT) in terms of intra- and postoperative complications, moreover, functional outcomes relating to the pelvic organs were assessed using validated questionnaires [Knowles-Eccersley-Scott-Symptom (KESS) questionnaire and Gastro-Intestinal Quality of Life Index (GIQLI)] for bowel function. Pain symptoms were assessed using Visual Analogue Scale (VAS) scores. RESULTS: The sample included 64 women. TICA was performed on 31.2% (n = 20) of the women, whereas CT was used on 68.8% (n = 44). None of the patients experienced rectovaginal, vesicovaginal, ureteral or vesical fistula, or ureteral stenosis and uroperitoneum, and in no cases was it necessary to reoperate. Regarding the two surgical approaches, no significant difference was observed in terms of complications. As concerns pain symptoms at 6-month follow-up evaluations on stratified data, except for dysuria, all VAS scales reported showed significant reductions between median values, for both surgery interventions. As well, significant improvements were further observed in KESS scores and overall GIQLI. Only the GIQLI evaluation was significantly smaller in the TICA group compared to CT after the 6-month follow-up. CONCLUSIONS: We did not find any significant differences in terms of intra- or post-operative complications compared TICA and CT, but only a slight improvement in the Gastro-Intestinal Quality of Life Index in patients who underwent the CT compared to the TICA technique.

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Outcome instruments

VAS-pain

Condition tags

mesh:D004715endometriosisbowel_endometriosis

MeSH descriptors

Anastomosis, Surgical Anastomosis, Surgical Anastomosis, Surgical Anastomosis, Surgical Anastomosis, Surgical Anastomosis, Surgical Anastomosis, Surgical Anastomosis, Surgical Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Postoperative Complications Postoperative Complications Postoperative Complications Postoperative Complications

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References (35)

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