Mesenteric vascular and nerve sparing surgery in laparoscopic segmental intestinal resection for deep infiltrating endometriosis

Ricciarda Raffaelli, Simone Garzon, Silvia Baggio, Michele Genna, Genna M, Paola Pomini, Pomini P, Antonio Simone Laganà, Fabio Ghezzi, Massimo Piergiuseppe Franchi, Massimo Franchi
European journal of obstetrics, gynecology, and reproductive biology · 2018 · vol. 231 , pp. 214–219 · doi:10.1016/j.ejogrb.2018.10.057 · PMID:30415128 · W2899099555
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This study investigated the efficacy and safety of mesenteric vascular and nerve sparing surgery during laparoscopic segmental intestinal resection for deep infiltrating endometriosis.

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Abstract

Objective(s)To investigate Mesenteric vascular and nerve Sparing Surgery (MSS) as surgical laparoscopic technique to perform segmental intestinal resection for deep infiltrating endometriosis (DIE).Study designProspective cohort study between January 2013 and December 2016. Consecutive patients with suspected intestinal DIE underwent clinical and imaging evaluation to confirm intestinal involvement. Indications for radical surgery and surgical technique (intestinal resection versus shaving) were consistent with Abrão algorithm. Surgeons aimed to perform MSS in all the consecutive patients that required intestinal resection. MSS consists in mesenteric artery, branching arteries, and surrounding nerve fibers preservation by dissecting mesentery adherent to the intestinal wall. Data about history, preoperative and post-operative evaluation, surgery and complications were recorded. Symptoms were evaluated before and 30-60 days after surgery with numeric rating scale for pain. Constipation was evaluated with the Constipation Assessment Scale (CAS). Patients with diagnosis of irritable bowel syndrome, inflammatory bowel diseases, diverticulitis, and previous segmental intestinal resection were excluded.ResultsSixty-two out of 75 (82.7%) consecutive women with intestinal endometriosis underwent laparoscopic segmental intestinal resection performed with MSS. Major complications that required repeated operation occurred in 4 cases (6.5%). Anastomotic leakage occurred in only 1 case (1.6%). Dysmenorrhea (p < .001; r = -0.86), dyspareunia (p < .001; r = -0.80), dyschezia (p < .001; r = -0.86) and dysuria (p < .001; r = -0.56) were significantly improved after surgery. After an average of 33.1 months from surgery, severe constipation was reported only by two patients (3.6%) (CAS: 13-16). The median time from surgery to intestinal function recovery (flatus or stool passage) was one day. Logistic regression analysis showed constipation related to the distance from anal verge and time since surgery.Conclusion(s)MSS in laparoscopic intestinal resection for DIE may be reproducible, safe and effective. MSS could be combined with pelvic nerve-sparing surgery as an effective approach to improve intestinal symptoms after radical surgery for DIE that requires segmental intestinal resection.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Constipation Endometriosis Intestinal Diseases Laparoscopy Adult Constipation Constipation Endometriosis Endometriosis Female Humans Intestinal Diseases Intestinal Diseases Laparoscopy Laparoscopy Postoperative Complications Postoperative Complications Prospective Studies Treatment Outcome

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