Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study

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  • Sophia Braund, Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis
  • ,
  • Clotilde Hennetier, Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis
  • ,
  • Clemence Klapczynski, Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis
  • ,
  • Antoine Scattarelli, Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis
  • ,
  • Julien Coget, CHU Hopitaux de Rouen
  • ,
  • Valérie Bridoux, CHU Hopitaux de Rouen
  • ,
  • Jean Jacques Tuech, CHU Hopitaux de Rouen
  • ,
  • Horace Roman, Clinique Bordeaux Tivoli-Ducos

Study Objective: To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR). Design: Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database. Setting: University tertiary referral center. Patients: Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study. Interventions: Laparoscopic SR or DE. Measurements and Main Results: One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR. Conclusion: Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma.

OriginalsprogEngelsk
TidsskriftJournal of minimally invasive gynecology
Vol/bind28
Nummer1
Sider (fra-til)50-56
Antal sider7
ISSN1553-4650
DOI
StatusUdgivet - jan. 2021

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