Annals of Coloproctology

Original Article

Benign bowel disease

Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases: Sara Gortázar de las Casas, Emanuela Spagnolo, Salomone Di Saverio, Mario Álvarez-Gallego, Ana López Carrasco, María Carbonell López, Sergio Torres Cobos, Constantino Fondevila Campo, Alicia Hernández Gutiérrez, Isabel Pascual Miguelañez; Ann Coloproctol. 2023;39(3):216-222. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00829.0118

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Purpose
The surgical management of deep infiltrative endometriosis (DE) involving the rectum remains a challenge. The objective of this study was to assess the outcomes from a single tertiary center over a decade with an emphasis on the role of a protective loop ileostomy (PI).
Methods
A retrospective review of outcomes for 168 patients managed between 2008 and 2018 is presented including 57 rectal shaves, 23 discoid excisions, and 88 segmental rectal resections.
Results
The nodule size (mean±standard deviation) in the segmental resection group was 32.7±11.2 mm, 23.4±10.5 mm for discoid excision, and 18.8±6.0 mm for rectal shaves. A PI was performed in 19 elective cases (11.3%) usually for an ultra-low anastomosis <5 cm from the anal verge. All Clavien-Dindo grade III/IV complications occurred after segmental resections and included 5 anastomotic leaks, 6 rectovaginal fistulas, 2 ureteric fistulas, and 1 ureteric stenosis. Of 26 stomas (15.5%), there were 19 PIs, 3 secondary ileostomies (after complications), and 4 end colostomies. The median time to PI closure was 5.8 months (range, 0.4–16.7 months) in uncomplicated disease compared with 9.2 months (range, 4.7–18.4 months) when initial postoperative complications were recorded (P=0.019). Only 1 patient with a recurrent rectovaginal fistula had a permanent colostomy.
Conclusion
In patients with DE and rectal involvement a PI is selectively used for low anastomoses and complex pelvic reconstructions. Protective stomas and those used in the definitive management of a major postoperative complication can usually be reversed.

Citations

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Surgeons' workload assessment during indocyanine-assisted deep endometriosis surgery using the surgery task load index: The impact of the learning curve
Emanuela Spagnolo, Ignacio Cristóbal Quevedo, Sara Gortázar de las Casas, Ana López Carrasco, Maria Carbonell López, Isabel Pascual Migueláñez, Alicia Hernández Gutiérrez
Frontiers in Surgery.2022;[Epub] CrossRef
Quality of Life in Women after Deep Endometriosis Surgery: Comparison with Spanish Standardized Values
Alicia Hernández, Elena Muñoz, David Ramiro-Cortijo, Emanuela Spagnolo, Ana Lopez, Angela Sanz, Cristina Redondo, Patricia Salas, Ignacio Cristobal
Journal of Clinical Medicine.2022; 11(20): 6192. CrossRef

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