Surgical Outcomes After Colorectal Surgery for Intestinal Deep Endometriosis: A Retrospective Cohort Study

Abstract

Aim: Deep endometriosis (DE) is defined as infiltrating lesions greater than 5 mm in depth and is one of the more severe forms of endometriosis. The surgical management of DE infiltrating the bowel is complex and controversial. The primary aim of this study was to determine post-operative complications and outcomes in patients undergoing surgical treatment for bowel endometriosis. Method: A retrospective study was conducted of all patients who underwent surgical treatment for bowel endometriosis between 2012 and 2020 at two centers. All demographic data and peri-operative data, including symptoms, imaging, type of operation, length of stay, complications, and length of follow-up were analyzed. Results: A total of 167 patients underwent combined gynecological and colorectal surgery for intestinal DE. Complete data was available for 108 patients, who were included in the final analyses. Pelvic pain was the most common symptom, with 82/108 (75.9%) patients reporting it as the main symptom. Pre-operative dedicated ultrasound detected a rectal endometrial nodule in 101/108 (93.5%) patients. All operations were performed laparoscopically; 27/108 (25%) patients underwent a rectal shave, 15/108 (13.9%) patients underwent a disc resection, and 66/108 (61.1%) patients underwent segmental resection for bowel endometriosis. One anastomotic leak was identified in our cohort. Sonographic recurrence of endometriosis was identified in 22.5% of the patients after a median follow-up of 12 months. All of the patients with recurrence were treated with medical management only. Conclusion: Laparoscopic surgery for endometriosis was performed with an acceptable rate of complications and recurrence in this cohort.

Keywords

• laparoscopic
• endometriosis
• segmental resection
• colorectal
• complications