Outcome after surgery for deep endometriosis infiltrating the rectum

Abstract

Objective: To evaluate the rate of postoperative complications between conservative surgery and segmental resection in patients with rectal endometriosis.

Design: Single-center retrospective study.

Setting: University hospital.

Patient(s): A total of 232 women undergoing surgery for deep endometriosis infiltrating the rectum up to 15 cm from the anus with at least involvement of the muscularis layer, stratified into two arms according to surgical technique. Subgroup analysis was performed in patients without previous therapeutic laparoscopy for endometriosis (n = 108). A propensity-score approach was used to correct for group differences.

Intervention(s): All patients underwent CO₂-laser laparoscopic surgery: 61 underwent conservative surgery, and 171 had a segmental resection.

Main outcome measure(s): Postoperative complication rate (Clavien-Dindo classification).

Result(s): Clavien-Dindo type 1 and 2 complications did not differ between both groups. Clavien-Dindo type 3 complications were more frequent in the segmental resection group (1/61 [1.6%] conservative vs. 18/171 [10.5%] segmental), after propensity analysis only a trend was retained. In the subgroup analysis, no difference or trend was found (1/27 [3.7%] conservative vs. 5/81 [6.2%] segmental). A low rate of temporary diverting stoma was recorded: 24/232 (10.3%).

Conclusion(s): A higher major complication (Clavien-Dindo ≥3) rate for segmental resections compared with conservative surgical treatment was shown in the overall population, although after correction for group differences this was attenuated to a trend only. However, in patients without previous therapeutic laparoscopy no significant difference or trend was found regardless of the surgical technique used. This not only suggests that redo/repeated surgery has a potentially increased morbidity, but also emphasizes the importance of a well executed primary surgery.

Keywords: Laparoscopy; colorectal resection; conservative surgery; postoperative complications; rectal endometriosis.