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. 2024 Jul 1:37:e1806.
doi: 10.1590/0102-6720202400013e1806. eCollection 2024.

INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER

Leandro Cardoso Barchi  1   2   3 , Gustavo Yano Callado  4 , Rogério Bonassi Machado  5 , Marcelo Antunes Chico  3 , Daniella Closer Damico  3 , Daniela Pereira Lacerda  3 , Rocco Ricciardi  6 , Rodrigo Moises de Almeida Leite  4   6
Affiliations

INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER

Leandro Cardoso Barchi et al. Arq Bras Cir Dig. .

Abstract
in English, Portuguese

Background: Deep penetrating endometriosis (DE) can affect abdominal and pelvic organs like the bowel and bladder, requiring treatment to alleviate symptoms.

Aims: To study and investigate clinical and surgical outcomes in patients diagnosed with DE involving the intestines, aiming to analyze the effectiveness of surgical treatments.

Methods: All cases treated from January 2021 to July 2023 were included, focusing on patients aged 18 years or older with the disease affecting the intestines. Patients without intestinal involvement and those with less than six months of post-surgery follow-up were excluded. Intestinal involvement was defined as direct invasion of the intestinal wall or requiring adhesion lysis for complete resection. Primary outcomes were adhesion lysis, rectal shaving, disc excision (no-colectomy group), and segmental resection (colectomy group) along with surgical complications like anastomotic leak and fistulas, monitored for up to 30 days.

Results: Out of 169 patients with DE surgically treated, 76 met the inclusion criteria. No colectomy treatment was selected for 50 (65.7%) patients, while 26 (34.2%) underwent rectosigmoidectomy (RTS). Diarrhea during menstruation was the most prevalent symptom in the RTS group (19.2 vs. 6%, p<0.001). Surgical outcomes indicated longer operative times and hospital stays for the segmental resection group, respectively 186.5 vs. 104 min (p<0.001) and 4 vs. 2 days, (p<0.001). Severe complications (Clavien-Dindo ≥3) had an overall prevalence of 6 (7.9%) cases, without any difference between the groups. There was no mortality reported. Larger lesions and specific symptoms like dyschezia and rectal bleeding were associated with a higher likelihood of RTS. Bayesian regression highlighted diarrhea close to menstruation as a strong predictor of segmental resection.

Conclusions: In patients with DE involving the intestines, symptoms such as dyschezia, rectal bleeding, and menstrual period-related diarrhea predict RTS. However, severe complication rates did not differ significantly between the segmental resection group and no-colectomy group.

RACIONAL:: A endometriose profunda infiltrativa (EP) pode afetar órgãos abdominais e pélvicos, tais como o intestino e a bexiga, necessitando de tratamento para aliviar os sintomas.

OBJETIVOS:: Estudar e investigar resultados clínicos e cirúrgicos em pacientes com diagnóstico de EP envolvendo o intestino, visando analisar a eficácia dos tratamentos cirúrgicos.

MÉTODOS:: Foram incluídos todos os casos atendidos de janeiro de 2021 a julho de 2023, com foco em pacientes com 18 anos ou mais com a doença acometendo o intestino. Foram excluídos pacientes sem comprometimento intestinal e aqueles com menos de seis meses de acompanhamento pós-operatório. O envolvimento intestinal foi definido como invasão direta da parede intestinal ou necessidade de lise de aderências para ressecção completa. Os desfechos primários foram lise de aderências, raspagem retal e excisão discóide (grupo não colectomia), e ressecção segmentar (grupo colectomia), juntamente com complicações cirúrgicas como fístulas, monitoradas por até 30 dias.

RESULTADOS:: Das 169 pacientes com EP tratadas cirurgicamente, 76 preencheram os critérios de inclusão. Não foi indicado colectomia em 50 (65,7%) pacientes, enquanto 26 (34,2%) foram submetidos à retossigmoidectomia (RTS). A diarreia durante a menstruação foi o sintoma mais prevalente no grupo RTS (19,2% vs. 6,0%, p<0,001). Os resultados cirúrgicos indicaram tempos operatórios e internações hospitalares mais longos para o grupo de ressecção segmentar, respectivamente, 186,5 vs. 104 min (p<0,001) e 4 vs. 2 dias, (p<0,001). As complicações graves (Clavien-Dindo ≥3) tiveram prevalência global de 6 (7,9%) casos, sem diferença entre os grupos. Não houve mortalidade relatada. Lesões mais graves e sintomas específicos como disquezia e sangramento retal foram associados a maior probabilidade de indicação de RTS. A regressão bayesiana destacou a diarreia próxima à menstruação como um forte preditor de ressecção segmentar.

CONCLUSÕES:: Em pacientes com endometriose envolvendo os intestinos, sintomas como disquezia, sangramento retal e diarreia relacionada ao período menstrual predizem a indicação de RTS. No entanto, as taxas de complicações graves não diferiram significativamente entre o grupo de ressecção segmentar e o grupo sem colectomia.

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Conflict of interest statement

Conflict of interests: None

Figures

Figure 1
Figure 1. Visual map with Bayesian regression model demonstrating positive and negative correlations with rectosigmoidectomy. No strong single predictor for major surgical complications could be identified.
Figure 2
Figure 2. Visual map with Bayesian regression model demonstrating positive and negative correlations with surgical complications. Diarrhea in the perimenstrual period was the strongest predictor for rectosigmoidectomy.
See this image and copyright information in PMC

References

    1. Abdalla-Ribeiro H, Maekawa MM, Lima RF, Nicola ALA, Rodrigues FCM, Ribeiro PA. Intestinal endometriotic nodules with a length greater than 2.25 cm and affecting more than 27% of the circumference are more likely to undergo segmental resection, rather than linear nodulectomy. PLoS One. 2021;16(4):e0247654. doi: 10.1371/journal.pone.0247654. - DOI - PMC - PubMed
    1. Abo C, Moatassim S, Marty N, Ghislain MS, Huet E, Bridoux V, et al. Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril. 2018;109(1):172–8.e1. doi: 10.1016/j.fertnstert.2017.10.001. - DOI - PubMed
    1. Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015;21(3):329–39. doi: 10.1093/humupd/dmv003. - DOI - PubMed
    1. Araújo RSC, Ribeiro HSAA, Sekula VG, Porto BTC, Ribeiro PAAG. Long-term outcomes on quality of life in women submitted to laparoscopic treatment for bowel endometriosis. J Minim Invasive Gynecol. 2014;21(4):682–8. doi: 10.1016/j.jmig.2014.02.005. - DOI - PubMed
    1. Balla A, Quaresima S, Subiela JD, Shalaby M, Petrella G, Sileri P. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis. 2018;33(7):835–47. doi: 10.1007/s00384-018-3082-y. - DOI - PubMed