Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases

• Published in: Annals of coloproctology Vol. 39; no. 3; pp. 216 - 222
• Main Authors: Casas, Sara Gortázar de Las, Spagnolo, Emanuela, Saverio, Salomone Di, Álvarez-Gallego, Mario, Carrasco, Ana López, López, María Carbonell, Cobos, Sergio Torres, Campo, Constantino Fondevila, Gutiérrez, Alicia Hernández, Miguelañez, Isabel Pascual
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Coloproctology 01.06.2023
• Subjects: colostomy; endometriosis; ileostomy; laparoscopic surgery; Original; Ileostomy; Endometriosis; Laparoscopic surgery; Colostomy
• ISSN: 2287-9714; 2287-9722
• DOI: 10.3393/ac.2021.00829.0118

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). 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. 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. 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.