Abstract
Background
Although several studies have shown that laparoscopic resection is safe and feasible in bowel endometriosis, limited data are available on the specific treatment for endometriosis of the rectum. The aim of this study is to describe operative and postoperative outcomes after laparoscopic resection of the mid/low rectum for endometriosis.
Methods
Between 2002 and 2010, 750 patients (median age 33 years) underwent laparoscopic resection of the mid/low rectum for deep infiltrating endometriosis at a single institution. All operations were performed with a standardized technique by a single surgeon.
Results
Median operative time was 255 min, and median blood loss 150 ml. Of patients, 7% required blood transfusions. Laparotomic conversion rate was 1.6%. Mechanical low and very low colorectal anastomoses were carried out in 92.5 and 7.5% of patients, respectively. Temporary ileostomy rate was 14.5%. Median length of stay was 8 days. Overall surgical morbidity was 9% with no mortality. Rates of anastomotic leak, rectovaginal fistula, and intraabdominal bleeding were 3, 2, and 1.2%. Forty patients (5.5%) required reoperation.
Conclusions
Laparoscopic resection of the mid/low rectum for endometriosis can be performed safely with acceptable rates of morbidity/reoperation and with low rates of specific complications, including anastomotic leak and rectovaginal fistula. The very high surgical volume of the operating surgeon is probably one of the most important factors in order to maximize postoperative outcomes.
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References
de Jong MJ, Mijatovic V, van Waesberghe JH, Cuesta MA, Hompes PG (2009) Surgical outcome and long-term follow-up after segmental colorectal resection in women with a complete obstruction of the rectosigmoid due to endometriosis. Dig Surg 26:50–55
Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G (2007) Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol 19(4):308–313 Review
Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37:747–753
Brouwer R, Woods RJ (2007) Rectal endometriosis: results of radical excision and review of published work. ANZ J Surg 77:562–571
Dousset B, Leconte M, Borghese B, Millischer AE, Roseau G, Arkwright S, Chapron C (2010) Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg 251:887–895
Redwine DB, Sharpe DR (1991) Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1(4):217–220
Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L (2010) Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 24(1):63–67
Darai E, Ackerman G, Bazot M, Rouzier R, Dubernard G (2007) Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg Endosc 21(9):1572–1577
Zanetti-Dällenbach R, Bartley J, Müller C, Schneider A, Köhler C (2008) Combined vaginal-laparoscopic-abdominal approach for the surgical treatment of rectovaginal endometriosis with bowel resection: a comparison of this new technique with various established approaches by laparoscopy and laparotomy. Surg Endosc 22(4):995–1001
No Authors listed (1997) Revised American Society for Reproductive Medicine classification of endometriosis. Fertil Steril 67:817–821
Daraï E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M (2010) Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg 251:1018–1023
Sartori CA, Dal Pozzo A, Franzato B, Balduino M, Sartori A, Baiocchi GL (2010) Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients. Surg Endosc 25(2):508–514
Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237(3):335–342
Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18(2):281–289
Hidalgo JM, Targarona EM, Martinez C, Hernandez P, Balague C, Trias M (2010) Laparoscopic rectal surgery: does immediate outcome differ in respect to sex? Dis Colon Rectum 53(4):438–444
Harmon JW, Tang DG, Gordon TA, Bowman HM, Choti MA, Kaufman HS, Bender JS, Duncan MD, Magnuson TH, Lillemoe KD, Cameron JL (1999) Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann Surg 230(3):404–411
Rogers SO Jr, Wolf RE, Zaslavsky AM, Wright WE, Ayanian JZ (2006) Relation of surgeon and hospital volume to processes and outcomes of colorectal cancer surgery. Ann Surg 244(6):1003–1011
Borowsi DW, Kelly SB, Bradburn DM, Wilson RG, Gunn A, Ratcliffe AA (2007) Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. Br J Surg 94(7):880–889
Ko CY, Chang JT, Chaudhry S, Kominski G (2002) Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery 132(2):268–273
Karanicolas PJ, Dubois L, Colquhoun PH, Swalloa CJ, Walter SD, Guyatt GH (2009) The more the better? The impacto f surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg 249(6):954–959
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Authors Ruffo, Sartori, Crippa, Partelli, Barugola, Manzoni, Steinkasserer, Minelli, and Falconi have no conflicts of interest or financial ties to disclose.
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Ruffo, G., Sartori, A., Crippa, S. et al. Laparoscopic rectal resection for severe endometriosis of the mid and low rectum: technique and operative results. Surg Endosc 26, 1035–1040 (2012). https://doi.org/10.1007/s00464-011-1991-8
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DOI: https://doi.org/10.1007/s00464-011-1991-8