Archives of Gynecology and Obstetrics

, Volume 295, Issue 5, pp 1277–1285 | Cite as

Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis

  • Stefan P. Renner
  • Hermann Kessler
  • Nalan Topal
  • Kim Proske
  • Werner Adler
  • Stefanie Burghaus
  • Werner Haupt
  • Matthias W. Beckmann
  • Johannes Lermann
Gynecologic Endocrinology and Reproductive Medicine



The aim of the present study was to analyze major and minor complications—including long-term impairment of intestinal, bladder, and sexual function—following surgery for deeply infiltrating endometriosis using anterior rectal resection.


Patients who had undergone anterior rectal resection due to endometriosis between 2001 and 2011 were included (n = 113). Clinical and surgical data, as well as minor and major complications, were recorded. A questionnaire was sent to the patients and also to a healthy control group (n = 100).


Major complications occurred in 15.9% of cases and minor complications in 15%. Patients with postoperative ileostomies (n = 8) initially had ultralow anastomoses significantly more often. The questionnaire response rate was 77%, with a mean follow-up period of 85.9 months. Weak urinary flow was reported by 22.4% of the patients: a feeling of residual urine by 18.4%; more than one bowel movement/day by 57.5%; and insufficient lubrication during intercourse by 36.5%. These results differed significantly from the control group. Subgroup analysis showed no statistical associations between questionnaire responses and major or minor complications, ultralow anastomoses, bilateral dissection of the sacrouterine ligaments, or dissection of the vagina and rectovaginal space.


The major complication rate was consistent with the literature, but there were fewer minor complications. Patients with bowel anastomoses below 6 cm (ultralow) should receive information postoperatively about the high risk of insufficiency and should be closely monitored. The high rate of bladder, bowel, and sexual function impairment, and inadequate data make further prospective studies on this topic necessary.


Deeply infiltrating endometriosis Minor complications Long-term results Major complications Intestinal endometriosis Anterior rectal resection 



The contribution of K. Proske to this publication was performed in partial fulfillment of the requirements for obtaining the doctoral degree “Dr. med”.

Author contributions

SPR project development. HK data collection in the Department of Surgery. NT data collection. KP data collection and postgraduate. WA statistician. SB data analysis. WH project development in the Department of Surgery. MWB data analysis. JL project development, manuscript writing, and data analysis.

Compliance with ethical standards

Conflict of interest

Author S.P. Renner declares that he has no conflict of interest. Author H. Kessler declares that he has no conflict of interest. Author N. Topal declares that she has no conflict of interest. Author K. Proske declares that she has no conflict of interest. Author W. Adler declares that he has no conflict of interest. Author S. Burghaus declares that she has no conflict of interest. Author W. Haupt declares that he has no conflict of interest. Author M.W. Beckmann declares that he has no conflict of interest. Author J. Lermann declares that he has no conflict of interest.

Human rights and participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Stefan P. Renner
    • 1
  • Hermann Kessler
    • 2
  • Nalan Topal
    • 1
  • Kim Proske
    • 1
  • Werner Adler
    • 3
  • Stefanie Burghaus
    • 1
  • Werner Haupt
    • 4
  • Matthias W. Beckmann
    • 1
  • Johannes Lermann
    • 1
  1. 1.Department of Obstetrics and Gynecology, Erlangen University HospitalFriedrich Alexander University of Erlangen-NurembergErlangenGermany
  2. 2.Department of Colorectal Surgery, Digestive Disease and Surgery InstituteCleveland ClinicClevelandUSA
  3. 3.Department of Biometry and EpidemiologyFriedrich-Alexander-University Erlangen-NurembergErlangenGermany
  4. 4.Department of Surgery, Erlangen University HospitalFriedrich-Alexander-University Erlangen-NurembergErlangenGermany

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