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Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Endometriosis as a benign disease appears frequently in premenopausal women with highly variable symptoms. In advanced stages bowel involvement is common. In symptomatic disease the adequate treatment requires complete resection of all residues. Indications of colorectal resection for endometriosis remain controversial because of the risk of major complications. The purpose of this study was to show the feasibility of planned complete laparoscopic management of symptomatic deep pelvic endometriosis with bowel involvement performing segmental colorectal resection in a center of excellence.

Methods

Between 2007 and 2012 all patients treated for symptomatic colorectal endometriosis in our institution were included and retrospectively evaluated. Laparoscopic excision of all visible disease was planned. Data analysis included age, previous history of endometriosis, intraoperative findings, operative procedure and intra- and postoperative complications.

Results

In this time period 35 patients with bowel infiltrating endometriosis were treated. Affected locations were the rectovaginal space in 31 patients (89 %), the rectum in 32 patients (91 %), the sigmoid colon in 10 patients (29 %), the coecum in 2 patients (5.7 %), the appendix in 3 patients (8.6 %) and the terminal ileum in 1 patient (2.9 %). In the majority of patients (85.7 %) the resection was achieved laparoscopically, in 3 patients a conversion to laparotomy was necessary and in 2 patients a primary laparotomia was performed. Complications occurred in 2 cases with anastomotic leakage in 1 patient (2.8 %) and a rectovaginal fistula in another patient. Radical resection was achieved in almost all patients (97 %).

Conclusions

A well-trained interdisciplinary team can perform treatment of deep infiltrating endometriosis laparoscopically with low incidence of major complications as anastomotic leakage or rectovaginal fistula. Criteria of complete endometriosis restoration of the rectum can be achieved by total or subtotal rectal excision.

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Conflict of interest

The authors (Dr. R. Bachmann, Dr. C. Bachmann, Dr. J. Lange, Dr. B. Krämer, Professor SY Brucker, Professor W. Wallwiener, Professor A. Königsrainer and Dr. M. Zdichavsky) certify that they have no conflicts of interest or financial ties in connection with the submitted article. There are no funding sources supporting the work. All institutional or corporate affiliations are acknowledged in the article.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany

    Robert Bachmann, Jessica Lange, Alfred Königsrainer & Marty Zdichavsky

  2. Department of Gynecology and Obstetrics, University Hospital Tübingen, Tübingen, Germany

    Cornelia Bachmann, Bernhard Krämer, Sara Y. Brucker & Diethelm Wallwiener

Authors
  1. Robert Bachmann
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  2. Cornelia Bachmann
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  3. Jessica Lange
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  4. Bernhard Krämer
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  5. Sara Y. Brucker
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  6. Diethelm Wallwiener
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  7. Alfred Königsrainer
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  8. Marty Zdichavsky
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Correspondence to Robert Bachmann.

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Bachmann, R., Bachmann, C., Lange, J. et al. Surgical outcome of deep infiltrating colorectal endometriosis in a multidisciplinary setting. Arch Gynecol Obstet 290, 919–924 (2014). https://doi.org/10.1007/s00404-014-3257-x

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  • DOI: https://doi.org/10.1007/s00404-014-3257-x

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