Skip to main content

Advertisement

SpringerLink
Log in

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

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Keckstein J, Ulrich U, Kandolf O, Wiesinger H, Wustlich M (2003) Laparoscopic therapy of intestinal endometriosis and the ranking of drug treatment. Zentralbl Gynakol 125:259–266. doi:10.1055/s-2003-42281

    Article  CAS  PubMed  Google Scholar 

  2. Minelli L, Fanfani F, Fagotti A, Ruffo G, Ceccaroni M, Mereu L, Landi S, Pomini P, Scambia G (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg Chic Ill 1960 144:234–239. doi:10.1001/archsurg.2008.555 (discussion 239)

    Google Scholar 

  3. Mohr C, Nezhat FR, Nezhat CH, Seidman DS, Nezhat CR (2005) Fertility considerations in laparoscopic treatment of infiltrative bowel endometriosis. JSLS 9:16–24

    PubMed  PubMed Central  Google Scholar 

  4. Meuleman C, Tomassetti C, D’Hoore A, Van Cleynenbreugel B, Penninckx F, Vergote I, D’Hooghe T (2011) Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 17:311–326. doi:10.1093/humupd/dmq057

    Article  PubMed  Google Scholar 

  5. De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P (2011) Bowel resection for deep endometriosis: a systematic review. BJOG Int J Obstet Gynaecol 118:285–291. doi:10.1111/j.1471-0528.2010.02744.x

    Article  Google Scholar 

  6. Keckstein J, Wiesinger H (2005) Deep endometriosis, including intestinal involvement—the interdisciplinary approach. Minim Invasive Ther Allied Technol 14:160–166. doi:10.1080/14017430510035916

    Article  CAS  PubMed  Google Scholar 

  7. 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 24:63–67. doi:10.1007/s00464-009-0517-0

    Article  PubMed  Google Scholar 

  8. Tarjanne S, Heikinheimo O, Mentula M, Härkki P (2015) Complications and long-term follow-up on colorectal resections in the treatment of deep infiltrating endometriosis extending to bowel wall. Acta Obstet Gynecol Scand 94:72–79. doi:10.1111/aogs.12515

    Article  PubMed  Google Scholar 

  9. Zilberman S, Ballester M, Touboul C, Chéreau E, Sèbe P, Bazot M, Daraï E (2013) Partial colpectomy is a risk factor for urologic complications of colorectal resection for endometriosis. J Minim Invasive Gynecol 20:49–55. doi:10.1016/j.jmig.2012.08.775

    Article  PubMed  Google Scholar 

  10. 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. doi:10.1097/SLA.0b013e3181d9722d

    Article  PubMed  Google Scholar 

  11. Dubernard G, Rouzier R, David-Montefiore E, Bazot M, Daraï E (2008) Urinary complications after surgery for posterior deep infiltrating endometriosis are related to the extent of dissection and to uterosacral ligaments resection. J Minim Invasive Gynecol 15:235–240. doi:10.1016/j.jmig.2007.10.009

    Article  PubMed  Google Scholar 

  12. Koninckx PR, Martin D (1994) Treatment of deeply infiltrating endometriosis. Curr Opin Obstet Gynecol 6:231–241

    Article  CAS  PubMed  Google Scholar 

  13. Wolthuis AM, Meuleman C, Tomassetti C, D’Hooghe T, de Buck van Overstraeten A, D’Hoore A (2014) Bowel endometriosis: colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol 20:15616–15623. doi:10.3748/wjg.v20.i42.15616

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, Buchweitz O, Greb R, Kandolf O, Mangold R, Masetti W, Neis K, Rauter G, Reeka N, Richter O, Schindler AE, Sillem M, Terruhn V, Tinneberg HR (2008) ENZIAN-Klassifikation zur Diskussion gestellt: Eine neue differenzierte Klassifikation der tief infiltrierenden Endometriose. J Gynäkol Endokrinol 18:7–13

    Google Scholar 

  15. Baessler K, Junginger B (2011) Validation of a pelvic floor questionnaire with improvement and satisfaction scales to assess symptom severity, bothersomeness and quality of life before and after pelvic floor therapy. Aktuelle Urol 42:316–322. doi:10.1055/s-0031-1271544

    Article  CAS  PubMed  Google Scholar 

  16. Baessler K, O’Neill SM, Maher CF, Battistutta D (2009) Australian pelvic floor questionnaire: a validated interviewer-administered pelvic floor questionnaire for routine clinic and research. Int Urogynecol J Pelvic Floor Dysfunct 20:149–158. doi:10.1007/s00192-008-0742-4

    Article  PubMed  Google Scholar 

  17. Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186. doi:10.1097/SLA.0b013e3181afde41

    Article  PubMed  Google Scholar 

  18. Gehrich A, Stany MP, Fischer JR, Buller J, Zahn CM (2007) Establishing a mean postvoid residual volume in asymptomatic perimenopausal and postmenopausal women. Obstet Gynecol 110:827–832. doi:10.1097/01.AOG.0000284445.68789.ee

    Article  PubMed  Google Scholar 

  19. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res 63(Suppl 11):S240–S252. doi:10.1002/acr.20543

    Article  Google Scholar 

  20. R Core Team (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. http://www.R-project.org/. Accessed 20 Feb 2017

  21. Burghaus S, Fehm T, Fasching PA, Blum S, Renner SK, Baier F, Brodkorb T, Fahlbusch C, Findeklee S, Häberle L, Heusinger K, Hildebrandt T, Lermann J, Strahl O, Tchartchian G, Bojahr B, Porn A, Fleisch M, Reicke S, Füger T, Hartung CP, Hackl J, Beckmann MW, Renner SP (2016) The international endometriosis evaluation program (IEEP Study)—a systematic study for physicians, researchers and patients. Geburtshilfe Frauenheilkd 76:875–881. doi:10.1055/s-0042-106895

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Akladios C, Messori P, Faller E, Puga M, Afors K, Leroy J, Wattiez A (2015) Is ileostomy always necessary following rectal resection for deep infiltrating endometriosis? J Minim Invasive Gynecol 22:103–109. doi:10.1016/j.jmig.2014.08.001

    Article  PubMed  Google Scholar 

  23. Brouwer R, Woods RJ (2007) Rectal endometriosis: results of radical excision and review of published work. ANZ J Surg 77:562–571. doi:10.1111/j.1445-2197.2007.04153.x

    Article  PubMed  Google Scholar 

  24. Minelli L, Ceccaroni M, Ruffo G, Bruni F, Pomini P, Pontrelli G, Rolla M, Scioscia M (2010) Laparoscopic conservative surgery for stage IV symptomatic endometriosis: short-term surgical complications. Fertil Steril 94:1218–1222. doi:10.1016/j.fertnstert.2009.08.035

    Article  PubMed  Google Scholar 

  25. Fanfani F, Fagotti A, Gagliardi ML, Ruffo G, Ceccaroni M, Scambia G, Minelli L (2010) Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study. Fertil Steril 94:444–449. doi:10.1016/j.fertnstert.2009.03.066

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany

    Stefan P. Renner, Nalan Topal, Kim Proske, Stefanie Burghaus, Matthias W. Beckmann & Johannes Lermann

  2. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, USA

    Hermann Kessler

  3. Department of Biometry and Epidemiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany

    Werner Adler

  4. Department of Surgery, Erlangen University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany

    Werner Haupt

Authors
  1. Stefan P. Renner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hermann Kessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nalan Topal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kim Proske
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Werner Adler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefanie Burghaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Werner Haupt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matthias W. Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Johannes Lermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johannes Lermann.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Renner, S.P., Kessler, H., Topal, N. et al. Major and minor complications after anterior rectal resection for deeply infiltrating endometriosis. Arch Gynecol Obstet 295, 1277–1285 (2017). https://doi.org/10.1007/s00404-017-4360-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4360-6

Keywords

Search

Navigation