Skip to main content

Advertisement

SpringerLink
Log in

Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients

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

Abstract

Purpose

Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery.

Methods

We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics.

Results

164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision.

In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96–221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74–188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43–159.18); p = 0.005].

Conclusion

The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.

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. de Ziegler D, Borghese B, Chapron C (2010) Endometriosis and infertility: pathophysiology and management. Lancet Lond Engl 376:730–738

    Google Scholar 

  2. Maignien C et al (2017) Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility. Am J Obstet Gynecol 216(280):e1–280.e9

    Google Scholar 

  3. Pluchino N et al (2016) Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update 22:762–774

    PubMed  Google Scholar 

  4. Nnoaham KE et al (2011) Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 96:366–373.e8

    PubMed  PubMed Central  Google Scholar 

  5. Facchin F et al (2015) Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstet Gynaecol 36:135–141

    PubMed  Google Scholar 

  6. Márki G, Bokor A, Rigó J, Rigó A (2017) Physical pain and emotion regulation as the main predictive factors of health-related quality of life in women living with endometriosis. Hum Reprod Oxf Engl 32:1432–1438

    Google Scholar 

  7. Minelli L et al (2009) Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg Chic 144:234–239 (discussion 239)

    Google Scholar 

  8. De Cicco C et al (2011) Bowel resection for deep endometriosis: a systematic review. BJOG Int J Obstet Gynaecol 118:285–291

    Google Scholar 

  9. Coronado C, Franklin RR, Lotze EC, Bailey HR, Valdés CT (1990) Surgical treatment of symptomatic colorectal endometriosis. Fertil Steril 53:411–416

    CAS  PubMed  Google Scholar 

  10. Tran KT, Kuijpers HC, Willemsen WN, Bulten H (1996) Surgical treatment of symptomatic rectosigmoid endometriosis. Eur J Surg Acta Chir 162:139–141

    CAS  Google Scholar 

  11. Jerby BL, Kessler H, Falcone T, Milsom JW (1999) Laparoscopic management of colorectal endometriosis. Surg Endosc 13:1125–1128

    CAS  PubMed  Google Scholar 

  12. Remorgida V, Ferrero S, Fulcheri E, Ragni N, Martin DC (2007) Bowel endometriosis: presentation, diagnosis, and treatment. Obstet Gynecol Surv 62:461–470

    PubMed  Google Scholar 

  13. Bailey HR, Ott MT, Hartendorp P (1994) Aggressive surgical management for advanced colorectal endometriosis. Dis Colon Rectum 37:747–753

    CAS  PubMed  Google Scholar 

  14. Darai E et al (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192:394–400

    PubMed  Google Scholar 

  15. Nyangoh Timoh K et al (2018) Magnetic resonance enterography to assess multifocal and multicentric bowel endometriosis. J Minim Invasive Gynecol 25:697–705

    PubMed  Google Scholar 

  16. Berlanda N et al (2017) Surgery versus hormonal therapy for deep endometriosis: is it a choice of the physician? Eur J Obstet Gynecol Reprod Biol 209:67–71

    PubMed  Google Scholar 

  17. Millochau J-C et al (2016) Continuous amenorrhea may be insufficient to stop the progression of colorectal endometriosis. J Minim Invasive Gynecol 23:839–842

    PubMed  Google Scholar 

  18. Zheng Y et al (2018) Rectovaginal fistula following surgery for deep infiltrating endometriosis: does lesion size matter? J Int Med Res 46:852–864

    PubMed  Google Scholar 

  19. Abo C et al (2018) Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril 109:172–178.e1

    PubMed  Google Scholar 

  20. Riiskjær M et al (2017) Diagnostic value of serial measurement of c-reactive protein in the detection of a surgical complication after laparoscopic bowel resection for endometriosis. Gynecol Obstet Invest 82:410–416

    PubMed  Google Scholar 

  21. Oliveira MAP et al (2016) Bowel complications in endometriosis surgery. Best Pract Res Clin Obstet Gynaecol 35:51–62

    PubMed  Google Scholar 

  22. Vallée A et al (2018) Surgery for deep endometriosis without involvement of digestive or urinary tracts: do not worry the patients! Fertil Steril 109:1079–1085.e1

    PubMed  Google Scholar 

  23. Working group of ESGE, ESHRE, and WES et al (2020) Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020:hoaa002

    Google Scholar 

  24. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    PubMed  PubMed Central  Google Scholar 

  25. Belghiti J et al (2014) Role of protective defunctioning stoma in colorectal resection for endometriosis. J Minim Invasive Gynecol 21:472–479

    PubMed  Google Scholar 

  26. Knabben L et al (2015) Urinary tract endometriosis in patients with deep infiltrating endometriosis: prevalence, symptoms, management, and proposal for a new clinical classification. Fertil Steril 103:147–152

    PubMed  Google Scholar 

  27. Saavalainen L, Heikinheimo O, Tiitinen A, Härkki P (2016) Deep infiltrating endometriosis affecting the urinary tract-surgical treatment and fertility outcomes in 2004–2013. Gynecol Surg 13:435–444

    PubMed  PubMed Central  Google Scholar 

  28. Erdem S et al (2018) Functional outcomes after rectal resection for deep infiltrating pelvic endometriosis: long-term results. Dis Colon Rectum 61:733–742

    PubMed  Google Scholar 

  29. Hudelist G et al (2018) Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis—a prospective cohort study. Acta Obstet Gynecol Scand 97:1438–1446

    PubMed  Google Scholar 

  30. Hudelist G et al (2018) Outcome of sonography-based minimally invasive surgery for deep infiltrating endometriosis of the ureter and urinary bladder—a retrospective cohort study. Acta Obstet Gynecol Scand 97:277–284

    PubMed  Google Scholar 

  31. Bendifallah S et al (2018) Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers. Surg Endosc 32:2003–2011

    PubMed  Google Scholar 

  32. Roman H (2017) A national snapshot of the surgical management of deep infiltrating endometriosis of the rectum and colon in France in 2015: a multicenter series of 1135 cases. J Gynecol Obstet Hum Reprod 46:159–165

    CAS  PubMed  Google Scholar 

  33. Kondo W et al (2011) Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG Int J Obstet Gynaecol 118:292–298

    CAS  Google Scholar 

  34. Fanfani F et al (2010) Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study. Fertil Steril 94:444–449

    PubMed  Google Scholar 

  35. Guo S-W (2009) Recurrence of endometriosis and its control. Hum Reprod Update 15:441–461

    PubMed  Google Scholar 

  36. Weir E, Mustard C, Cohen M, Kung R (2005) Endometriosis: what is the risk of hospital admission, readmission, and major surgical intervention? J Minim Invasive Gynecol 12:486–493

    PubMed  Google Scholar 

  37. Vignali M et al (2005) Surgical treatment of deep endometriosis and risk of recurrence. J Minim Invasive Gynecol 12:508–513

    PubMed  Google Scholar 

  38. Fedele L et al (2006) Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery. Fertil Steril 85:694–699

    CAS  PubMed  Google Scholar 

  39. Busacca M et al (2006) Determinants of long-term clinically detected recurrence rates of deep, ovarian, and pelvic endometriosis. Am J Obstet Gynecol 195:426–432

    PubMed  Google Scholar 

  40. Meuleman C et al (2011) Surgical treatment of deeply infiltrating endometriosis with colorectal involvement. Hum Reprod Update 17:311–326

    PubMed  Google Scholar 

  41. Roman H et al (2016) Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol 215(762):e1–762.e9

    Google Scholar 

  42. Jayot A, Nyangoh Timoh K, Bendifallah S, Ballester M, Darai E (2018) Comparison of laparoscopic discoid resection and segmental resection for colorectal endometriosis using a propensity score matching analysis. J Minim Invasive Gynecol 25:440–446

    PubMed  Google Scholar 

Download references

Funding

No financial support was received for this study.

Author information

Authors and Affiliations

  1. Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France

    H. Gornes, C. Vaysse, B. André, S. Motton, J. Rimailho, A. Weyl & E. Chantalat

  2. Department of General Gynecological Surgery and Breast Diseases, Clinique Pasteur - Toulouse, Toulouse, France

    P. Leguevaque

  3. Epidemiology Department, Research Methodology Support Unit (USMR), Toulouse University Hospital Center, Toulouse, France

    A. Gallini

  4. Department of Gynecological Surgery, University Hospital Center–Purpan, Hôpital Paule de Viguier, Toulouse, France

    P. Guerby

  5. Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France

    S. Kirzin & B. Suc

Authors
  1. H. Gornes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Vaysse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Leguevaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Gallini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. André
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Guerby
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Kirzin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. Suc
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Motton
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. J. Rimailho
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Weyl
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. E. Chantalat
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HG: manuscript writing, data collection, project development, CV: project development, data collection, PL: project development, data collection, AG: data analysis, BA: data collection, project development, PG: data collection, SK: project development, BS: project development, SM: project development, JR: project development, AW: project development, EC: manuscript writing, data collection, project development.

Corresponding author

Correspondence to E. Chantalat.

Ethics declarations

Conflict of interest

The authors hereby declare that there is no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gornes, H., Vaysse, C., Leguevaque, P. et al. Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients. Arch Gynecol Obstet 302, 383–391 (2020). https://doi.org/10.1007/s00404-020-05604-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05604-4

Keywords

Search

Navigation