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“The Sword in the Stone”: radical excision of deep infiltrating endometriosis with bowel shaving—a single-centre experience on 703 consecutive patients

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A Correction to this article was published on 12 October 2021

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Abstract

Background

Laparoscopic segmental bowel resection, disc excision and rectal shaving are described as surgical options for the treatment of bowel endometriosis, but the gold standard has not yet established. The aim of the study is to investigate the efficacy of the laparoscopic bowel shaving technique in terms of pain symptomatology and to analyse early and late postoperative complications.

Methods

Retrospective cohort study of a series of 703 consecutive patients treated between January 2014 and December 2019 in a tertiary care referral centre. All patients underwent laparoscopic bowel shaving with concomitant radical excision of DIE.

Results

Bilateral posterolateral parametrectomy and ureterolysis were performed, respectively, in 314 (44.7%) and 318 cases (45.2%). A radical hysterectomy was performed in 107 cases (82.9%). Postoperative complications were infrequent: 17 patients required a reoperation (2.4%) and in this subgroup we registered 2 rectovaginal fistulas (0.3%), 4 patients received blood transfusion (0.6%), 12 patients (1.7%) experienced postoperative fever, 6 patients experienced impaired bladder voiding (0.9%) after 6 months. Median follow-up was 14 months. The study reported good clinical and surgical results, with a regression of symptoms (p < 0.0001) and an overall rate of recurrence of 6.5%. Clinical and instrumental criteria of bowel endometriosis relapse were exclusively detected in 5 patients (0.8%). Eleven patients (1.7%) with relapsed endometriosis were reoperated.

Conclusions

Bowel shaving is a feasible and valuable surgical procedure. It is only the last step of a complex surgery which is aimed to minimize the residual quote of infiltrating nodule and requires a multidisciplinary team to achieve optimal treatment preoperatively, intraoperatively and postoperatively.

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Change history

  • 09 October 2021

    This article was updated to correct the author listing, where given and family names were reversed.

  • 12 October 2021

    A Correction to this paper has been published: https://doi.org/10.1007/s00464-021-08762-x

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy—IRCCS “Sacro Cuore—Don Calabria” Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy

    Marcello Ceccaroni, Roberto Clarizia, Anna Katarzyna Stepniewska, Paola De Mitri, Matteo Ceccarello & Francesco Bruni

  2. Department of Obstetrics and Gynecology, “Maggiore della Carità” Hospital, “Università del Piemonte Orientale”, Corso Mazzini 18, 28100, Novara, Italy

    Erica Adele Mussi & Daniela Surico

  3. Department of General Surgery, IRCCS “Sacro Cuore—Don Calabria” Hospital, Via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy

    Giacomo Ruffo & Lorenzo Rettore

Authors
  1. Marcello Ceccaroni
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  2. Roberto Clarizia
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  3. Erica Adele Mussi
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  4. Anna Katarzyna Stepniewska
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  5. Paola De Mitri
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  6. Matteo Ceccarello
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  7. Giacomo Ruffo
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  8. Francesco Bruni
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  9. Lorenzo Rettore
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  10. Daniela Surico
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Correspondence to Marcello Ceccaroni.

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Drs. Ceccaroni, Clarizia, Mussi, Stepniewska, De Mitri, Ceccarello, Ruffo, Bruni, Rettore and Surico have no conflicts of interest or financial ties to disclose.

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Bowel shaving is effective as the last step of a complex surgery, especially in the context of a “frozen pelvis” where the real extension of infiltration might be over-rated and halo fibrosis is represented around the infiltrating endometriotic nodule.

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Ceccaroni, M., Clarizia, R., Mussi, E.A. et al. “The Sword in the Stone”: radical excision of deep infiltrating endometriosis with bowel shaving—a single-centre experience on 703 consecutive patients. Surg Endosc 36, 3418–3431 (2022). https://doi.org/10.1007/s00464-021-08663-z

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