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Feasibility and safety of transvaginal specimen extraction in deep endometriosis colorectal resectional surgery and analysis of risk factors for postoperative complications

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Abstract

Background

The aim of the present study was to demonstrate that transvaginal specimen extraction is a feasible and safe approach in colorectal resection for deep endometriosis (DE) and to assess the risk factors for postoperative complications.

Methods

This retrospective cohort study included all the consecutive patients undergoing segmental bowel resection for symptomatic endometriosis at “La Paz” University Hospital (Madrid, Spain) and at “Hospital General Universitario de Valencia” (Valencia, Spain) from January 2014 to December to 2017. Patients were grouped according to specimen extraction approach into those who had transvaginal extraction (Group I) and those who had suprapubic extraction (Group II). Clinic-demographical, surgical and post-surgical data were recorded. Intra- and postoperative complications were classified according to Clavien–Dindo criteria. Postoperative data were compared between groups. Risk factors associated with surgery were investigated.

Results

Out of 99 female patients included (average age 36.91 ± 5.36 years), 23 patients (23.2%) had transvaginal and 76 (76.8%) had suprapubic specimen extraction. The groups were comparable regarding operative time, nodule size, level of anastomosis, hospital stay and intraoperative complications. We observed no statistically significant differences in postoperative complications and rectovaginal fistula rate between the groups. Binary logistic regression analyses determined that vaginal endometriosis is an independent risk factor for postoperative complications (OR: 2.63, 95% CI [1.10–6.48], p = 0.03).

Conclusions

Transvaginal specimen extraction is a safe and feasible technique in DE colorectal surgery and should be taken into consideration whenever vaginal endometriosis exists. Nevertheless, vaginal endometriosis can be an independent risk factor for postoperative complications in DE surgery.

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Availability of data and materials

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank all the women who accepted to participate in this study. Additionally, authors thank Juan Manuel Mascarós, from the Biostatistics Service of the Fundación para la Investigación del Hospital General Universitario de Valencia for his support with the statistical analyses conducted in this study.

Funding

This work has been supported by ‘‘Instituto de Salud Carlos III’’ and Fondo Europeo de Desarrollo Regional (FEDER) ‘‘Unión europea, Una manera de hacer Europa’’ (PI17/01945 and PI20/01368), by “Fundación de Investigación Biomédica del Hospital Universitario La Paz” (Premio Jesús Antolín Garciarena-2018), by “Proyecto de Investigación en Salud 2020” Instituto de Salud Carlos III (PI20/01368), by “Fundación para la Investigación del Hospital General Universitario de Valencia” (Premio FIHGUV-2019) and by Generalitat Valenciana (GV/2020/200). JM-A and EG-Care supported by Grants from Generalitat Valenciana Grant (APOST/2019/087 and ACIF/2020/216, respectively).

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Author notes

  1. E. Spagnolo and J. Marí-Alexandre contributed equally and both should be considered as first authors.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, “La Paz” University Hospital, Madrid, Spain

    E. Spagnolo, P. Garcia-Casarrubios, A. López & A. Hernández

  2. Research Laboratory in Biomarkers in Reproduction, Gynecology and Obstetrics, Fundación Hospital General Universitario de Valencia, Valencia, Spain

    J. Marí-Alexandre, J. Gilabert-Estellés, C. Agababyan & E. González-Cantó

  3. General Surgery One, University of Insubria, University Hospital of Varese, Viale Luigi Borri, 57, 21100, Varese, VA, Italy

    S. Di Saverio

  4. Comprehensive Multidisciplinary Endometriosis Unit, Consorcio Hospital General Universitario de Valencia, Valencia, Spain

    J. Gilabert-Estellés & C. Agababyan

  5. Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain

    J. Gilabert-Estellés

  6. Department of General Surgery, “La Paz” University Hospital, Madrid, Spain

    I. Pascual

  7. Department of Obstetrics and Gynaecology, Universidad Autónoma de Madrid, Madrid, Spain

    A. Hernández

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  1. E. Spagnolo
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Corresponding author

Correspondence to S. Di Saverio.

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Conflict of interest

The authors declare that they have no conflicts of interest and nothing to disclose.

Ethics approval

The study was approved by the Institutional Review Board of both the Hospital Universitario La Paz (Madrid) (PI3349, September 6, 2018) and Consorcio Hospital General Universitario de Valencia (Valencia) (PI JGE-TAX-2017-01, September 28, 2017). The study was conducted following the Ethical Principles of the Declaration of Helsinki and its successive amendments.

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Informed consent exemption was provided by the Institutional Review Board of the involved institutions.

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Spagnolo, E., Marí-Alexandre, J., Di Saverio, S. et al. Feasibility and safety of transvaginal specimen extraction in deep endometriosis colorectal resectional surgery and analysis of risk factors for postoperative complications. Tech Coloproctol 26, 261–270 (2022). https://doi.org/10.1007/s10151-021-02565-x

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