Treatment of complication after colo-rectal surgery for endometriosis
1 – U.O.C. General Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona
Corresponding Author: Roberto Rossini
Background: endometriosis is a chronic benign disease, characterized by the presence of endometrial glands and stroma outside the uterine cavity. It can frequently affect the intestinal tract, the rectum and the sigmoid colon are often interested. Surgery is a valid option in case of infertility, chronic pelvic pain, intestinal obstruction and worsening of quality of life. Postoperative outcome is often favourable. Most frequent complication are colorectal and recto-vaginal fistulas. Aim of our study is to review our datas and present our experience in the treatment of colo-rectal complication after surgery for endometriosis
Methods: we retrospectively included 3054 cases of colorectal surgery for intestinal endometriosis performed from 2001 to 2020 in our institution. On the basis of the postoperative outcome we included 543 complications for the segmental resection and 50 for the disc resection.
Results: major colo-rectal complications such as anastomotic leackage and recto-vaginal fistula were 218 (8.3%) and 43 (1,6 %) respectively. Other intestinal complications were: 23 (0.9%) bowel occlusions, 15 (0.3%) intestinal perforations and 132 (5.0%) anastomotic strictures. We also had 76 (2.9%) haemoperitoneum and 36 (1.4%) urinary tract injuries. The group of disc resection only had 47 (11.3%) intraluminal bowel bleeding and 3 (0.7%) perforations.
Conclusion: when conservative treatment fails surgery represents a safe and feasible approach for bowel deep infiltrating endometriosis, resulting in an improvement of pain, fertility and quality of life. The rate of complications after bowel resection appear to be acceptable and often reversible. To achieve this goal surgeons, gynecologist, urologist and all other professionals of the multidisciplinary team from high volume centers need to work together.
Keywords: endometriosis; colorectal resection; complications; anastomotic leackage; recto-vaginal fistula.
Available in LRIOG Nr.3 – 2021