Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients

In a prospective series of 111 patients managed for rectal endometriosis, disc excision was performed instead of colorectal resection with the objective of avoiding low anterior rectal resection syndrome.

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Volume 107, Issue 4, Pages 977–986.e2

Authors:

Horace Roman, M.D., Ph.D., Basma Darwish, M.D., Valérie Bridoux, M.D., Ph.D., Rachid Chati, M.D., Sabrina Kermiche, M.D., Julien Coget, M.D., Emmanuel Huet, M.D., Jean-Jacques Tuech, M.D., Ph.D.

Abstract:

Objective

To assess the postoperative outcomes of patients with rectal endometriosis managed by disc excision using transanal staplers.

Design

Prospective study using data recorded in the CIRENDO database (NCT02294825).

Setting

University tertiary referral center.

Patient(s)

A total of 111 consecutive patients managed between June 2009 and June 2016.

Intervention(s)

We performed rectal disc excision using two different transanal staplers: [1] the Contour Transtar stapler (the Rouen technique); and [2] the end to end anastomosis circular transanal stapler.

Main Outcomes Measure(s)

Pre- and postoperative digestive function was assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott Symptom Questionnaire.

Result(s)

The two staplers were used in 42 (37.8%) and 69 patients (62.2%), respectively. The largest diameter of specimens achieved was significantly higher using the Rouen technique (mean ± SD, 59 ± 11 mm vs. 36 ± 7 mm), which was used to remove nodules located lower in the rectum (5.5 ± 1.3 cm vs. 9.7 ± 2.5 cm) infiltrating more frequently the adjacent posterior vaginal wall (83.3% vs. 49.3%). Associated nodules involving sigmoid colon were managed by distinct procedures, either disc excision (2.7%) or segmental resection of sigmoid colon (9.9%). Postoperative values for the Gastrointestinal Quality of Life Index increased 1 and 3 years after the surgery, but improvement in constipation was not significant. The probability of pregnancy at 1 year after the arrest of medical treatment was 73.3% (95% confidence interval 54.9%–88.9%), with a majority of spontaneous conceptions.

Conclusion(s)

Disc excision using transanal staplers is a valuable alternative to colorectal resection in selected patients presenting with rectal endometriosis, allowing for good preservation of rectal function.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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