Outcome after surgery for deep endometriosis infiltrating the rectum

A higher major complication rate for segmental resections was found compared with conservative surgery for rectal endometriosis. However, in patients without previous therapeutic laparoscopy, the major complication rates did not differ.

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Volume 113, Issue 6, Pages 1319–1327.e3

Authors:

Celine Bafort, M.D., Barbara van Elst, M.D., Sofie Neutens, M.D., Christel Meuleman, M.D., Ph.D., Annouschka Laenen, Ph.D., André d’Hoore, M.D., Ph.D., Albert Wolthuis, M.D., Ph.D., Carla Tomassetti, M.D., Ph.D.

Abstract:

Objective

To evaluate the rate of postoperative complications between conservative surgery and segmental resection in patients with rectal endometriosis.

Design

Single-center retrospective study.

Setting

University hospital.

Patient(s)

A total of 232 women undergoing surgery for deep endometriosis infiltrating the rectum up to 15 cm from the anus with at least involvement of the muscularis layer, stratified into two arms according to surgical technique. Subgroup analysis was performed in patients without previous therapeutic laparoscopy for endometriosis (n = 108). A propensity-score approach was used to correct for group differences.

Intervention(s)

All patients underwent CO2-laser laparoscopic surgery: 61 underwent conservative surgery, and 171 had a segmental resection.

Main Outcome Measure(s)

Postoperative complication rate (Clavien-Dindo classification).

Result(s)

Clavien-Dindo type 1 and 2 complications did not differ between both groups. Clavien-Dindo type 3 complications were more frequent in the segmental resection group (1/61 [1.6%] conservative vs. 18/171 [10.5%] segmental), after propensity analysis only a trend was retained. In the subgroup analysis, no difference or trend was found (1/27 [3.7%] conservative vs. 5/81 [6.2%] segmental). A low rate of temporary diverting stoma was recorded: 24/232 (10.3%).

Conclusion(s)

A higher major complication (Clavien-Dindo ≥3) rate for segmental resections compared with conservative surgical treatment was shown in the overall population, although after correction for group differences this was attenuated to a trend only. However, in patients without previous therapeutic laparoscopy no significant difference or trend was found regardless of the surgical technique used. This not only suggests that redo/repeated surgery has a potentially increased morbidity, but also emphasizes the importance of a well executed primary surgery.

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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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