Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases.

Autor:	Casas SGL; Department of General Surgery, La Paz University Hospital, Madrid, Spain., Spagnolo E; Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain., Saverio SD; Department of General Surgery, Hospital of San Benedetto del Tronto (AP), San Benedetto, Italy., Álvarez-Gallego M; Department of General Surgery, La Paz University Hospital, Madrid, Spain., Carrasco AL; Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain., López MC; Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain., Cobos ST; Department of Stoma Therapy, La Paz University Hospital, Madrid, Spain., Campo CF; Department of General Surgery, La Paz University Hospital, Madrid, Spain., Gutiérrez AH; Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain., Miguelañez IP; Department of General Surgery, La Paz University Hospital, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Annals of coloproctology [Ann Coloproctol] 2023 Jun; Vol. 39 (3), pp. 216-222. Date of Electronic Publication: 2022 Mar 07.
DOI:	10.3393/ac.2021.00829.0118
Abstrakt:	Purpose: The surgical management of deep infiltrative endometriosis (DE) involving the rectum remains a challenge. The objective of this study was to assess the outcomes from a single tertiary center over a decade with an emphasis on the role of a protective loop ileostomy (PI). Methods: A retrospective review of outcomes for 168 patients managed between 2008 and 2018 is presented including 57 rectal shaves, 23 discoid excisions, and 88 segmental rectal resections. Results: The nodule size (mean±standard deviation) in the segmental resection group was 32.7±11.2 mm, 23.4±10.5 mm for discoid excision, and 18.8±6.0 mm for rectal shaves. A PI was performed in 19 elective cases (11.3%) usually for an ultra-low anastomosis <5 cm from the anal verge. All Clavien-Dindo grade III/IV complications occurred after segmental resections and included 5 anastomotic leaks, 6 rectovaginal fistulas, 2 ureteric fistulas, and 1 ureteric stenosis. Of 26 stomas (15.5%), there were 19 PIs, 3 secondary ileostomies (after complications), and 4 end colostomies. The median time to PI closure was 5.8 months (range, 0.4-16.7 months) in uncomplicated disease compared with 9.2 months (range, 4.7-18.4 months) when initial postoperative complications were recorded (P=0.019). Only 1 patient with a recurrent rectovaginal fistula had a permanent colostomy. Conclusion: In patients with DE and rectal involvement a PI is selectively used for low anastomoses and complex pelvic reconstructions. Protective stomas and those used in the definitive management of a major postoperative complication can usually be reversed.
Databáze:	MEDLINE
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