Different segmental resection techniques and postoperative complications in patients with colorectal endometriosis: A systematic review

Abstract

Introduction The aim of this study was to analyze the available literature by conducting a systematic review to assess the possible effects of nerve‐sparing segmental resection and conventional bowel resection on postoperative complications for the treatment of colorectal endometriosis. Material and methods Pubmed, Clinical http://trials.gov, Cochrane Library, and Web of Science were comprehensively searched from 1997 to 2021 in order to perform a systematic review. Studies including patients undergoing segmental resection for colorectal endometriosis including adequate follow‐up, data on postoperative complications and postoperative sequelae were enrolled in this review. Selected articles were evaluated and divided in two groups: Nerve‐sparing resection (NSR), and conventional segmental resection not otherwise specified (SRNOS). Within the NSRs, studies mentioning preservation of the rectal artery supply (artery and nerve‐sparing SR – ANSR) and not reporting preservation of the artery supply (NSR not otherwise specified – NSRNOS) were further analyzed. PROSPERO ID: CRD42021250974. Results A total of 7549 patients from 63 studies were included in the data analysis. Forty‐three of these publications did not mention the preservation or the removal of the hypogastric nerve plexus, or main rectal artery supply and were summarized as SRNOS. The remaining 22 studies were listed under the NSR group. The mean size of the resected deep endometriosis lesions and patients’ body mass index were comparable between SRNOS and NSR. A mean of 3.6% (0–16.6) and 2.3% (0–10.5%) of rectovaginal fistula development was reported in patients who underwent SRNOS and NSR, respectively. Anastomotic leakage rates varied from 0% to 8.6% (mean 1.7 ± 2%) in SRNOS compared with 0% to 8% (mean 1.7 ± 2%) in patients undergoing NSR. Urinary retention (4.5% and 4.9%) and long‐term bladder catheterization (4.9% and 5.6%) were frequently reported in SRNOS and NSR. There was insufficient information about pain or the recurrence rates for women undergoing SRNOS and NSR. Conclusions Current data describe the outcomes of different segmental resection techniques. However, the data are inhomogeneous and not sufficient to reach a conclusion regarding a possible advantage of one technique over the other.

Vascular‐ and nerve‐sparing bowel resection for deep endometriosis: A retrospective single‐center study

“…More specifically, no rectovaginal, ureteral, or vesicovaginal fistulas were reported, nor was there ureteral or colorectal anastomosis stenosis. These data findings are consistent with what was reported in a recent review by Darici et al, 8 which showed a rate between 0% and 3.6% for rectovaginal fistulas and between 0% and 6.1% for ureteral fistulas in the group of patients undergoing segmental resection using nerve-and vascular-sparing techniques.…”

“…9 However, there is no adequate evidence to establish its superiority compared with the classic technique. 8 In our series, there were no major Clavien-Dindo complications 3 or 4. More specifically, no rectovaginal, ureteral, or vesicovaginal fistulas were reported, nor was there ureteral or colorectal anastomosis stenosis.…”

“…0.6% and 4.6%, respectively. 8 We did not observe any cases of reintervention, as the only anastomotic leak occurred in a patient for whom a temporary ileostomy had previously been performed due to an anastomosis <5 cm from the anal margin. As such, the patient was treated conservatively, maintaining the stoma for 70 days, and it then closed without complications after performing a barium enema, which confirmed the healing of the millimetric colorectal dehiscence.…”

“…8,9 In any case, besides the increasing use of nervesparing techniques for the treatment of DE with bowel involvement, several authors have recently pointed out the potential benefits of preserving the superior rectal artery (SRA) by preserving the IMA, thus ensuring better perfusion of the anastomosis. 8,9 However, data findings are still heterogeneous and not sufficient to confirm a real advantage for a nerve-and vascular-sparing technique over others. 8As such, the aim of our study was to evaluate the complication rates and functional outcomes of a bowel resection technique for DE involving a nerve-and vascular-sparing approach.…”

Pain, gastrointestinal function and fertility outcomes of modified nerve‐vessel sparing segmental and full thickness discoid resection for deep colorectal endometriosis – A prospective cohort study

“…Taking into account anastomotic height as a main factor for risk of leakage and rectovaginal fistula, a retrospective multicenter study was unable to support this view when complication rates of FTDR using transanal staplers were compared with a modified nerve and vessel sparing technique for segmental resection (NVSSR) in women undergoing low resections for colorectal DE 14 . Within this, a recent systematic review on differences in surgical techniques of segmental resection for colorectal DE concluded that data so far were inhomogeneous and insufficient to show a proven advantage of nerve and nerve plus vessel sparing approaches 15 . The primary aim of the present study was to further investigate changes in pre‐ and postsurgical GI function following a modified nerve and vessel sparing segmental resection (NVSSR) method compared with FTDR.…”