Discoid resection for colorectal endometriosis: results from a prospective cohort from two French tertiary referral centres

Abstract

Aim Using a prospective database of discoid resection performed in two tertiary referral centres, the aim of this study is to assess the feasibility, short‐term complication rates and clinical outcomes, including voiding dysfunction, of the procedure. Method A retrospective analysis of a prospective cohort database was conducted from February 2010 to October 2017 in two tertiary referral centres. One hundred and forty‐eight consecutive patients scheduled for colorectal endometriosis by discoid resection were enrolled. The median follow‐up was 21 months. All the women underwent complete preoperative assessment (MRI, transvaginal ultrasonography and rectal echo‐endoscopy) before the removal of colorectal endometriosis. Postoperative complications were classified according to the Clavien–Dindo classification system as minor (grades I and II) or major (grades IIIA, IIIB and IV). Cases of voiding dysfunction were also noted. Results The procedure was abandoned in seven patients. In 91 (64.5%) of the remaining 141 patients, the diameter of discoid resection removed was ≥ 30 mm. Surgery was performed by laparoscopy in 137/141 cases (92.7%). Grade I–III complications were observed in 37 patients (26.2%) with 11 grade IIIb (7.8%). Postoperative voiding dysfunction occurred in 16 patients (11.3%), 11 of whom required self‐catheterization for < 1 month. In a multivariate analysis including age, body mass index, lesion size and history of previous surgery for endometriosis, a history of previous surgery was independently correlated to complication outcome (P = 0.043). Conclusions This analysis suggests that discoid resection is associated with good short‐term results for women with colorectal endometriosis in a tertiary referral centre as it is associated with a low rate of postoperative complications.

Systematic Nerve Sparing during Surgery for Deep-infiltrating Posterior Endometriosis Improves Immediate Postoperative Urinary Outcomes

“…Furthermore, perioperative and postoperative complication rates are not elevated. The postoperative complication rates in our series are, as expected, lower than those reported by other experienced teams after laparoscopic management of colorectal endometriosis [23,28,35,36], but higher than in studies looking into endometriosis without rectal or urinary [37,38] involvement. These variable complication rates are related to different DIE lesion size, the severity and rate of additional resected lesions, and the technique adopted for colorectal DIE excision (shaving or discoid/segmental resection) [39].…”

“…The major difficulty of comparing postoperative voiding dysfunction rates in different studies lies in the lack of a unanimous definition of the concept, variously described as urinary retention, bladder atony, voiding dysfunction calling for intermittent bladder catheterization (7 days postoperatively) [20,23], and the lack of consensus about what constitutes a normal/abnormal PVR [24−26]. Similarly, the definition of "transitory" voiding dysfunction differs and may refer to selfÀcatheterization of less than 30 days or 6 weeks, between 3 weeks and 6 months, and so on.…”

“…This was not the case in other previous studies [9,13,20,22] and may partially explain the lower bladder morbidity rate obtained in our control group (12.5% of self-catheterization at discharge and no longterm self-catheterization) compared with the 34% in the study by Kavallaris et al [27], with 14% of their patients still requiring intermittent self-catheterization 6 years after surgery. The results from 2 studies conducted at French tertiary referral centers reporting surgery for bowel endometriosis without systematic nerve sparing show rates of postoperative voiding dysfunction with the need for selfcatheterization of 11.3% (median selfÀcatheterization duration: 30 days; range 15−180 days) [23] and 15% [28], respectively. In another large-series laparoscopic DIE excision by the shaving technique with use of a carbon dioxide laser but without systematic nerve sparing, the urinary retention rates after surgery were very low (0.8% in a series of 500 cases) [29].…”

Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients

“…HIFU thus appears to be a safe, minimally invasive transrectal approach. Comparatively, in a longitudinal study involving 364 gastrointestinal surgical procedures, Abo et al (2019) encountered a 14.8% rate of Grade III complications, including 3.8% cases of RVF ( Abo et al , 2019 ). More recently, a meta-analysis by Bendifallah et al (2021) found a 1.5% rate of RVF, of which 0.3% occurred following rectal shaving, pointing to the safety of that approach.…”

Surgical Techniques for the Treatment of Rectal Endometriosis: A Systematic Review of Randomized Controlled Trials and Observational Studies

“…The prospective data analysis of patients who underwent discoid resection in two endometriosis reference centers revealed good short-term results and low complication rates. According to the authors, the average size of the lesions was 30 mm (7 to 70 mm) (50) . Despite the possibility, after a disc resection, of the margins being compromised in up to 40% of cases (51) , there are few prospective and controlled studies comparing the technique with segmental resection in regard to late postoperative period, quality of life, travenously both intraoperatively and postoperatively, for 24 hours.…”