Feasibility and safety of two different surgical routes for the eradication of recto‐vaginal endometriosis with vaginal mucosa infiltration (Endo‐Vag‐r study)

Abstract

Introduction: Recto-vaginal endometriosis surgical management needing partial colpectomy is a surgically challenging condition and has been associated with a notable risk of major postoperative complications. In the present study we sought to compare feasibility and safety of total laparoscopic (TL) and vaginal-assisted (VA) routes in women affected by symptomatic rectovaginal endometriosis with vaginal mucosa infiltration scheduled for minimally invasive surgery. Material and methods: Multi-centric, retrospective cohort study on medical records of consecutive reproductive age women submitted to complete macroscopic eradication of symptomatic recto-vaginal endometriosis with vaginal mucosa infiltration between March 2013 and November 2017. The two groups were compared in terms of preoperative data and surgical outcomes. Results: 84 women were included in the study (TL=57 and VA=27). The two groups were comparable in terms of preoperative, surgical and postoperative data. The major postoperative complications rate was 5.3% (three out of 57) in TL group and 7.4% (two out of 27) in VA group, without a significant difference. In the TL group we reported one case of bowel anastomosis dehiscence and two cases of pelvic abscess; in the VA group, one case of small bowel perforation after extensive adhesiolysis treated with ileal resection and one case of rectal subocclusion after segmental resection and mechanical anastomosis were noticed. Conclusions: In women affected by recto-vaginal endometriosis with vaginal mucosal infiltration, perioperative outcomes seem not to be influenced by the surgical route adopted.

Near-Infrared Imaging With Indocyanine Green for the Treatment of Endometriosis: Results From the Gre-Endo Trial

“…For these reasons, different approaches to increase the potential for intraoperative recognition of endometriosis (enhanced vision) have been investigated using different dyes or technologies such as 3D robotic vision, with different efficacy and safety profiles ( 9 – 11 , 21 – 24 , 45 – 47 ). The results of the Gre-Endo trial seem to answer to the need of an “enhanced vision” and the utility of an intraoperative screening test.…”

Horizontal versus vertical direction of posterior vaginal wall suture after eradication of rectovaginal endometriosis: A multicenter study

“…Surgical procedures were performed by expert surgeons as previously described 11,23–25 . After total laparoscopic or vaginally‐assisted laparoscopic (i.e., combined vaginal approach) removal of the vaginal nodule, the vaginal breach was sutured in Ho or Ve direction with an absorbable thread specifically polyglactin 910 (Vicryl; Ethicon) 26,27 .…”

“…It can be isolated or involving adjacent structures, especially the recto‐sigmoid tract (recto‐vaginal endometriosis [RVE]) 4,8 . RVE incidence is estimated from 4% to 37% among women with endometriosis 9–11 . While hormonal therapy can improve pain symptoms in 30% of women with RVE, surgical eradication is required in cases of nonrespondent women, bowel or urinary obstruction, or infertility after assisted reproductive technology attempts 6,7,12 .…”

“…4,8 RVE incidence is estimated from 4% to 37% among women with endometriosis. [9][10][11] While hormonal therapy can improve pain symptoms in 30% of women with RVE, surgical eradication is required in cases of nonrespondent women, bowel or urinary obstruction, or infertility after assisted reproductive technology attempts. 6,7,12 Moreover, RVE surgical eradication needing partial colpectomy is commonly associated with a high risk of major postoperative complications, especially urinary and colorectal ones.…”

Efficacy and safety of different subsequent therapies after fertility preserving surgery for endometriosis: A systematic review and network meta-analysis

“…Evidence suggests that long-term outcomes and the risk of complications are more favorable with medication than surgery for both EMT and deep lesions.Hormonal therapy improves pain symptoms in around 2-thirds of women with EMT. [2] However, Patients affected by posterior deep infiltrating EMT usually have severe painful symptoms (dysmenorrhea, deep dyspareunia, chronic pelvic pain and dyschezia) that severely reduce quality of life. [3] Surgical excision of EMT is required in the case of pain symptoms resistant to hormonal therapy, complicated disease (bowel or urinary obstruction) or infertility after several assisted reproductive technology cycles.…”