Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients

Roman, Horace; Darwish, Basma; Bridoux, Valérie; Chati, R.; Kermiche, Sabrina; Coget, J; Huet, Emmanuel; Tuech, Jean‐Jacques

doi:10.1016/j.fertnstert.2016.12.030

Cited by 69 publications

(60 citation statements)

References 46 publications

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“…In addition to intra-and short-term complication rates, the incidence of voiding dysfunction is a major issue due to its impact on quality of life. In our study, immediate voiding dysfunction was reported in 11 patients (7.8%), similar to the results of Oliveira et al and Roman et al [11,35] who observed 9% and Slack et al [36] who noted 3.9% in each of their studies. Jayot et al recorded six cases of immediate voiding dysfunction (19%) after discoid resection, all of which had resolved by 1 month.…”

Section: Discussionsupporting

confidence: 92%

“…We report a postoperative global incidence of pelvic abscess of 1.4%: one case required a second surgery (0.7%) and the other (0.7%) was managed exclusively by antibiotics. Wills et al [31] reported one case of pelvic abscess (1.2%) in a series of 82 patients, and Roman et al [11] noted a rate of 2.7% of patients managed exclusively by antibiotics and 2.7% requiring a second laparoscopy in a series of 111 patients. In the literature, the reported rate of pelvic abscess ranges between 0 and 5.1%.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…Similar outcomes are reported from a French team performing open or laparoscopic bowel resection, where cumulative pregnancy rates following surgery were 60% with a median of 19 months follow‐up although it was reported in an extended analysis from the same group that pregnancy after expectant management only occurred in the laparoscopy group . In the most recent series of 111 women having bowel resection for deeply invasive disease, 73% of women were pregnant at 12 months of follow‐up with the majority after expectant management . Similar data are reported from other centres where deep disease involving bowel resection has resulted in expectant pregnancies following surgery, with substantial improvement in pain and bowel function in addition.…”

Section: Deeply Invasive Endometriosis Bowel Resection and Fertilitysupporting

confidence: 80%

Surgical treatment is an excellent option for women with endometriosis and infertility

Abbott

2017

Aust NZ J Obst Gynaeco

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K E Y W O R D S endometriosis, infertility, surgery SURGERY IN PREVIOUS UNSUCCESSFUL IVF Surgery is often successful after previous failed IVF cycles and this has been previously reported, with 22/29 (75%) women with endometriosis having multiple failed IVF cycles treated surgically, with 15/22 (68%) pregnant with expectant management. 19This demonstrates that where IVF has been unsuccessful, the role of surgery should still be considered and in fact may be of substantial benefit. CONCLUSIONSSo how do we wrap all this up? It is clear that surgery has a number of advantages for the often symptomatic woman with endometriosis with regards to pain management and reduction in her pelvic symptoms of dyspareunia, dyschesia and non-menstrual pelvic pain is likely to improve pregnancy from expectant management as her quality of life is improved and she is more likely to have regular timed intercourse. It should also be apparent that the first attempt at fertility should be the best and the adage here is that it is better to peek and shriek than peek and poke. If you cannot finish the surgery with removal of disease, then you should not start and refer to a specialist centre which can undertake optimal disease removal with minimal risk and a multidisciplinary team where appropriate. Deeply invasive disease can and has been successfully removed with improvements in fertility as well as the benefits of symptom reduction. Many women, and their families, will want choices in how they may approach future parenthood and that is not always the one-size-fits-all approach of IVF. Certainly it is an option, but an invasive and expensive option, so at least there should be the choice of a second invasive and less expensive option in surgery.

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“…Full thickness disc excision consists in removing the nodule along with surrounding bowel, followed by transversal suture of the bowel. Our team routinely use two disc excision techniques: the Rouen technique employed in large deep endometriosis nodules infiltrating the low and the mid rectum, and disc excision using circular transanal staplers in nodules involving upper rectum and sigmoid colon . Segmental colorectal resection involves removal of a rectosigmoid segment followed by colorectal anastomosis using transanal circular staplers or by hand stitch .…”

Section: Methodsmentioning

confidence: 99%

C‐reactive protein assessment to predict early septic complications after laparoscopic bowel resection for endometriosis: a diagnostic study

Scattarelli

Carriou

Boulet

et al. 2019

BJOG

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Objective To assess the predictive value of C‐reactive protein (CRP) level for early septic complications after laparoscopic bowel resection for endometriosis. Design Retrospective study using data prospectively recorded in the CIRENDO database. Setting University tertiary referral centre. Population Three hundred and three women managed by segmental resection or disc excision for colorectal endometriosis in 40 consecutive months. Methods C‐reactive protein was routinely measured at postoperative days 4, 5, and 6. Bowel fistula, pelvic abscess, and pelvic infected haematoma were prospectively recorded. Main outcome measures A receiver operating characteristic (ROC) curve was built to assess the best cut off CRP value to predict early septic complications. Results The incidence of bowel fistula and pelvic abscess/infected hematoma were 2 and 7.9%, respectively. The CRP cut‐off value of 100 mg/l at postoperative day 4 predicts early septic pelvic complications (sensitivity, specificity, positive and negative predictive values of, respectively, 76, 83, 30.2, and 90.4%), and the area under the curve was 0.85 (95% CI 0.78–0.92). Conclusion Postoperative CRP monitoring is useful in the prediction of early septic pelvic complications following bowel endometriosis surgery, with possible impact on the management of postoperative outcomes and hospitalisation stay. Tweetable abstract Levels of CRP ≥100 mg/l at day 4 after bowel resection or excision for endometriosis are associated with early septic pelvic complications.

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Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients

Cited by 69 publications

References 46 publications

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

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

Surgical treatment is an excellent option for women with endometriosis and infertility

C‐reactive protein assessment to predict early septic complications after laparoscopic bowel resection for endometriosis: a diagnostic study

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