Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis

Belghiti, J.; Ballester, Marcos; Zilberman, Sonia; Thomin, Anne; Zacharopoulou, Chrysoula; Bazot, Marc; Thomassin‐Naggara, Isabelle; Daraı̈, Émile

doi:10.1016/j.jmig.2013.12.094

Cited by 52 publications

(35 citation statements)

References 30 publications

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“…Concomitant rectal excision may be followed by specific complications such as rectovaginal fistula or low anterior rectal resection syndrome (LARS) 12 . Although our rectovaginal fistula rate may be considered high, it remains comparable to that reported in other series of patients undergoing low rectal resection for deep endometriosis associated with colpectomy 19 . The high rate of vaginal involvement requiring colpectomy also led to the relatively high prevalence of early postoperative pelvic abscess and frequent use of preventive stoma.…”

Section: Discussionsupporting

confidence: 86%

Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Roman¹,

Dehan

Merlot³

et al. 2020

Preprint

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Background: Surgical management of deep endometriosis infiltrating pelvic nerves may allow an overall improvement in pain and neurologic disorders. Objective: To assess 1-year postoperative outcomes of surgery for deep endometriosis involving sacral roots and the sciatic nerve. Study Design: Retrospective study including 52 women undergoing surgery for deep endometriosis involving sacral roots and the sciatic nerve. We assessed 1-year postoperative outcomes. Results: Deep endometriosis involved sacral roots in 49 women (94.2%) and the sciatic nerve in 3 cases (5.8%). Sciatic pain was recorded in 43 women (82.7%), pudendal neuralgia in 11 women (21.2%) and leg motor weakness in 14 cases (27%). Surgical procedures carried out on pelvic nerves included complete releasing and decompression (92.3%), excision of epineurium (5.8%) and intraneural excision (1.9%). Additional procedures involved the digestive tract in 82.7% of cases and the urinary tract in 46.2%. Rectovaginal fistula occurred in 13.5% of cases. Self-catheterisation was required in 14 cases (27%) at 3 weeks after surgery, and in only 3 women (5.8%) 12 months later. One-year follow up showed significant improvement in quality of life using SF36 and standardised gastrointestinal scores. De novo hypoesthesia, hyperaesthesia or allodynia were recorded in 9 women (17.2%). The cumulative pregnancy rate was 77.2% following natural conception in 47%. Conclusions: Laparoscopic management of deep endometriosis involving sacral roots and the sciatic nerve improves patient symptoms and overall quality of life. Although pain reduction may be rapid following surgery, other sensory or motor complaints including bladder dysfunction may be recorded over months or years.

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Section: Discussionsupporting

confidence: 86%

Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Roman¹,

Dehan

Merlot³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…A defunctioning loop ileostomy was performed at the surgeon's discretion, typically when the anastomosis was at or below 6 cm from the anal verge or in cases of a major opening to the vagina. This seems to reduce the risk of fistula formation [28] . The diagnosis of bowel endometriosis was confirmed histologically in all cases.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Riiskjær¹,

Forman²,

Kesmodel

et al. 2016

Gynecol Obstet Invest

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Aims: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometriosis. Methods: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. Results: The frequency of anastomotic leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second postoperative day (POD 2, p = 0.004). WBC was significantly higher (p < 0.05) on POD 2 and 3 in patients with a surgical complication. A decrease in CRP from POD 1 to 3 predicted an uncomplicated course in 92.1% of the cases. Conclusion: A decrease in CRP from POD 1 to 3 was an indicator of uncomplicated subsequent postoperative course. The test is recommended when early discharge after rectal resection for deep infiltrating endometriosis is considered.

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“… 26 The reported incidence of PRF among patients who have undergone DIE-related surgeries ranges from 2.9% to 10.6%. 2 , 27 – 29 In the present study, 5 (4.8%) of 104 patients who underwent surgical treatment of DIE in our single tertiary hospital developed PRF from 5 to 16 days postoperatively.…”

Section: Discussionmentioning

confidence: 51%

“…Belghiti et al 28 reported that colpectomy might increase the incidence of PRF because the proportion of patients who underwent colpectomy was higher in the PRF group than in the control [8/9 (89%) vs. 55/189 (29%), respectively; P <0.001]. In the present study, we found that 4 of 5 (80.0%) patients with PRF had undergone colpectomy, while only 46 of 99 (46.5%) patients without PRF had undergone this surgery.…”

Section: Discussionmentioning

confidence: 99%

Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter?

Zheng

Zhang

et al. 2017

J Int Med Res

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ObjectiveThis study was performed to identify risk factors for postoperative rectovaginal fistula (PRF) in patients with deep infiltrating endometriosis (DIE).MethodsData were retrospectively obtained from the medical records of 104 patients with DIE, and statistical analysis was used to detect risk factors for PRF.ResultsFive of 104 (4.8%) patients developed PRF from 5 to 16 days postoperatively. The operative procedures included 84 (80.8%) superficial excisions, 6 (5.8%) full-thickness disc excisions, and 14 (13.5%) bowel resections. Most lesions were located in the cul-de-sac, and the mean lesion size was 2.6 cm (range, 0.5–7.0 cm). The univariate analysis showed that lesion location, larger lesion size, and surgical technique were statistically significant risk factors for PRF.ConclusionSurgical procedures should be very carefully executed in patients with DIE lesions of ≥4 cm.

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Role of Protective Defunctioning Stoma in Colorectal Resection for Endometriosis

Cited by 52 publications

References 30 publications

Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Postoperative outcomes following surgery for deep endometriosis of the sacral plexus and sciatic nerve: a 52-patient consecutive series

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter?

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