Urological and colorectal complications following surgery for rectovaginal endometriosis

Abstract

Urological and colorectal complications following surgery for rectovaginal endometriosisSir, We read with interest the article by Slack et al. 1 and have several comments to make about this important area of research. First, we would like to point out that working at a busy district general hospital, we see a large number of women who have either minimal symptoms from rectovaginal endometriosis or, in a few cases, are entirely asymptomatic and are diagnosed incidentally at the time of another procedure. The women who have been selected by the study group are likely to represent a small percentage of women who actually have this disease, and thus the estimated incidence is far from accurate. Second, the authors do not state whether any of the women underwent hysterectomy at the same time. If the age range includes women who are likely to have completed their family, then reasons for not performing this step should be explained. Many women with rectovaginal endometriosis have coexisting adenomyosis and thus complain of persistent pelvic pain following surgery to remove extrauterine endometriosis. We also presume that none of the women had posthysterectomy vault endometriosis, which can pose greater intraoperative difficulties. The follow-up data for these women seem to be very limited, and these data are very important to determine whether such radical surgery is indeed worthwhile. The authors only managed to follow up just less than half of those women enrolled into the study, and it is not clear what proportion of women had follow up over 2 years. This period of time is essential to cover in order to determine the percentage of women who develop a recurrence of symptoms. In addition, fertility rates of appropriately aged women would be another area to assess in order to help justify this type of surgery and to determine symptom severity. j Reference 1 Slack A, Child T, Lindsey I, et al. Urological and colorectal complications following surgery for rectovaginal endometriosis.

Histopathology‐based combined surgical approach to rectovaginal endometriosis

“…Impairment of autonomic bladder and bowel functions is reported in up to 30% of patients. The need for a temporary or a definitive colstomy or ileostomy for a benign disease is a serious event for the affected woman, with colostomy rates stated to range between 0% and 6% [2][3][4][5][6][7][8][9][10][11][12][13][14][17][18][19]. In our series, there were no instances of colostomy, ileostomy, rectovaginal fistulas, or anastomosis insufficiency.…”

“…Strategies not only vary from study to study but also within the studies published [2][3][4][5][7][8][9][10][11][12][13][14][17][18][19], and no standardized operative strategy has been implemented for rectovaginal endometriosis. We have described a technique that differs from previous contributions to the literature, making it possible to treat the disease according to its extent.…”

“…Operating on this benign disease using either ablative or resective techniques may lead to severe complications such as rectovaginal fistulas, anastomosis insufficiencies, laparoconversions, primary or secondary colostomies or ileostomies, sepsis, transfusions, or impairment of the autonomic bladder and bowel functions (up to 30%) [2,[5][6][7]9,[10][11][12][13][17][18][19].…”

Ist die Sentinel-Lymphknotenmarkierung bei Patientinnen mit tief infiltrierender rektovaginaler Endometriose sinnvoll?

“…Die chirurgische Exzision ist die effektivste Therapie der tief infiltrierenden rektovaginalen Endometriose [8,28]. Die notwendige Radikalität solcher Operationen bedingt ein erhöhtes Risiko für intra-und postoperative Komplikationen, wie etwa rektovaginale Fisteln oder funktionelle Blasen-und Darmentleerungsstö-rungen [9,[29][30][31][32][33][34][35][36]. Um die Risiken zu minimieren, wurden nerven-und gewebeschonende Verfahren mit verschiedenen kombinierten Zugängen etabliert [33].…”

Value of diagnostic procedures in rectovaginal endometriosis

“…However, the extension of rectovaginal endometriosis does not necessarily correlate with the severity of pain or infertility problems. 4,6,8,[12][13][14][15][16][17][18][19] However, surgery on this benign disease may lead to severe complications, such as rectovaginal fistulas, anastomotic insufficiencies with primary or secondary colostomies, ileostomies, sepsis, considerable blood loss and impairment of the autonomic bladder and bowel functions in up to 30% of women. 1,2,7,9 The precise preoperative definition of size and invasive growth of infiltrative rectovaginal endometriosisa prerequisite for optimal treatmentis still a challenge.…”