Choosing the Right Technique for Deep Colorectal Endometriosis

Three Different Approaches of Deep Endometriosis

Key Points

Highlight:

• Dr. Tebache group from Belgium describe the different approaches of colorectal endometriosis surgery, the associated complications, and the recurrence after surgery.

Background:

• Endometriosis is a benign gynecologic condition, histologically defined by the presence of ectopic endometrium outside the endometrial cavity.
• Three clinical presentations of endometriosis have been described and could coexist in the pelvis: peritoneal endometriosis, ovarian endometrioma, and deep infiltrating endometriosis.
• Deep bowel endometriosis is defined by the infiltration of the muscular layer of the rectum, rectosigmoid junction or the sigmoid.
• The surgical management of bowel endometriosis is a real challenge. Until today, no consensus has been reached concerning the surgical removal of colorectal deep endometriosis.
• Here, Dr. Tebache group describe the different approaches of colorectal endometriosis surgery, the associated complications, and the recurrence after surgery.

Key points:

• Among the surgical techniques, 3 different procedures are described in the removal of colorectal endometriosis: the rectal shaving, the disc excision, and the segmental colorectal resection.
• All these procedures are associated with complications, but the risk of rectovaginal fistula is higher if disc excision or segmental colorectal resection is performed.
• Preoperative evaluation of the bowel infiltration by imaging techniques is important to estimate the feasibility of a deep rectal shaving with possible incomplete removal of the endometriotic lesions.
• The surgeon has to explain that all types of procedures are associated with complications during patients counseling.
• Patients must be aware that rectal shaving can lead to incomplete removal of the lesion, but this remains an option as endometriosis, even deeply infiltrating the bowel.
• Regardless of the planned surgical procedure (conservative or radical), the surgeon has to follow the recommendations to minimize surgical complications, especially in cases of radical surgery.

Lay Summary

Endometriosis is a benign gynecologic condition, histologically defined by the presence of ectopic endometrium outside the endometrial cavity. Three clinical presentations of endometriosis have been described and could coexist in the pelvis: peritoneal endometriosis, ovarian endometriosis, and deep infiltrating endometriosis. Deep bowel endometriosis is defined by the infiltration of the muscular layer of the rectum, rectosigmoid junction or the sigmoid.

The surgical management of bowel endometriosis is a real challenge. Until today, no consensus has been reached concerning the surgical removal of colorectal deep endometriosis. However, all authors agree that only symptomatic patients should undergo surgery.

Therefore, in this study, Dr. Tebache group from Belgium describe the different approaches of colorectal endometriosis surgery, the associated complications, and the recurrence after surgery. the article is published in the journal "Best Practice & Research Clinical Obstetrics & Gynecology".

Among the current possible surgical techniques, 3 different procedures are described for colorectal endometriosis: the rectal shaving, the disc excision, and the segmental colorectal resection. All these procedures are associated with complications, but the risk of rectovaginal fistula is higher if disc excision or segmental colorectal resection is performed.

It is therefore of utmost importance to evaluate preoperatively the bowel infiltration by several imaging techniques to estimate the feasibility of a deep rectal shaving with possible incomplete removal of the endometriotic lesions.

During patient counseling, the surgeon has to explain that all types of procedures are associated with complications. Moreover, patients must be aware that rectal shaving can lead to incomplete removal of the lesion, but this remains an option as endometriosis, even deeply infiltrating the bowel, is a benign condition.

Whatever the planned surgical procedure (conservative or radical), the surgeon has to follow the recommendations to minimize surgical complications, especially in cases of radical surgery.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30824210