How Could Doctors Reduce Risk of Complications Following Rectal Endometriosis Surgery?

A temporary digestive stoma could be the answer.

Key Points

Highlights:

• Introducing a temporary digestive stoma in patients operated for rectal endometriosis could reduce the risk of post-operative complications.

Importance:

• This finding could help guide doctors in decision making regarding the introduction of a digestive stoma to patients who are operated for rectal endometriosis.

What’s done here?

• Researchers analyzed 47 patients who were operated for rectal endometriosis with and without temporary digestive stoma regarding complications arising following surgery.

Key results:

• The rate of postoperative complications in patients who underwent rectal endometriosis was 57 percent if they had a temporary digestive stoma, and 48 percent if they did not. This difference is not statistically significant.
• Looking specifically at anastomotic leakage, the complication rate was 21 percent in patients who did not have a protective stoma and three percent of those who did, but this difference was still not statistically significant.

Limitations of the study:

• The study only included 47 patients of which 14 did not have a protective stoma. These low numbers made statistical analyses precarious.
• Some variables lacked completeness in the study, for example, the level of anastomosis was not reported.
• Radiological features of the patients such as the extent of the lesions before surgery are not mentioned in the study.
• Other patient-related individual medical and surgical factors related to decision making for a digestive stoma should be mentioned.

Lay Summary

Introducing a temporary opening, known as a stoma, in the abdomen of patients that are operated for rectal endometriosis to collect waste products could reduce the risk of complications such as anastomotic leakage.

This is according to a study by French researchers published in the Journal of Gynecology Obstetrics and Human Reproduction.

To assess the value of protective stoma in patients with rectal endometriosis, the team led by Dr. Pierre Collinet at Université Lille-Nord-de-France analyzed a total of 47 patients who were operated for rectal endometriosis between June 2009 and December 2011. Seventy percent (33 out of 47) of the patients had protective stoma while 30 percent (14 out 47) did not.

There did not seem to be a statistically significant difference in the rate of complications following surgery in patients who did and those who not have protective stoma with a rate of complication of 57 percent in patients who did not have protective stoma versus 48 percent in those who did. 

When researchers specifically looked at the rate of anastomotic leakage, which occurs when the intestinal tissue regenerates rapidly and incorrectly at the site where bowel continuity is restored with surgery, they found that the rate was 21 percent in patients who did not have protective stoma (corresponding to three patients) but only three percent (corresponding to one patient) in those who did. However, this difference was still not statistically significant.

“The difference is not significant probably because of the lack of power due to small numbers,” the researchers wrote. “A trend is however noted,” they added, “patients without protective stoma seem to present more anastomotic leakage.”  

All three patients in the non-stoma group who had anastomotic leakage had to be re-operated because their complications were more severe, while the patient in the stoma group could be treated medically, again suggesting that stoma could prevent severe anastomotic leakage. 

The presence of a stoma could negatively affect a patient’s quality of life. However, the researchers found no difference between patients who had a protective stoma and those who did not, using the medical outcomes study, 36 item short form health survey (MOS-SF56). This finding led them to suggest: “the overall benefit to the quality of life does not seem to be questioned in patients with a temporary stoma.”

The authors concluded that doctors could consider temporary digestive stoma in patients operated for rectal endometriosis as it could reduce the risk of post-operative complications such as anastomotic leakage. However this finding has to be confirmed in a more significant number of patients, they said. 

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29097291