Personalized Surgical Strategies for Bowel Endometriosis to Enhance Patient Outcomes

Tailored surgery enhances outcomes for bowel endometriosis patients

Key Points

Highlight

• Customizing surgery based on patient needs and surgeon experience is crucial for effective management and improved outcomes in bowel endometriosis.

Importance

• The study focuses on the need for customized surgical and postoperative management strategies for patients with bowel endometriosis, addressing the unique challenges of the disease to improve patient outcomes, reduce complications, and enhance recovery.

 What’s done here

• The study reviews and analyzes various surgical techniques and postoperative management strategies for bowel endometriosis, and evaluates the effectiveness of different approaches.

 Key results

• Preoperative preparation, including dietary rehabilitation and smoking cessation, can reduce postoperative complications.
• Shaving, discoid excision, and segmental bowel resection, each have specific indications and outcomes, with no single technique being superior in all cases.
• Postoperative management protocols like early re-feeding and fast mobilization (ERAS) improve recovery and reduce hospital stay.
• The recurrence rate of deep nodules after surgery is low, with a 10-year recurrence rate of 5.5% in symptomatic patients.
• Tailored surgery and follow-up care significantly enhance patient outcomes and minimize complications.

Lay Summary

Bowel endometriosis often impacts the rectum or sigmoid colon, causing significant symptoms and reducing fertility. Treatments include hormonal therapy and surgery, with techniques varying widely. Crestani et al., in the leadership of Dr. Horace Roman, conducted a study aiming to reflect on how surgeons can customize the management of bowel endometriosis lesions. The article was published in the June 2024 issue of the journal Best Practice & Research Clinical Obstetrics & Gynaecology.

First, they look into the pre-operative care for bowel endometriosis which requires careful planning and expert involvement. Clinical exams alone are insufficient, and imaging techniques like transvaginal ultrasound and MRI are essential for accurate diagnosis and surgical planning. Surgical strategies may involve multidisciplinary teams, including gynecologists, bowel surgeons, and possibly urologists or thoracic surgeons. Robotic assistance, though costlier, offers improved precision and reduced complications, particularly for complex cases. Proper pre-operative assessment and planning are crucial to optimize surgical outcomes and patient care.

Secondly, they explore tailoring surgery for bowel endometriosis which is challenging. Preoperative preparation, including dietary rehabilitation, smoking and alcohol cessation, and selective bowel preparation, may reduce complications. Surgery types include shaving, discoid excision, and segmental resection. Shaving is less invasive but may have higher recurrence rates. Discoid excision preserves rectal function with low recurrence. Segmental resection is used for extensive lesions but carries a higher risk of complications. Newer techniques, like NOSE and using indocyanine green for better visualization, show promise in reducing postoperative issues, but require careful consideration based on individual patient conditions.

Postoperative management after bowel endometriosis surgery should be customized. Nasogastric tubes and systematic drainage are no longer recommended, while early re-feeding and rapid mobilization (ERAS) are encouraged to reduce complications and hospital stays. ERAS protocols support faster recovery, with close monitoring of C-reactive protein levels to detect potential issues like bowel leakage. Long-term follow-up focuses on managing postoperative outcomes, with MRI reserved for pain relapse. Recurrence rates are low, and many patients can achieve pregnancy naturally.

To conclude, the authors add that patients with endometriosis require comprehensive, expert multidisciplinary care. Surgeons must tailor the surgery to the patient's specific condition, expectations, and their expertise. This involves adjusting numerous factors, from diagnosis to post-operative follow-up, to optimize the patient’s experience and outcomes.

Research Source: https://pubmed.ncbi.nlm.nih.gov/38593673/