H. R. Zahiri1, S. G. Devlin1, B. E. Ebert1, M. A. Benenati1, R. Marvel1, A. Park1, I. Belyansky1 1Anne Arundel Medical Center,Surgery,Annapolis, MD, USA
Introduction:
Deep endometriosis affects tissues at least 5 mm below the peritoneum, such as bowel, bladder, or ureters. Dyspareunia, dysmenorrhea, dyschezia are common manifestations. Surgical management of colonic endometriosis is either segmental resection or less invasive, local excision of colonic wall lesions with primary repair. Bowel resection is more invasive and morbid for patients. Nevertheless, at present, no general consensus on indication for bowel resection in this setting exists. Surgeons select resection either preoperatively, based on exam and imaging, or intraoperatively after direct examination of the colon and rectum. Our common practice is intraoperative assessment for selection of appropriate intervention. The study aim was to determine outcomes post intraoperative assessment and selection of surgical intervention for colonic endometriosis.
Methods:
We conducted a retrospective review of all patients operated on for endometriosis at Anne Arundel Medical Center. From January 2012 to August of 2014, 7 patients had deep endometriosis involving the colon or rectum who had either local excision or segmental colorectal resection. The surgical approach for therapy was selected after a detailed intraoperative examination of the colon and rectum.
Results:
Seven patients in our study underwent surgical therapy for their colonic endometriosis. Mean age, BMI, and ASA were 37.7, 29, and 2.1 respectively. All were affected by stage 4 endometriosis involving the rectum or rectosigmoid junction. Intraoperative assessment found 3 patients with severe disease affecting the rectosigmoid region including obstruction. All 3 underwent laparoscopic low anterior resection (LAR) with primary anastomosis. The remainder of patients did not exhibit evidence of obstruction and were managed with local excision of colonic wall lesions with muscularis or serosal repair. Mean surgery time and blood loss were 257.7 minutes and 200 ml. Complication rates were 29%, 2 UTIs, 1 Seroma, and 1 ureteral injury unrelated to colon resection. All complications occurred in 2 LAR patients. Mean hospital length of stay was 2.7 days. Mean followup was 92 days. All patients had significant resolution of their endometriosis symptoms post surgery.
Conclusion:
Intraoperative assessment of deep endometriosis affecting the colon may serve to accurately determine disease burden and spare patients of invasive colonic resection and its complications while providing them with effective symptomatic relief.