"A Space Odyssey" on Laparoscopic Segmental Rectosigmoid Resection for Deep Endometriosis : A Seventeen-year Retrospective Analysis of Outcomes and Postoperative Complications among 3050 Patients Treated in a Referral Center
Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved..
STUDY OBJECTIVE: To evaluate the feasibility of laparoscopic rectosigmoid resection for bowel endometriosis (RSE), reporting surgical and short-term postoperative outcomes in a consecutive large series of patients.
DESIGN: A retrospective cohort study.
SETTING: Third-level national referral center for deep endometriosis (DE).
PATIENTS: 3050 patients with symptomatic RSE requiring surgical treatment.
INTERVENTIONS: Nerve-sparing laparoscopic resection for RSE perfomed by a multidisciplinary team. After collecting intraoperative surgical characteristics, postoperative complications were collected by evaluating the risk factors associated with their onset.
MEASUREMENTS AND MAIN RESULTS: Clavien-Dindo IIIb postoperative complications were noted in 13.1% of patients, with anastomotic leakage and rectovaginal fistula accounting for 3.0% and 1.9%, respectively. Postoperative bladder impairment was observed in 13.9% of patients during hospital discharge but spontaneously decreased to 4.5% at the first evaluation after 30 days, alongside a statistically significant change towards global symptom improvement. Multivariate analyses were done to identify the risk factors for segmental bowel resection in terms of occurrence of postoperative major complications. Ultralow (≤5 cm from the anal verge), low rectal anastomosis (<8 cm, >5 cm), parametrectomy, vaginal resection, and previous surgeries seemed more related to anastomotic leakage, rectovaginal fistula, and bladder retention.
CONCLUSIONS: Laparoscopic rectosigmoid resection for RSE seems an effective and feasible procedure. The surgical complication rate is not negligible but could be reduced by implementing a multidisciplinary approach, an endless improvement in nerve-sparing techniques and surgical anatomy, as well as technological enhancements. Real future challenges will be to reduce the time for the first diagnosis of DE and the likelihood of surgical indications.
| Errataetall: |
CommentIn: J Minim Invasive Gynecol. 2023 Aug;30(8):599-600. - PMID 37330136 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Journal of minimally invasive gynecology - 30(2023), 8 vom: 10. Aug., Seite 652-664 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ceccaroni, Marcello [VerfasserIn] |
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| Links: |
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| Themen: |
Bowel endometriosis |
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| Anmerkungen: |
Date Completed 11.08.2023 Date Revised 11.01.2024 published: Print-Electronic ClinicalTrials.gov: NCT05682690 CommentIn: J Minim Invasive Gynecol. 2023 Aug;30(8):599-600. - PMID 37330136 Citation Status MEDLINE |
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| doi: |
10.1016/j.jmig.2023.04.005 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM356203034 |
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| 245 | 1 | 0 | |a "A Space Odyssey" on Laparoscopic Segmental Rectosigmoid Resection for Deep Endometriosis |b A Seventeen-year Retrospective Analysis of Outcomes and Postoperative Complications among 3050 Patients Treated in a Referral Center |
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| 500 | |a Date Completed 11.08.2023 | ||
| 500 | |a Date Revised 11.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT05682690 | ||
| 500 | |a CommentIn: J Minim Invasive Gynecol. 2023 Aug;30(8):599-600. - PMID 37330136 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a STUDY OBJECTIVE: To evaluate the feasibility of laparoscopic rectosigmoid resection for bowel endometriosis (RSE), reporting surgical and short-term postoperative outcomes in a consecutive large series of patients | ||
| 520 | |a DESIGN: A retrospective cohort study | ||
| 520 | |a SETTING: Third-level national referral center for deep endometriosis (DE) | ||
| 520 | |a PATIENTS: 3050 patients with symptomatic RSE requiring surgical treatment | ||
| 520 | |a INTERVENTIONS: Nerve-sparing laparoscopic resection for RSE perfomed by a multidisciplinary team. After collecting intraoperative surgical characteristics, postoperative complications were collected by evaluating the risk factors associated with their onset | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: Clavien-Dindo IIIb postoperative complications were noted in 13.1% of patients, with anastomotic leakage and rectovaginal fistula accounting for 3.0% and 1.9%, respectively. Postoperative bladder impairment was observed in 13.9% of patients during hospital discharge but spontaneously decreased to 4.5% at the first evaluation after 30 days, alongside a statistically significant change towards global symptom improvement. Multivariate analyses were done to identify the risk factors for segmental bowel resection in terms of occurrence of postoperative major complications. Ultralow (≤5 cm from the anal verge), low rectal anastomosis (<8 cm, >5 cm), parametrectomy, vaginal resection, and previous surgeries seemed more related to anastomotic leakage, rectovaginal fistula, and bladder retention | ||
| 520 | |a CONCLUSIONS: Laparoscopic rectosigmoid resection for RSE seems an effective and feasible procedure. The surgical complication rate is not negligible but could be reduced by implementing a multidisciplinary approach, an endless improvement in nerve-sparing techniques and surgical anatomy, as well as technological enhancements. Real future challenges will be to reduce the time for the first diagnosis of DE and the likelihood of surgical indications | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bowel endometriosis | |
| 650 | 4 | |a Laparoscopy | |
| 650 | 4 | |a Nerve-sparing surgery | |
| 650 | 4 | |a Rectosigmoid resection | |
| 650 | 4 | |a Segmental bowel resection | |
| 700 | 1 | |a Ceccarello, Matteo |e verfasserin |4 aut | |
| 700 | 1 | |a Raimondo, Ivano |e verfasserin |4 aut | |
| 700 | 1 | |a Roviglione, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Clarizia, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Bruni, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Mautone, Daniele |e verfasserin |4 aut | |
| 700 | 1 | |a Manzone, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Facci, Enrico |e verfasserin |4 aut | |
| 700 | 1 | |a Rettore, Lorenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Rossini, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Bertocchi, Elisa |e verfasserin |4 aut | |
| 700 | 1 | |a Barugola, Giuliano |e verfasserin |4 aut | |
| 700 | 1 | |a Ruffo, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Barra, Fabio |e verfasserin |4 aut | |
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