1
|
Potolicchio A, Jehaes C, Merlot B, Assenat V, Dennis T, Roman H, Francois MO, Denost Q. Treatment techniques for rectovaginal fistulas after low rectal resection for deep endometriosis. Tech Coloproctol 2024; 28:51. [PMID: 38684547 DOI: 10.1007/s10151-024-02923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for correcting RVF after rectal resection for endometriosis, with a combination of perineal surgery and laparoscopy: a mucosal flap, a transanal transection and single stapled anastomosis (TTSS) and a pull through. Supplementary file1 (MP4 469658 KB).
Collapse
Affiliation(s)
- A Potolicchio
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| | - C Jehaes
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France.
| | - B Merlot
- Clinique Tivoli-Ducos, Franco-European Multidisciplinary Endometriosis Institute, Bordeaux, France
| | - V Assenat
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| | - T Dennis
- Clinique Tivoli-Ducos, Franco-European Multidisciplinary Endometriosis Institute, Bordeaux, France
| | - H Roman
- Clinique Tivoli-Ducos, Franco-European Multidisciplinary Endometriosis Institute, Bordeaux, France
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - M-O Francois
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| | - Q Denost
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| |
Collapse
|
2
|
Zheng Y, Gu S, Ruan J, Yi X, Xu C. Bowel wall thickness measured by MRI is useful for early diagnosis of bowel endometriosis. Eur Radiol 2023; 33:9244-9253. [PMID: 37498383 PMCID: PMC10667399 DOI: 10.1007/s00330-023-09795-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To evaluate MRI features of bowel endometriosis (BE) and verify its clinical significance compared with pathological diagnosis. MATERIALS AND METHODS Since 2018, patients clinically diagnosed with deep endometriosis (DE) and planned to undergo surgery were enrolled prospectively. MRI parameters including traction, thickening sign of the rectum, obliteration of the Douglas Pouch, sign of adenomyosis, and pelvic adhesion were extracted. Uni- and multi-variate analyses were performed to explore their association with pathological diagnosis of BE. ROC curve was utilized to ascertain the appropriate cutoff value for predicting the presence and assessing the severity of BE. RESULTS A total of 226 patients with DE were recruited, and 154 BE cases were pathologically confirmed. Logistic regression analysis revealed that thickness of the rectal wall, traction sign of the rectum, and obliteration of the Douglas Pouch were independent factors to predict the presence of BE with the OR 1.59 (95% CI: 1.29-1.96), 0.24 (95% CI: 0.09-0.67), and 0.17 (95% CI: 0.07-0.40), respectively (p all < 0.01). A cutoff value of 6.0 mm for the thickness of rectal wall resulted in the highest predictive value of BE (specificity: 90.3%; sensitivity: 78.6%). For patients with measured thickness of the rectal wall over 6.0 mm, 72.1% (93/129) was confirmed BE with lesions infiltrated more than muscular layer. CONCLUSION This prospective study indicates that based on precise definition of visualized features on MRI images, BE could be recognized pre-operatively. DE patients with thickness of rectal wall exceeding 6.0 mm have a greater probability of BE. CLINICAL RELEVANCE STATEMENT Based on precise definition of visualized features and accurate measurement on MRI images, bowel infiltrating among deep endometriosis patients could be recognized pre-operatively. KEY POINTS • Precise definition of measurable MRI parameters made it possible for early detection of bowel endometriosis. • Thickening sign, traction sign of the rectum, and obliteration of the Douglas Pouch were typical radiological indicators for bowel endometriosis. • Bowel involvement is more sensitive to be detected among pelvic deep endometriosis patients with the thickness of the rectal wall over 6.0 mm.
Collapse
Affiliation(s)
- Yunxi Zheng
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China
| | - Shouxin Gu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Jingyao Ruan
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China
| | - Xiaofang Yi
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China.
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
- Department of Obstetrics and Gynecology of Shanghai Medical School, Fudan University, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China.
| |
Collapse
|
3
|
Raimondo D, Maletta M, Malzoni M, Cosentino F, Scambia G, Falcone F, Coppola M, Turco LC, Borghese G, Raffone A, Casadio P, Fabbri C, Corsi C, Seracchioli R. Indocyanine green fluorescence angiography after full-thickness bowel resection for rectosigmoid endometriosis: A multicentric experience with quantitative analysis. Int J Gynaecol Obstet 2021; 158:679-688. [PMID: 34875108 DOI: 10.1002/ijgo.14059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate effectiveness and reproducibility of qualitative and quantitative near-infrared indocyanine green (NIR-ICG) analyses as a tool for anastomotic perfusion assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). METHODS Symptomatic women with RSE undergoing minimally invasive full-thickness surgical excision of RSE and NIR-ICG evaluation from November 2019 to July 2020 were included. Study outcomes were the accuracy of qualitative and quantitative NIR-ICG analyses in predicting bowel fistula and their reproducibility. NIR-ICG predictive accuracy was assessed by calculating sensitivity, specificity, and area under the curve on receiver operating characteristic curves with 95% confidence intervals (CI). NIR-ICG reproducibility was assessed through Cohen's k coefficient to determine interoperator agreement between two observers. RESULTS Of 33 patients, 2 (6%) developed bowel fistula. In predicting bowel fistula, qualitative and quantitative NIR-ICG evaluations showed sensitivity of 100% and 100%, specificity of 71% and 93%, and area under the curve of 0.86 (95% CI 0.67-1.00) and 0.96 (95% CI 0-1.00), respectively. Regarding interoperator agreement rate, it was reported as excellent for the qualitative analysis and very good for the quantitative analysis. CONCLUSION Qualitative and quantitative NIR-ICG evaluations might be effective and reproducible tools for anastomotic perfusion assessment after discoid or segmental resection for RSE. Quantitative evaluation might be even more effective than qualitative evaluation in predicting bowel fistula.
Collapse
Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Manuela Maletta
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Francesco Cosentino
- Dipartimento di Medicina e Scienze della Salute "V. Tiberio" Unimol, Campobasso, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Falcone
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Marina Coppola
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Luigi C Turco
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Borghese
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Claudio Fabbri
- Computational Physiopathology Unit, Department of Electrical, Electronics and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Cristiana Corsi
- Computational Physiopathology Unit, Department of Electrical, Electronics and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Klebanoff JS, Barnes WA, Denny K, Mangini MG, Kazma J, Laganà AS, Habib N, Ayoubi JM, Moawad GN. Rates of anastomotic leak and fistula following surgical management of bowel endometriosis: a comparison of shaving, discoid excision, and segmental resection. Horm Mol Biol Clin Investig 2021; 43:145-150. [PMID: 33611866 DOI: 10.1515/hmbci-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022]
Abstract
Endometriosis is a complex chronic inflammatory condition that can create a multitude of bothersome painful symptoms for women. Bowel endometriosis is often misdiagnosed or overlooked leading to years of suffering for many women. The surgical management of bowel endometriosis varies based on extent of disease as well as surgeon experience. Surgical treatment for bowel endometriosis is complex and a variety of intraoperative and postoperative complications must be considered. Two significant postoperative complications for bowel endometriosis include anastomotic leak and fistula formation. There is continued debate regarding the appropriate surgical treatment for bowel endometriosis. Aggressive surgery with segmental bowel resection is being utilized more cautiously, with an increase in less aggressive shaving or disc excision techniques. Historic beliefs regarding the limitations of shaving and disc excision are being challenged, and with a reduction in morbidity these less aggressive techniques are winning favor among gynecologic surgeons. Shaving, discoid excision, and segmental bowel resection are all feasible surgical management options for bowel endometriosis. Segmental resection is associated with the highest rates of both anastomotic leak and fistula formation, while shaving is associated with the lowest.
Collapse
Affiliation(s)
- Jordan S Klebanoff
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA.,Department of Obstetrics and Gynecology, Main Line Health System, Wynnewood, PA, USA
| | - Whitney A Barnes
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Katherine Denny
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Marissa G Mangini
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Jamil Kazma
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Nassir Habib
- Department of Obstetrics and Gynaecology, Beaujon Hospital-University of Paris, Clichy Cedex, France
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gyncology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest (UVSQ), Suresnes, France
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, The George Washington University Hospital, Washington, DC, USA
| |
Collapse
|
5
|
Raimondo D, Maletta M, Borghese G, Mastronardi M, Arena A, Del Forno S, Salucci P, Giaquinto I, Casadio P, Seracchioli R. Indocyanine Green Fluorescence Angiography after Full-thickness Bowel Resection for Rectosigmoid Endometriosis-A Feasibility Study. J Minim Invasive Gynecol 2021; 28:1225-1230. [PMID: 33352315 DOI: 10.1016/j.jmig.2020.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 12/13/2020] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE To evaluate feasibility of near-infrared (NIR)-indocyanine green (ICG) imaging for bowel vascularization assessment after full-thickness bowel resection for rectosigmoid endometriosis (RSE). DESIGN This is a prospective, single-center, preliminary study on consecutive patients who were symptomatic submitted to discoid or segmental resection for RSE and NIR-ICG evaluation for vascular assessment of the anastomotic line from May 2018 to January 2020. SETTING Tertiary university hospital. PATIENTS Thirty-two women with RSE meeting eligibility criteria were included for study analysis. INTERVENTIONS NIR-ICG evaluation of anastomotic line vascularization after RSE removal. MEASUREMENTS AND MAIN RESULTS Fluorescence degree of the anastomotic line was assessed with a 0 to 2 Likert scale, as follows: 0 or "absent" (no fluorescence observed), 1 or "irregular" (not uniform distribution or weak fluorescence), and 2 or "regular" (uniform distribution of fluorescence and similar to the proximal colon). In all the patients included in the study (100%), NIR-ICG imaging allowed the evaluation of fluorescence degree of the anastomotic line. No adverse reaction related to ICG use was recorded. The protocol did not greatly lengthen operating time (median, 4 [range, 3-5] minutes). Excellent interoperator agreement was observed. Most of the patients (31 of 32, 96.9%) showed regular fluorescence on the anastomotic line; in 1 patient with irregular fluorescence at NIR-ICG after discoid excision, the anastomotic suture was reinforced through interrupted stitches. We had 1 case of anastomotic leakage after segmental resection with intraoperative good fluorescence at NIR-ICG evaluation. CONCLUSION NIR-ICG imaging for anastomotic perfusion assessment after discoid or segmental resection for RSE seems to be a feasible, safe, and reproducible method.
Collapse
Affiliation(s)
- Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)..
| | - Manuela Maletta
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Giulia Borghese
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Manuela Mastronardi
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Alessandro Arena
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Simona Del Forno
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Paolo Salucci
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Ilaria Giaquinto
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy (all authors)
| |
Collapse
|
6
|
Gornes H, Vaysse C, Leguevaque P, Gallini A, André B, Guerby P, Kirzin S, Suc B, Motton S, Rimailho J, Weyl A, Chantalat E. Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients. Arch Gynecol Obstet 2020; 302:383-391. [PMID: 32500217 DOI: 10.1007/s00404-020-05604-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. METHODS We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. RESULTS 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005]. CONCLUSION The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.
Collapse
Affiliation(s)
- H Gornes
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - C Vaysse
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - P Leguevaque
- Department of General Gynecological Surgery and Breast Diseases, Clinique Pasteur - Toulouse, Toulouse, France
| | - A Gallini
- Epidemiology Department, Research Methodology Support Unit (USMR), Toulouse University Hospital Center, Toulouse, France
| | - B André
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - P Guerby
- Department of Gynecological Surgery, University Hospital Center-Purpan, Hôpital Paule de Viguier, Toulouse, France
| | - S Kirzin
- Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France
| | - B Suc
- Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France
| | - S Motton
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - J Rimailho
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - A Weyl
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - E Chantalat
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France.
| |
Collapse
|
7
|
Jayot A, Bendifallah S, Abo C, Arfi A, Owen C, Darai E. Feasibility, Complications, and Recurrence after Discoid Resection for Colorectal Endometriosis: A Series of 93 Cases. J Minim Invasive Gynecol 2019; 27:212-219. [PMID: 31326634 DOI: 10.1016/j.jmig.2019.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Laparoscopic discoid colorectal resection is a surgical option for bowel endometriosis, 1 of the most severe forms of endometriosis. However, no study has clearly analyzed the feasibility or the complication and recurrence rates of the procedure in a homogeneous population with specific criteria for discoid resection. The aims of this study were to evaluate the rate of conversion to segmental resection, the need for double discoid resection, and the complication and recurrence rates. We conducted a prospective study of 93 consecutive patients who underwent discoid resection in Tenon University Hospital, Paris, France. The median follow-up was 20 months. We included patients with colorectal endometriosis (≤3 cm long and <90° of bowel circumference) experiencing failure of medical treatment or associated infertility. All the patients underwent a discoid colorectal resection using a transanal circular stapler. The primary end point was the rate of conversion to segmental resection (3.2%). The secondary end point was the rate of double discoid resection (6.5%). The overall complication rate was 24%, and the severe complication rate (i.e., Clavien-Dindo IIIB) was 3% (n = 4). Postoperative voiding dysfunction requiring bladder self-catheterization was observed in 16% (n = 15). The mean duration of bladder self-catherization was 30 days (range, 15-90) including 11 cases (74%) lasting less than 30 days and 4 cases lasting more than 30 days. No patients required bladder self-catheterization over 3 months. No difference in the complication rate or in voiding dysfunction was observed between double and single discoid resection. The low rate of conversion to radical resection confirms the satisfactory preoperative evaluation of bowel endometriosis. Few publications report the rate of conversion to radical surgery. This raises the crucial issue of the right indications for discoid resection. The present study confirms that discoid resection is probably the best option for small lesions because of its high feasibility and low complication rate. Further studies are required to evaluate the technique for larger colorectal endometriotic lesions.
Collapse
Affiliation(s)
- Aude Jayot
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai).
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai); INSERM UMR_S_707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris, France (Dr. Bendifallah)
| | - Carole Abo
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai)
| | - Alexandra Arfi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai)
| | - Clémentine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai)
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai); Groupe de Recherche Clinique 6 (GRC6-UPMC): Centre Expert En Endométriose (C3E), Paris, France (Dr. Darai); UMR_S938, Université Pierre et Marie Curie, Paris, France (Dr. Darai)
| |
Collapse
|
8
|
Hanacek J, Havluj L, Drahonovsky J, Urbankova I, Krepelka P, Feyereisl J. Interposition of the mesorectal flap as prevention of rectovaginal fistula in patients with endometriosis. Int Urogynecol J 2019; 30:2195-2198. [PMID: 31263915 DOI: 10.1007/s00192-019-04030-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Endometriosis is a gynecological condition characterized by endometrial tissue outside of the uterus. It affects up to 15% of women of reproductive age. In the case of bowel infiltration, about 90% of lesions are localized on the sigmoid colon or the rectum and may interfere with bowel function. Three surgical approaches are possible: (1) shaving technique, (2) discoid resection of the nodule, and (3) segmental resection with end-to-end anastomosis. A rectovaginal fistula is feared as a postoperative complication mainly in simultaneous resection of the vaginal and the rectosigmoid nodules. Its prevention is a two-step surgery (the first operation on the vagina and the second on the colon) or a preventive colostomy, both of which are often thought to be too invasive for a benign condition. Herein, we suggest a one-step surgery to prevent its development. METHODS In three women, a concomitant laparoscopic resection of the vaginal and rectosigmoid endometrial nodule was completed with interposition of a mesorectal flap. RESULTS All surgeries were uncomplicated with no rectovaginal fistula in the postoperative period. CONCLUSION In the hands of skilled surgeons, this one-step technique can be used to prevent rectovaginal fistula development.
Collapse
Affiliation(s)
- Jiri Hanacek
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic.
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Lukas Havluj
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of General Surgery, Third Faculty of Medicine and University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Jan Drahonovsky
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Iva Urbankova
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Krepelka
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jaroslav Feyereisl
- Institute for the Care of Mother and Child, Podolske nabrezi 157, 14700, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
9
|
Mattos LA, Goncalves MO, Andres MP, Young SW, Feldman M, Abrão MS, Kho RM. Structured Ultrasound and Magnetic Resonance Imaging Reports for Patients with Suspected Endometriosis: Guide for Imagers and Clinicians. J Minim Invasive Gynecol 2019; 26:1016-1025. [PMID: 30849475 DOI: 10.1016/j.jmig.2019.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/19/2022]
Abstract
In this article we propose a structured imaging report applied to ultrasound and magnetic resonance imaging in patients with suspected endometriosis.
Collapse
Affiliation(s)
- Leandro A Mattos
- Department of Imaging Diagnosis (Drs. Mattos and Goncalves), Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Alta Medicina Diagnóstica. Sao Paulo, SP, Brazil; Endometriosis Section, Gynecologic Division (Drs. Mattos, Goncalves, Andres, and Abrao), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Manoel O Goncalves
- Department of Imaging Diagnosis (Drs. Mattos and Goncalves), Escola Paulista de Medicina da Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Alta Medicina Diagnóstica. Sao Paulo, SP, Brazil; Endometriosis Section, Gynecologic Division (Drs. Mattos, Goncalves, Andres, and Abrao), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina P Andres
- Endometriosis Section, Gynecologic Division (Drs. Mattos, Goncalves, Andres, and Abrao), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. Andres and Abrao), BP-Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Scott W Young
- Department of Radiology (Dr. Young), Mayo Clinic, Phoenix, Arizona
| | - Myra Feldman
- Section of Abdominal Imaging, Imaging Institute (Dr. Feldman)
| | - Mauricio S Abrão
- Endometriosis Section, Gynecologic Division (Drs. Mattos, Goncalves, Andres, and Abrao), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Gynecologic Division (Drs. Andres and Abrao), BP-Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil.
| | - Rosanne M Kho
- Section of Benign Gynecology, Women's Health Institute (Dr. Kho), Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|