Full-Thickness Disc Excision in Deep Endometriotic Nodules of the Rectum

Abstract

BACKGROUND: To date, a majority of patients presenting with large endometriosis of the rectum are managed worldwide by colorectal resection. However, postoperative rectal function may be impacted by radical rectal surgery. OBJECTIVE: The purpose of this study was to assess the postoperative outcomes of patients with rectal endometriosis who are managed by full-thickness disc excision and to compare outcomes of the 2 procedures using a transanal approach. DESIGN: This was a prospective study. SETTINGS: The study was conducted at a university hospital. PATIENTS: Fifty patients with colorectal endometriosis that was managed by disc excision between June 2009 and November 2014 were included in the study. INTERVENTIONS: The procedure included laparoscopic deep shaving, followed by full-thickness disc excision to remove the shaved rectal area. Disc excision was performed using a semicircular transanal stapler (the Rouen technique) in 20 patients, an end-to-end anastomosis circular transanal stapler in 28 patients, and transvaginal excision in 2 patients. MAIN OUTCOMES MEASURES: Preoperative and postoperative assessments of pelvic symptoms and digestive function using standardized gastrointestinal questionnaires were the main measures. RESULTS: The largest diameter of specimens achieved was significantly higher using the Rouen technique (58 ± 9 mm) than the end-to-end anastomosis stapler (34 ± 6 mm). Two rectovaginal fistulas were recorded (4%), and 8 patients presented with transitory bladder voiding (16%). Median postoperative values for the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott-Symptom Questionnaire improved progressively 1 and 3 years after surgery. For patients intending to get pregnant, the cumulative pregnancy rate was 80%, and 63% of pregnancies were spontaneous. LIMITATIONS: The study sample size is small and the design is not comparative; however, direct comparison of patients managed by disc excision and colorectal resection would be inappropriate, because of differences regarding nodule localization and size. CONCLUSIONS: Disc excision is a valuable alternative to colorectal resection in selected patients presenting with rectal endometriosis, achieving better preservation of rectal function. The Rouen technique allows for successful removal of large nodules of the low and midrectum, with favorable postoperative outcomes. (See video abstract, http://links.lww.com/DCR/A208.).