Digital Presentation AGES XXVIII Annual Scientific Meeting 2018

Medium to long-term gastrointestinal outcomes following segmental bowel resection for deep invasive endometriosis. (5535)

Kiran Vanza 1 , Bradley deVries 2 , Shing Wong 3 , Surya Krishnan 4
  1. Obstetrics and Gynaecology, WSLHD, Blacktown, NSW, Australia
  2. Women's and Babies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  3. Colorectal Surgeon, Royal Hospital for Women, Royal Prince Alfred Hospital and Prince of Wales Private Hospitals, Randwick, Camperdown, NSW, Australia
  4. Royal Hospital for Women and Royal Prince Alfred Gynaecology Endoscopy Departments, Royal Hospital for Women and Royal Prince Alfred Hospitals, Randwick and Camperdown, NSW, Australia

Segmental bowel resections for deeply invasive endometriosis (DIE) are becoming less common with the advent of more conservative approaches such as bowel shaving and disc resection. These conservative methods demonstrate a lower complication rate, particularly for rectovaginal fistulas, anastomotic leak, haemorrhage and long-term bladder dysfunction1,2,3. However, in cases where conservative approached have failed, or the presence of more advanced lesions causing significant bowel stenosis or multiple rectosigmoid nodules, segmental bowel resection remains the appropriate surgical modality1.

 

Aim

To share our experience of cases performed over the past 4 years and surgical technique implemented. To evaluate the gastrointestinal functional outcomes, symptoms and complications following segmental bowel resection for DIE.

 

Methods

A case series study was performed. Women who underwent segmental bowel resection for DIE from January 2012- December 2017 at Prince of Wales Private Hospital were included. The segment was greater than 5cm of rectosigmoid where nodules involved the muscularis, submucosa and/or mucosa. Outcomes including postoperative pain, fertility and surgical complications were collected. Data was pooled from a single database kept by the primary surgeon. Post operative gastrointestinal symptoms were assessed through the use of 4 validated questionnaires including the Gastrointestinal Quality of Life Index, the Knowles-Eccersley Scott Symptoms score for constipation, the Wexner Score for anal continence and the Bristol Stool Score.

 

Results

Twenty women met the inclusion criteria. The mean age was 40 years (range 33-46). All procedures were undertaken laparoscopically. Eight women (40%) underwent a hysterectomy in addition to segmental bowel resection and excision of endometriosis. Mean operative time was 182 ± 68 minutes and mean length of hospital stay was 7 ± 2 days.

 

Emphasis was placed on the same surgical team operating consistently, i.e. one advanced laparoscopic gynaecology surgeon together with the same colorectal surgeon. This was thought to improve surgical outcomes.

 

Overall, there was an improvement in medium-long term postoperative pain, fertility outcomes in women who did not undergo a concurrent hysterectomy and a relatively low risk of surgical complications and bowel dysfunction as assessed by validated questionnaires.

 

Conclusion

Our data demonstrates a relatively low risk of significant bowel complications post segmental bowel resection for DIE and improvements in postoperative pain and fertility. Working within a trusted surgical team and surgical techniques employed may contribute to these findings and minimise significant bowel complications.

  1. Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc resection, or bowel resection? Fertility and Sterility 2017 December: 108(6): 931-942
  2. Roman H, Bubenheim M, Huet E, Bridoux V, Zacharopolou C, Darai E, Collinet P, Tuech JJ. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Human Reproduction 2017 November: 29: 1-11
  3. Roman H, illes M, Vassilieff M, Resch B, Tuech JJ, Huet E, Darwish B, Abo C. Long-term functional outcomes following colorectal resection versus shaving for rectal endometiosis. American Journal of Obstetrics and Gynecology 2016 December: 215(6): 762.e1-762.e9
  • Have you presented oral, video or DCS at an AGES meeting before?: No
  • Are you a trainee and if so at what level?: 5
  • Are you a subspecialists or AGES member?: Yes