LAPAROSCOPIC SURGICAL TREATMENT OF DEEP ENDOMETRIOSIS WITH INTESTINAL INVOLVEMENT: EXPERIENCE OF A REFERRAL CENTER

Objective This study aimed to describe the experience of a referral center in the laparoscopic surgical treatment of deep endometriosis with involvement of the rectosigmoid.

Methods A retrospective study using prospectively recorded electronic data. The following parameters were evaluated: type of surgery, operative time, length of hospitalization, conversion rate to open surgery, need for stoma, and postoperative complications Clavien Dindo ≥ 2. The study was approved by the Ethics and Research Committee.

Results A total of 290 surgeries were performed between March 2012 and April 2024. The average age was 36.1±5.7 years (range, 20-55). There were 172 segmental resections (RES) of the rectosigmoid (59.3%), 81 disc resections (DIS) (29.9%), and 40 shavings (nodule excisions) (SHA) of the rectum (13.8%). Three patients (1.0%) had both DIS and RES in the same operative session. Additional procedures were performed in 123 patients (42.4%) and included appendectomy (n=71, 24.5%), hysterectomy (n=45, 15.5%), ileo-cecectomy (n=13, 10.5%), and segmental enterectomy (n=8, 2.8%). In 13 patients undergoing RES (7.5%), the surgical specimen was removed via the vagina (NOSES). There were 4 conversions to open surgery (1.4%). The mean surgical time was 134±55.9 minutes (range, 45-380 minutes), significantly shorter for SHA compared to DIS and RES (p<0.001) and shorter for DIS compared to RES (p<0.001). The average length of hospitalization was 1.6±0.9 days (range, 1-12 days), significantly shorter for SHA compared to DIS or RES (p<0.001) and shorter for DIS compared to RES (p<0.001). Thirty-three patients (11.4%) had Clavien Dindo complications grade 2 (n=19, 6.6%) or 3 (n=14, 4.8%), with no statistical difference in comparisons between SHA vs DIS or RES (p=0.592), DIS vs SHA or RES (p=0.416), and RES vs SHA or DIS (p=0.259). Thirty-six patients (12.4%) required rehospitalization, and 11 patients (3.8%) needed reoperation within 60 days post-surgery, with no differences between SHA, DIS, or RES. Eight patients required a stoma (2.8%), 3 for protection and 5 due to postoperative complications. No deaths occurred.

Conclusion The laparoscopic surgical treatment of intestinal endometriosis presents low morbidity and low rates of stoma formation. Patients undergoing SHA or DIS have shorter surgical times, shorter hospital stays, and no differences in rehospitalization or reoperation rates.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025