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Nerve-sparing laparoscopic disc excision of deep endometriosis involving the bowel: a single-center experience on 371 consecutives cases

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Abstract

Background

Bowel endometriosis is the most common pattern of Deep Endometriosis (DE). Arising from the posterior portion of the cervix and spreading to the recto-vaginal septum, utero-sacral and parametrial ligaments could lead to a distortion of normal pelvic anatomy, causing pain and infertility. Hormonal therapy is the first-line treatment in non-symptomatic patient. Conversely, laparoscopic surgical treatment has to be considered when symptoms relief are not optimal or with signs of bowel occlusion.

Methods

Retrospective experience of consecutive series of patients who referred to a third-level referral center with suspected bowel DE and failure of multiple medical treatments. After an intraoperative evaluation of nodule size with a rectal shaving of its external portion, patients underwent radical DE eradication with concomitant disc excision in rectal nodules < 3 cm with no signs of substantial full-thickness infiltration.

Results

A total of 371 patients were considered eligible for analysis, with a median age of 37 years. The median operative time of was 180 min, with an estimated blood loss of 100 mL and a median diameter of removed rectal nodule of 25 mm. Early postoperative procedure-related complications were 47 cases of acute rectal bleeding (12.7%), that were managed by rectal endoscopy, 3 bowel anastomotic dehiscence (0.8%), 8 hemoperitoneum (2.2%) and 3 ureteral fistula (0.8%). 22 patients experienced postoperative hyperpyrexia (5.9%), while 17 women underwent transient bladder deficiency (4.6%). Median follow-up was 60 months with a bowel recurrence rate of 2.2%. There was an improvement of all symptoms in the immediate postoperative follow-up (p < 0.0001). Among all patients with childbearing desire, the pregnancy rate found was 42.2% and was obtained by in vitro fertilization (IVF) techniques in 32% of cases.

Conclusions

Laparoscopic disc excision for bowel endometriosis is an effective surgical treatment in selected residual rectal nodules < 3.0 cm. The concomitant radical DE excision contributes to a significant improvement of symptoms with an acceptable complications’ rate.

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References

  1. Giudice LC (2010) Clinical practice. Endometriosis. N Engl J Med 362:2389–2398

    Article  CAS  Google Scholar 

  2. Working group of ESGE, ESHRE, and WES, Keckstein J, Becker CM, Canis M, Feki A, Grimbizis GF, Hummelshoj L, Nisolle M, Roman H, Saridogan E, Tanos V, Tomassetti C, Ulrich UA, Vermeulen N, De Wilde RL (2020) Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open. https://doi.org/10.1093/hropen/hoaa002

    Article  Google Scholar 

  3. Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C (2015) Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 21(3):329–339

    Article  Google Scholar 

  4. Abrão MS, Borrelli GM, Clarizia R, Kho RM, Ceccaroni M (2017) Strategies for management of colorectal endometriosis. Semin Reprod Med 35(1):65–71

    PubMed  Google Scholar 

  5. Nezhat C, Li A, Falik R et al (2018) Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol 218(6):549–562

    Article  Google Scholar 

  6. Ruffo G, Scopelliti F, Manzoni A et al (2014) Long-term outcome after laparoscopic bowel resections for deep infiltrating endometriosis: a single-center experience after 900 cases. BioMed Res Int. https://doi.org/10.1155/2014/463058

    Article  PubMed  PubMed Central  Google Scholar 

  7. Donnez O, Roman H (2017) Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril 108(6):931–942

    Article  Google Scholar 

  8. Ceccaroni M, Ceccarello M, Caleffi G, Clarizia R, Scarperi S, Pastorello M, Molinari A, Ruffo G, Cavalleri S (2018) Total laparoscopic ureteroneocystostomy for ureteral endometriosis: a single-center experience of 160 consecutive patients. J Minim Invasive Gynecol 26:78–86

    Article  Google Scholar 

  9. Rossini R, Lisi G, Pesci A, Ceccaroni M, Zamboni G, Gentile I, Rettore L, Ruffo G (2018) Depth of intestinal wall infiltration and clinical presentation of deep infiltrating endometriosis: evaluation of 553 consecutive cases. J Laparoendosc Adv Surg Tech A 28(2):152–156

    Article  Google Scholar 

  10. Vercellini P, Buggio L, Borghi A, Monti E, Gattei U, Frattaruolo MP (2018) Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review. Acta Obstet Gynecol Scand 97:942–955

    Article  Google Scholar 

  11. Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Breart G (2003) Deep infiltrating endometriosis: relation between severity of dysmenorrhea and extent of disease. Hum Reprod 18:760–766

    Article  Google Scholar 

  12. Ceccaroni M, Clarizia R, Bruni F et al (2012) Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single center, prospective, clinical trial. Surg Endosc 26:2029–2045

    Article  Google Scholar 

  13. de Almeida A, Fernandes LF, Averbach M, Abrão MS (2014) Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter. Surg Technol Int 24:243–248

    PubMed  Google Scholar 

  14. Fanfani F, Fagotti A, Gagliardi ML et al (2010) Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case control study. Fertil Steril 94(2):444–449

    Article  Google Scholar 

  15. Roman H, Tuech JJ (2014) New disc excision procedure for low and mid rectal endometriosis nodules using combined transanal and laparoscopic approach. Colorectal Dis 16(7):253–256

    Article  Google Scholar 

  16. Roman H, Abo C, Huet E et al (2015) Full-thickness disc excision in deep endometriotic nodules of the rectum: a prospective cohort. Dis Colon Rectum 58(10):957–966

    Article  Google Scholar 

  17. Roman H, Darwish B, Bridoux V et al (2017) Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients. Fertil Steril 107:977–986

    Article  Google Scholar 

  18. Oliveira MA, Crispi CP, Oliveira FM, Junior PS, Raymundo TS, Pereira TD (2014) Double circular stapler technique for bowel resection in rectosigmoid endometriosis. J Minim Invasive Gynecol 21(1):136–141

    Article  Google Scholar 

  19. Kondo W, Ribeiro R, Zomer MT, Hayashi R (2015) Laparoscopic double discoid resection with a double circular stapler for bowel endometriosis. J Minim Invasive Gynecol 22:929–931

    Article  Google Scholar 

  20. Canis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS, Vernon MW (1997) Revised american society for reproductive medicine classification of endometriosis: 1996. Fertil Steril 67(5):817–821

    Article  Google Scholar 

  21. Vanhie A, Meuleman C, Tomassetti C et al (2016) Consensus on recording deep endometriosis surgery: the CORDES statement. Hum Reprod 31(6):1219–1223

    Article  CAS  Google Scholar 

  22. Ceccaroni M, Clarizia R, Roviglione G, Ruffo G (2013) Neuro-anatomy of the posterior parametrium and surgical considerations for a nerve sparing approach in radical pelvic surgery. Surg Endosc 27:4386–4394

    Article  Google Scholar 

  23. Ceccaroni M, Pontrelli G, Scioscia M, Ruffo G, Bruni F, Minelli L (2010) Nerve-sparing laparoscopic radical excision of deep endometriosis with rectal and parametrial resection. J Minim Invasive Gynecol 17(1):14–15

    Article  Google Scholar 

  24. Abo C, Bendifallah S, Jayot A, Nyangoh Timoh K, Tuech JJ, Roman H, Daraï E (2019) Discoid resection for colorectal endometriosis: results from a prospective cohort from two French tertiary referral centres. Colorectal Dis 21(11):1312–1320

    Article  CAS  Google Scholar 

  25. Hudelist G, Aas-Eng MK, Birsan T, Berger F, Sevelda U, Kirchner L, Salama M, Dauser B (2018) Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis—a prospective cohort study. Acta Obstet Gynecol Scand 97(12):1438–1446

    Article  Google Scholar 

  26. Jayot A, Bendifallah S, Abo C, Arfi A, Owen C, Darai E (2020) Feasibility, complications, and recurrence after discoid resection for colorectal endometriosis: a series of 93 cases. J Minim Invasive Gynecol 27(1):212–219

    Article  Google Scholar 

  27. Abo C, Moatassim S, Marty N, Saint Ghislain M, Huet E, Bridoux V, Tuech JJ, Roman H (2018) Postoperative complications after bowel endometriosis surgery by shaving, disc excision, or segmental resection: a three-arm comparative analysis of 364 consecutive cases. Fertil Steril 109(1):172–178

    Article  Google Scholar 

  28. de Resende Júnior JAD, Crispi CP, Cardeman L, Buere RT, Fonseca MF (2018) Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease. Int Urogynecol J 29(9):1349–1358

    Article  Google Scholar 

  29. Iversen ML, Seyer-Hansen M, Forman A (2017) Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review. Acta Obstet Gynecol Scand 96(6):688–693

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS “Sacro Cuore—Don Calabria” Hospital, Via Don A. Sempreboni 5, 37024, Negrar di Valpolicella, Verona, Italy

    Marcello Ceccaroni, Matteo Ceccarello, Roberto Clarizia, Giovanni Roviglione, Daniele Mautone & Camilla Cavallero

  2. Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy

    Enrico Fusco

  3. Department of Gynaecology and Obstetrics, University of East Piedmont “A. Avogadro”, Novara, Italy

    Camilla Cavallero

  4. Department of Gastroenterology and Digestive Endoscopy, IRCSS “Sacro Cuore—Don Calabria” Hospital, Negrar di Valpolicella, Verona, Italy

    Simone Orlandi

  5. Department of General Surgery, IRCSS “Sacro Cuore—Don Calabria” Hospital, Negrar di Valpolicella, Verona, Italy

    Roberto Rossini, Giuliano Barugola & Giacomo Ruffo

Authors
  1. Marcello Ceccaroni
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  2. Matteo Ceccarello
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  3. Roberto Clarizia
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  4. Enrico Fusco
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  7. Camilla Cavallero
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  8. Simone Orlandi
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  9. Roberto Rossini
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  10. Giuliano Barugola
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  11. Giacomo Ruffo
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Correspondence to Matteo Ceccarello.

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Marcello Ceccaroni, Matteo Ceccarello, Roberto Clarizia, Enrico Fusco, Giovanni Roviglione, Daniele Mautone, Camilla Cavallero, Simone Orlandi, Roberto Rossini, Giuliano Barugola, Giacomo Ruffo declares no conflict of interest.

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Ceccaroni, M., Ceccarello, M., Clarizia, R. et al. Nerve-sparing laparoscopic disc excision of deep endometriosis involving the bowel: a single-center experience on 371 consecutives cases. Surg Endosc 35, 5991–6000 (2021). https://doi.org/10.1007/s00464-020-08084-4

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