Surgical Principles of Segmental Rectosigmoid Resection and Reanastomosis for Deep Infiltrating Endometriosis |
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| Affiliation: | 1. Department of Gynecology and Obstetrics (Drs. Bendifallah, Vesale, and Daraï);2. Department of Radiology (Drs. Thomassin-Neggara and Bazot), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, Sorbonne University, Paris, France;3. Department of Surgery (Dr. Tuech);4. Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Dr. Abo), Rouen University Hospital, Rouen;5. Endometriosis Center (Dr. Roman), Clinique Bordeaux Tivoli-Ducos, Bordeaux, France;6. Endometriosis Center (Dr. Roman), Aarhus University Hospital, Aarhus, Denmark;7. Departments of Gynecology and Obstetric (Dr. Vesale) Centre hospitalier Sud Francilien, Corbeil Essonne, France;1. Endometriosis Section, Gynecologic Division (Dr. Fernandes and Abrão), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil;2. Gynecologic Division (all authors), Beneficência Portuguesa de São Paulo, São Paulo, Brazil.;1. Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli);2. Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen;3. Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux (Dr. Roman), France;4. Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark (Dr. Roman).;1. Department of Gynaecological Surgery, Vita Batel Hospital, Curitiba, Brazil (Drs. Cabrera, Tessmann Zomer, and Kondo);2. Department of Gynaecological Surgery, CHU Clermont Ferrand, Clermont-Ferrand, France (Drs. Bourdel and Canis);3. Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS/Université d''Auvergne), Clermont-Ferrand, France (Drs. Bourdel and Canis);4. Endometriosis Unit, Clinica Santa Maria, Santiago, Chile (Dr. Larrain).;1. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (Drs. Bendifallah, Puchar, Vesale, and Daraï);2. UMRS-938 (Drs. Bendifallah and Daraï);3. Groupe de Recherche Clinique 6, Centre Expert En Endométriose (Drs. Bendifallah and Daraï), Sorbonne University, Paris;4. Endometriosis Centre, Clinique Tivoli-Ducos, Bordeaux (Dr Roman), France;5. Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia (Dr. Moawad);6. Department of Surgical Gynaecology, University Hospital of Aarhus, Aarhus, Denmark (Dr. Roman);1. Department of Minimally Invasive Gynecologic Surgery, Centro Hospitalar Universitário do Porto, University of Porto (Drs. Ferreira and Vigueras Smith);2. General Surgery Department, Hospital da Luz Arrábida (Dr. Vilaça), Porto, Portugal |
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| Abstract: | Study ObjectiveTo demonstrate the surgical steps involved in segmental rectosigmoid resection and reanastomosis in a deep infiltrating endometriosis (DIE) setting.DesignStep-by-step video demonstration of the technique.SettingDespite efforts made to identify criteria able to reliably predict which patients would be more likely to benefit from segmental bowel resection, such predictability remains an area of controversy and ambiguity. Furthermore, a standardized surgical technique has not yet been defined. Based on our experience, patients with DIE and colorectal involvement should be considered for segmental resection followed by anastomosis if they present with lesions not suitable for shaving/nodulectomy (i.e., large, deeply infiltrating nodules with extensive circumferential involvement). In our practice, careful patient selection together with the adoption of a standardized surgical technique allowed us to minimize the potential complications associated with segmental bowel resection.InterventionThe patient was a 27-year-old woman diagnosed by ultrasonography with a bowel endometriotic nodule of 33 × 8 × 14 mm infiltrating the inner layer of the muscularis propria at the rectosigmoid junction, with a distance from the anal verge of approximately 12 cm and an estimated stenosis of 50%. A 3-dimensional laparoscopic segmental rectosigmoid resection was performed, and indocyanine green-enhanced fluorescent angiography was used to assess perfusion of the bowel before completion of the anastomosis. The total operative time was 135 minutes, and no intraoperative complications occurred. Complete excision of endometriosis was achieved. The estimated blood loss was 30 mL. An intra-abdominal drain was not placed, and the urinary catheter was removed at the end of surgery. The patient was discharged at 6 days after surgery and did not experience any postoperative complications. The bowel endometriotic nodule measured 34 × 8 × 13 mm in a fresh specimen.ConclusionAdvanced laparoscopic surgical skills are needed to properly perform segmental rectosigmoid resection. Subspecialization and adequate pretreatment evaluation are crucial to ensure the correct decision making process within a complex algorithm for surgical management of bowel endometriosis. |
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