Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13345
Peer-review started: June 27, 2015
First decision: July 10, 2015
Revised: July 30, 2015
Accepted: September 28, 2015
Article in press: September 30, 2015
Published online: December 21, 2015
AIM: To investigate the impact of different surgical techniques on post-operative complications after colorectal resection for endometriosis.
METHODS: A multicenter case-controlled study using the prospectively collected data of 90 women (22 with and 68 without post-operative complications) who underwent laparoscopic colorectal resection for endometriosis was designed to evaluate any risk factors of post-operative complications. The prospectively collected data included: gender, age, body mass index, American Society of Anesthesiologists risk class, endometriosis localization (from anal verge), operative time, conversion, intraoperative complications, and post-operative surgical complications such as anastomotic dehiscence, bleeding, infection, and bowel dysfunction.
RESULTS: A similar number of complicated cases have been registered for the different surgical techniques evaluated (laparoscopy, single access, flexure mobilization, mesenteric artery ligation, and transvaginal specimen extraction). A multivariate regression analysis showed that, after adjusting for major clinical, demographic, and surgical characteristics, complicated cases were only associated with endometriosis localization from the anal verge (OR = 0.8, 95%CI: 0.74-0.98, P = 0.03). After analyzing the association of post-operative complications and each different surgical technique, we found that only bowel dysfunction after surgery was associated with mesenteric artery ligation (11 out of 44 dysfunctions in the mesenteric artery ligation group vs 2 out of 36 cases in the no mesenteric artery ligation group; P = 0.03).
CONCLUSION: Although further randomized clinical trials are needed to give a definitive conclusion, laparoscopic colorectal resection for deep infiltrating endometriosis appears to be both feasible and safe. Surgical technique cannot be considered a risk factor of post-operative complications.
Core tip: To the best of our knowledge, this is the first study evaluating the impact of different surgical techniques on the occurrence of post-operative complications. We have evaluated the potential influence of the most relevant surgical differences, including: laparoscopic approach, single access laparoscopy, flexure mobilization, mesenteric artery ligation, specimen extraction site, and diverting ileostomy creation.