Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2015; 21(47): 13345-13351
Published online Dec 21, 2015. doi: 10.3748/wjg.v21.i47.13345
Colorectal resection in deep pelvic endometriosis: Surgical technique and post-operative complications
Marco Milone, Andrea Vignali, Francesco Milone, Giusto Pignata, Ugo Elmore, Mario Musella, Giuseppe De Placido, Antonio Mollo, Loredana Maria Sosa Fernandez, Guido Coretti, Umberto Bracale, Riccardo Rosati
Marco Milone, Francesco Milone, Mario Musella, Giuseppe De Placido, Antonio Mollo, Loredana Maria Sosa Fernandez, Guido Coretti, Department of Advanced Biomedical Science, University of Naples “Federico II”, 80131 Naples, Italy
Andrea Vignali, Ugo Elmore, Riccardo Rosati, Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita Salute, 20132 Milan, Italy
Giusto Pignata, Umberto Bracale, General and Mini-invasive Surgery, “San Camillo” Hospital, 38122 Trento, Italy
Author contributions: All authors contributed equally to this paper.
Institutional review board statement: Approval of Local Ethics Committee obtained.
Informed consent statement: Obtained from patients.
Conflict-of-interest statement: All authors have nothing to declare.
Data sharing statement: The depositary database is located in the Department of Advanced Biomedical Science, and all data are available for any further analysis. Data is stored anonymously to respect patient privacy.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marco Milone, MD, Surgery Unit, Department of Advanced Biomedical Science, University of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy. milone.marco.md@gmail.com
Telephone: +39-81-7463064 Fax: +39-81-7462896
Received: June 26, 2015
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.

Keywords: Endometriosis, Bowel, Complication, Technique, Laparoscopy, Mesenteric artery

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.