KEY TAKEAWAYS
- The study aimed to investigate the clinical and surgical outcomes of patients with DE involving the intestines, focusing on the effectiveness of surgical treatments.
- Symptoms predict returns to surgery in intestinal DE; complication rates similar post-segmental resection vs. no-colectomy.
Deep penetrating endometriosis (DE) is known to impact abdominal and pelvic organs, including the bowel and bladder, necessitating therapeutic intervention to manage symptoms effectively.
Leandro Cardoso Barchi and the team aimed to assess the management and outcomes of patients with DE affecting the intestines, emphasizing the effectiveness of surgical interventions in improving patient outcomes and quality of life.
They performed an inclusive analysis of all cases treated from January 2021 to July 2023, concentrating on patients aged 18 years or older with DE involving the intestines. Patients without intestinal involvement and those with less than six months of post-surgery follow-up were excluded from the study.
Intestinal involvement was characterized by direct invasion of the intestinal wall or the necessity of adhesion lysis for complete resection. Primary outcomes included the necessity for adhesion lysis, rectal shaving, disc excision (no-colectomy group), and segmental resection (colectomy group). Surgical complications such as anastomotic leaks and fistulas were also monitored for up to 30 days post-surgery.
About 169 patients with DE were surgically treated, and 76 met the inclusion criteria. No colectomy treatment was selected for 50 (65.7%) patients, while 26 (34.2%) underwent rectosigmoidectomy (RTS). Diarrhea during menstruation was the most prevalent symptom in the RTS group (19.2% vs. 6%, p<0.001). Surgical outcomes indicated longer operative times and hospital stays for the segmental resection group, respectively 186.5 vs. 104 minutes (P<0.001) and 4 vs. 2 days (P<0.001).
Severe complications (Clavien-Dindo ≥3) had an overall prevalence of 6 (7.9%) cases, without any difference between the groups. There was no mortality reported. Larger lesions and specific symptoms like dyschezia and rectal bleeding were associated with a higher likelihood of RTS. Bayesian regression highlighted diarrhea close to menstruation as a strong predictor of segmental resection.
The study concluded that in patients with DE involving the intestines, symptoms such as dyschezia, rectal bleeding, and menstrual period-related diarrhea predict the likelihood of requiring RTS. However, severe complication rates did not differ significantly between the segmental resection group and the no-colectomy group.
No funding information was given.
Source: https://pubmed.ncbi.nlm.nih.gov/38958344/
Barchi LC, Callado GY, Machado RB, et al. (2024). “INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER.” Arq Bras Cir Dig. 2024 Jul 1;37:e1806. doi: 10.1590/0102-6720202400013e1806. PMID: 38958344; PMCID: PMC11216408.
