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Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study

Abstract : Study objective: To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR). Design: Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database. Setting: University tertiary referral center. Patients: Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study. Interventions: Laparoscopic SR or DE. Measurements and main results: One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR. Conclusion: Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma.
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https://hal-normandie-univ.archives-ouvertes.fr/hal-02870135
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Submitted on : Tuesday, June 16, 2020 - 3:02:14 PM
Last modification on : Wednesday, May 25, 2022 - 3:06:02 PM

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Sophia Braund, Clotilde Hennetier, Clemence Klapczynski, Antoine Scattarelli, Julien Coget, et al.. Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study. Journal of Minimally Invasive Gynecology, Elsevier, 2020, ⟨10.1016/j.jmig.2020.04.034⟩. ⟨hal-02870135⟩

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