Choosing the right technique for deep endometriosis. (August 2019)

• Record Type: Journal Article
• Authors: Nisolle, Michelle; Brichant, Géraldine; Tebache, Linda
• Is Part Of: Best practice & research. Volume 59(2019)
• Page Start: 56
• Page End: 65
• Publication Date: 2019-08
• Subjects: Deep endometriosis -- Rectal shaving -- Disc excision -- Segmental rectal resection; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2019.01.010
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: The surgical management of bowel endometriosis is a real challenge. In addition to the fact that only symptomatic patients should undergo surgery, no consensus has been approved in the literature. Among the surgical techniques, the surgeon has to choose between rectal shaving, disc excision, or segmental colorectal resection. All those procedures are associated with complications, but the risk of rectovaginal fistula is higher if a disc excision or segmental colorectal resection is performed. It is therefore of utmost importance to evaluate preoperatively the bowel infiltration by several imaging techniques to estimate the feasibility of a deep rectal shaving with possible incomplete removal of the endometriotic lesions or to discuss with the patient about the indication of a segmental bowel resection. Because of the risk of major preoperative and postoperative complications, proper patient counseling is mandatory. Highlights: Deep colorectal endometriosis is challenging as the rate of complications is high in conservative and radical surgery. Surgical type, multidisciplinary approach and patient's counseling will be defined by preoperative mapping. Complications associated with conservative or radical surgery must be minimized thanks to surgical rules.