Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement

Parra, Rogério Serafim; Valério, Fernando Passador; Zanardi, José Vitor Cabral; Feitosa, Marley Ribeiro; Camargo, Hugo Parra; Féres, Omar

doi:10.1055/s-0042-1756212

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 44 (11) • 2022 • https://doi.org/10.1055/s-0042-1756212 copy

Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement

Complicações pós-operatórias e taxas de estomia após ressecção laparoscópica de endometriose infiltrativa profunda com envolvimento intestinal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The purpose was to assess the rates of postoperative complications and the need of temporary stoma of laparoscopic surgical treatment for bowel endometriosis in a referral center.

Methods

The surgical indication, type of operation, operative time, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, postoperative complications were evaluated.

Results

One-hundred and fifty patients were included. The average duration of surgery was significantly longer for segmental resection (151 minutes) than for disc excision (111.5 minutes, p < 0.001) and shaving (96.8 minutes, p < 0.001). Patients with segmental resection had longer postoperative lengths of hospital stay (1.87 days) compared with patients with disc excision (1.43 days, p < 0.001) and shaving (1.03 days, p < 0.001). A temporary stoma was performed in 2.7% of patients. Grade II and III postoperative complications occurred in 6.7% and 4.7% patients, respectively.

Conclusion

Laparoscopic intestinal resection has an acceptable postoperative complication rate and a low need for a temporary stoma.

Keywords
colorectal surgery; endometriosis; laparoscopy; postoperative complications; surgical stomas

Patients' characteristics		Observed
Age (mean ± SD) (min–max) (years)		35.1 ± 5.3 (20–53)
BMI (mean ± SD) (kg/m²)		25.1 ± 3.8
Previous surgeries for endometriosis n (%)		92(61.3)
	Previous pregnancies n (%)	111 (74)
	Nulliparous Previous birth	39 (26)

Surgical indication		N (%)
	Chronic pelvic pain	99 (66)
	Infertility	84 (56)
	Dyspareunia	69 (46)
	Dysmenorrhea	52 (34.7)
Bowel involved		N (%)
	Rectosigmoid	148 (98.7)
	Appendix	16 (10.7)
	Small bowel	5 (3.3)
	Cecum	4 (2.7)

Type of operations	N (%)
Shaving	35 (24.0)
Shaving (only)	21 (14.0)
Shaving + Hysterectomy	5 (3.3)
Shaving + rectal disc excision	3 (2.0)
Shaving + appendectomy	3 (2.0)
Shaving + ureter nodule excision	2(1.3)
Shaving + segmental	1 (0.67)
resection + appendectomy	45 (30)
Rectal disc excision	29 (19.3)
Rectal disc excision (only)	6 (4.0)
Rectal disc excision + hysterectomy	4(2.7)
Rectal disc excision + appendectomy	3 (2.0)
Rectal disc excision + shaving	1 (0.67)
Rectal disc excision + segmental resection	1 (0.67)
Rectal disc excision + ureter nodule excision	1 (0.67)
Rectal disc excision + ileal	73 (48.7)
resection + appendectomy	49 (32.7)
Segmental resection (rectosigmoid)	8(5.3)
Segmental resection (only)	4(2.7)
Segmental resection + Hysterectomy	3 (2.0)
Segmental resection + ureter/bladder	2(1.3)
nodule excision	2(1.3)
Segmental resection + appendectomy	2(1.3)
Segmental resection + ileal	1 (0.67)
resection + appendectomy	1 (0.67)
Segmental resection + ileal resection	1 (0.67)
Segmental resection + ileocecal resection	2(1.3)
Segmental resection + appendectomy + ureter
nodule excision
Segmental resection + shaving + appendectomy
Segmental resection + rectal disc excision
Ileal resection (without rectal involvement)

Complication	N (%)
Urinary complications	4 (2.7)
Shaving	0(0)
Disc excision	0(0)
Segmental resection	4 (2.7)
Infected hematoma of the Douglas cul-de-sac	1 (0.67)
Shaving	0(0)
Disc excision	0(0)
Segmental resection	1 (0.67)
Thermal bowel injury	2(1.3)
Shaving	1 (0.67)
Disc excision	1 (0.67)
Segmental resection	0(0)

Outcome	N (%)
Conversion rate to open surgery	3 (2.0)
Shaving	0(0)
Disc excision	1 (0.67)
Segmental resection	2(1.3)
Need of temporary stoma	4(2.7)
Shaving	1 (0.67)
Disc excision	2(1.3)
Segmental resection	1 (0.67)
30-day emergency room visit	5 (3.3)
Shaving	1 (0.67)
Disc excision	0(0)
Segmental resection	4(2.7)
30-day reoperation rate	3 (2.0)
Shaving	1 (0.67)
Disc excision	1 (0.67)
Segmental resection	1 (0.67)
Surgical recurrence	5 (3.3)
Shaving	2(1.3)
Disc excision	2(1.3)
Segmental resection	1 (0.67)
Blood transfusion	1 (0.67)
Shaving	0(0)
Disc excision	1 (0.67)
Segmental resection	0(0)
Bladder atony	1 (0.67)
Shaving	0(0)
Disc excision	1 (0.67)
Segmental resection	0(0)
Dehiscence of intestinal anastomosis	0(0)
Overall mortality	0(0)

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[1] Address for correspondence Rogério Serafim Parra, MD, PhD, Av. Bandeirantes, 3900, 14048-900, Ribeirão Preto, SP, Brazil (e-mail: rsparra@hcrp.usp.br).