Surgical Treatment of Intestinal Endometriosis: Outcomes of Three Different Techniques

Objective To outline the demographic and clinical characteristics of patients with deep intestinal endometriosis submitted to surgical treatment at a tertiary referral center with a multidisciplinary team, and correlate those characteristics with the surgical procedures performed and operative complications. Methods A prospective cohort from February 2012 to November 2016 of 32 women with deep intestinal endometriosis operations. The variables analyzed were: age; obesity; preoperative symptoms (dysmenorrhea, dyspareunia, acyclic pain, dyschezia, infertility, urinary symptoms, constipation and intestinal bleeding); previous surgery for endometriosis; Enzian classification; size of the intestinal lesion; and surgical complications. Results The mean age was 37.75 (5.72) years. A total of 7 patients (22%) had a prior history of endometriosis. The mean of the largest diameter of the intestinal lesions identified intraoperatively was of 28.12mm (14.29 mm). In the Enzian classification, there was a predominance of lesions of the rectum and sigmoid, comprising 30 cases (94%). There were no statistically significant associations between the predictor variables and the outcome complications, even after the multiple logistic regression analysis. Regarding the size of the lesion, there was also no significant correlation with the outcome complications ( p =0.18; 95% confidence interval [95%CI]:0.94-1.44); however, there was a positive association between grade 3 of the Enzia classification and the more extensive surgical techniques: segmental intestinal resection and rectosigmoidectomy, with a prevalence risk of 4.4 ( p <0.001; 95%CI:1.60-12.09). Conclusion The studied sample consisted of highly symptomatic women. A high prevalence of deep infiltrative endometriosis lesions was found located in the rectum and sigmoid region, and their size correlated directly with the extent of the surgical resection performed. Resumo Objetivo Delinear as caracteristicas das pacientes portadoras de endometriose profunda intestinal submetidas a tratamento cirurgico em centro de referencia com equipe multidisciplinar, e correlacionar tais achados com a extensAo de doenca e com os procedimentos cirurgicos realizados. Metodos Tratamento cirurgico no periodo de fevereiro de 2012 a novembro de 2016 em 32 mulheres portadoras de endometriose profunda intestinal. Variaveis analisadas: idade; obesidade; queixas pre-operatorias: dismenorreia, dispareunia, dor aciclica, disquezia, sangramento uterino anormal, infertilidade, sintomas urinarios, constipacAo, e sangramento intestinal; cirurgia previa para tratamento de endometriose profunda; classificacAo de Enzian; tecnica cirurgica aplicada; tamanho da lesAo intestinal; e complicacoes operatorias. Resultados A media de idade foi de 37,75 (+/- 5,72) anos. Um total de 7 (22%) pacientes tinha historico de abordagem previa da endometriose. A media do maior diametro das lesoes intestinais foi de 28,12mm (+/- 14,29 mm). Na classificacAo de Enzian, houve predominio das lesoes da regiAo de reto ou retossigmoide no compartimento posterior, num total de 30 casos (94%). NAo foi observada associacAo estatistica significativa entre as variaveis preditivas e o desfecho da complicacAo, mesmo apos analise de regressAo logistica multipla. Quanto ao tamanho da lesAo, tambem nAo houve correlacAo significativa com o desfecho complicacAo ( p =0,18; intervalo de confianca de 95% [IC95%]: 0,94-1,44). No entanto, Houve associacAo positiva entre o grau 3 da classificacAo de Enzian e a tecnica cirurgica mais extensa: resseccAo intestinal segmentar e retossigmoidectomia, com risco de prevalencia de 4,4 ( p =0,00003; IC95%: 1,60-12,09). ConclusAo A amostra populacional estudada foi constituida de mulheres muito sintomaticas. Foi encontrada prevalencia alta de lesoes de endometriose infiltrativa profunda localizadas em regiAo de retossigmoide, e seu tamanho correlacionou-se diretamente com a extensAo da resseccAo cirurgica realizada.