Management of Deeply Infiltrating Endometriosis Involving the Rectum

BACKGROUND: Rectal endometriosis can cause debilitating symptoms. Rectal resection in this setting has been shown to improve symptoms; however, there remain some reservations about this intervention because of the risk of complications such as anastomotic leak and rectovaginal fistula. OBJECTIVE: The aim of this study is to review our experience with rectal resection in patients with rectal endometriosis. DATA SOURCES: Hospital records and prospectively maintained electronic databases of an endogynecologist and colorectal surgeon were reviewed. STUDY SELECTION: This is a retrospective study of consecutive patients who underwent rectal resection for endometriosis from 2001 to 2010. INTERVENTIONS: All patients underwent either disc or segmental resection of the rectum. MAIN OUTCOME MEASURES: Outcomes of interest were operative complications and recurrence requiring surgical reintervention. RESULTS: Ninety-one patients underwent 92 resections for endometriosis. Sixty-five (71%) were disc resections, 25 (27%) were segmental resections, and 1 patient underwent both disc and segmental resections. Eighty-one (88%) procedures were completed laparoscopically. Patients requiring segmental resection had more extensive disease, and this was associated with open conversion (p <= 0.0001). Average duration of procedure was 209 minutes. Three patients (3%) required defunctioning ileostomies. Intramural endometriosis was confirmed in 96.7% of specimens. Complications occurred in 13 patients (15%); 4 were minor. Three patients had small pelvic collections treated with antibiotics, 5 patients required transfusion for bleeding (3 intraoperative, 2 anastomotic bleeds that settled conservatively), and 1 patient sustained ureteric injury that was reimplanted with no sequelae. None had anastomotic leak or rectovaginal fistula. Ten patients (11%) required reintervention for recurrent symptoms. Of these, 8 (8.8%) patients were found to have recurrent endometriosis. No correlation could be found between involved margins on pathology and need for redo surgery. LIMITATIONS: This study is limited by its retrospective nature. CONCLUSIONS: Laparoscopic rectal resection for deeply infiltrative endometriosis is feasible and safe, and it provides durable symptom control with acceptable recurrence rates.