DIFFERENTIATED APPROACH TO SURGICAL TREATMENT FOR DEEP INFILTRATIVE BOWEL ENDOMETRIOSIS


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Abstract

Objective. To define criteria for choosing the volume of surgery for deep infiltrative bowel endometriosis in relation to the location and depth of bowel wall involvement and to clinical manifestations. Subject and methods. Ninety-nine clinical cases of surgical treatment in patients with the verified diagnosis of deep infiltrative bowel endometriosis in the period 2010 to 2013 were considered. Results. The indications for surgical treatment for deep infiltrative bowel endometriosis were chronic pain syndrome in 99 (100%) cases, cyclic intestinal bleeding in 17(17.2%) cases, and colonic evacuatory dysfunction in 82 (82.3%) patients. The surgical volume depended on the location, extent, and depth of invasion of endometriosis into the bowel wall and the women’s readiness for undergoing the required surgical volume. Out of the total number of operations, laparoscopic surgery was performed in 81 (81.9%) cases; laparotomic conversion was required in 18 (18.1%) cases. The endometrioid infiltrate was excised within the visible intact tissues, without opening the bowel lumen in 48 (48.5%) cases, when the muscular and submucosal layers were involved by endometriosis in a limited area of up to 3 cm. The bowel was resected in 51 (51.5%) patients. Among them, 7 (7.1%) patients underwent discal resection involving three fourths of the lumen; circular colon resection (anterior resection of the rectum) was carried out in 43 (43.2%) cases. Simultaneous resection of the large and small bowels with their synchronous involvement was performed in 7 (7.1%) patients. A protective colostomy was needed to create a low anastomosis (less than 5 cm from the anus) in 4 (4.4%) cases. In the immediate postoperative period, 2 (2.0%) patients were found to have an incompetent enteric anastomosis, which required re-surgery. Conclusion. Surgical treatment for deep infiltrative bowel endometriosis is indicated for chronic pain syndrome unrelieved by medical therapy, for intestinal evacuatory dysfunction and intestinal bleeding. The correspondence of the volume of an undertaken operation to the found pathological changes will be able to avoid the situation that the risk of surgical treatment overweighs the expected result. The surgical approach to treating bowel endometriosis must not depend only on a surgeon’s readiness to perform one or another surgical volume.

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About the authors

M. V MELNIKOV

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: m_melnikov@oparina4.ru
Moscow

V. D CHUPRYNIN

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: v_chuprynin@oparina4.ru
Moscow

S. I ASKOLSKAYA

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: s_askolskaya@oparina4.ru
Moscow

M. S ABRAAMYAN

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: m_melnikov@oparina4.ru
Moscow

References

  1. Адамян Л.В., Сонова М.М., Логинова О.Н., Яроцкая Е.Л., Арсланян К.Н. Оптимизация лечения наружного генитального эндометриоза с использованием антиоксидантных средств. В кн.: Тезисы докладов VI Международного конгресса по репродуктивной медицине. М.; 2012: 147.
  2. Айламазян Э.К., Цвелев Ю.В., Беженарь В.Ф. Российская гинекологическая школа в разработке проблемы эндометриоза. Журнал акушерства и женских болезней. 2002; 51(3): 10—5.
  3. Краснопольский В. И., Буянова С.Н., Щукин Н.А., Попов А.А. Оперативная гинекология. М.: МЕДпресс-информ; 2010: 127—41.
  4. Chapron C. Глубокий инфильтрирующий эндометриоз: диагностика и терапевтические стратегии. Репродуктивная эндокринология. 2011; 1: 70—6.
  5. Баскаков В.П., Цвелев Ю.В., Кира Е.Ф. Эндометриоидная болезнь. СПб.: Издательство Н-JI; 2002. 452 с.
  6. Benbara A., Fortin A., Martin B., Palazzo L., Le Tohic A., Madelenat P. et al. Surgical and functional results of rectosig-moidal resection for severe endometriosis. Gynecol. Obstet. Fertil. 2008; 36: 1191— 201.
  7. Darai E., Thomassin I., Barranger E., Detchev R., Cortez A., Houry S., Bazot M. Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am. J. Obstet. Gynecol. 2005; 192(2): 394—400.
  8. Meuleman C., Tomassetti C., D’Hooghe T.M. Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr. Opin Obstet. Gynecol. 2012; 24(4): 245-52. doi: 10.1097/ GCO.0b013e3283556285.
  9. Yeung P.P., Shwayder J., Pasic R.P. Laparoscopic management of endometriosis: comprehensive review of best evidence. J. Minim. Invasive Gynecol. 2009; 16(3): 269—81.
  10. De Cicco C., Corona R., Schonman R., Mailova K., Ussia A., Koninckx P. Bowel resection for deep endometriosis: a systematic review. Br. J. Obstet. Gynaecol. 2011; 118(3): 285-91. doi: 10.1111/j.1471-0528.2010.02744.x.
  11. Ferrero S., Anserini P., Abbamonte L.H., Ragni N., Camerini G., Remorgida V. Fertility after bowel resection for endometriosis. Fertil. Steril. 2009; 92: 41—6.
  12. Pandis G.K., Saridogan E., Windsor A.C., Gulumser C., Cohen C.R., Cutner A.S. Short-term outcome of fertility-sparing laparoscopic excision of deeply infiltrating pelvic endometriosis performed in a tertiary referral center. Fertil. Steril. 2010; 93: 39—45.
  13. Chapron C., Chopin N., Borghese B., Foulot H., Dousset B., Vacher-Lavenu M.C. et al. Deeply infiltrating endometriosis: pathogenic implications of the anatomical distribution. Hum. Reprod. 2006; 21(7): 1839—45. doi: 10.1093/humrep/del079.
  14. Darai E., Ackerman G., Bazot M., Rouzier R., Dubernard G. Laparoscopic segmental colorectal resection for endometriosis: limits and complications. Surg. Endosc. 2007; 21: 1572—7.
  15. Yoon J.H., Choi D., Jang K.T., Kim C.K., Kim H., Lee S.J. et al. Deep rectosigmoid endometriosis: “mushroom cap” sign on T2-weighted MR imaging. Abdom. Imaging. 2010; 35(6): 726—31. doi: 10.1007/s00261-010-9643-3.
  16. Matsuzaki S., Houlle C., Botchorishvili R., Pouly J.L., Mage G., Canis M. Excision of the posterior vaginal fornix is necessary to ensure complete resection of rectovaginal endometriotic nodules of more than 2 cm in size.Fertil. Steril. 2009; 91: 1314—5.
  17. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004; 240(2): 205—13.

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