Complications in the surgical treatment of patients with colorectal endometriosis

Objective: To determine the prevalence and types of complications after surgical treatment of patients with colorectal endometriosis using the data of the Department of Surgery, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia. Materials and methods: The results of the examination of 692 reproductive-aged women with colorectal endometriosis were analyzed. All patients attended the Department of General Surgery of the above-mentioned Centre for planned surgical treatment in the period from 2010 to 2020. The patients included in the study were operated on by experienced surgeons when there were standard indications for the operation. Various surgical approaches were performed according to clinical recommendations. Depending on the presence or absence of complications in the postoperative period, the patients were divided into two groups: the study group included the patients with complications (n=78) and the control group included the patients without complications (n=614). Results: The median age was 33.1 years (Q1-Q3: 27.0-47.0 years). Anastomosis failure after low and ultra-low resections of the rectum developed in 29/692 (4.1%) cases and manifested as pelvic abscess, diffuse peritonitis, or symptoms of endogenous intoxication. The complication always required repeated surgical intervention, suturing of the site of anastomosis failure or dissociation of anastomosis and the formation of a protective colostomy, drainage of the abdominal cavity, intensive therapy, and combined antibacterial treatment. Enteroanastomosis bleeding developed in 17/692 (2.4%) patients and was intensive with a total volume of 500 to 1500 ml. In all cases, endoscopic method with the use of argon plasma coagulation and clipping of the artery (vein) was used to stop the bleeding. Anastomosis stricture was diagnosed in 32/692 (4.6%) women. The endoscopic method for treating cicatricial strictures of colonic anastomoses is preferable. Conclusion: The treatment of complications which occur after surgery for colorectal endometriosis proves to be challenging and requires the involvement of experts from surgical centers and a multidisciplinary approach.

colorectal surgery, endometriosis, complications, anastomosis failure, colon stenosis, bleeding