Surgical, Clinical, and Functional Outcomes in Patients with Rectosigmoid Endometriosis in the Gray Zone: 13-Year Long-Term Follow-up

Mabrouk, Mohamed; Raimondo, Diego; Altieri, Michele; Arena, Alessandro; Forno, Simona Del; Moro, Elisa; Mattioli, Giulia; Iodice, Raffaella; Seracchioli, Renato

doi:10.1016/j.jmig.2018.08.031

Cited by 45 publications

(53 citation statements)

References 28 publications

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“…Among the 41 articles included in the review (Table 1) [11,20−59], 37 were excluded from the meta-analysis according to the inclusion criteria: eleven were excluded because of a follow-up period <12 months and 26 on the basis of the definition of recurrence (either nonspecified or without follow-up surgery with histologic proof of recurrence). In total, 41 studies were retained for the systemic review [11,20−59], 4 of which were included (Table 2) [21,25,30,47] in the meta-analysis ( Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…When considering all included studies (n = 41) [11,20−59], no significant difference in overall recurrence was found among the 3 surgical groups, with ORs of 1.47 (95% CI, 0.89−2.43; I 2 = 72%; p = .7) ( Fig. 2A) [21,22,24,25,27,30,47,53], 1.08 (95% CI, 0.59−1.98; I 2 = 0%; p = .95) ( Fig. 2B) [21,25,35,40,47,53,59], and 1.21 (95% CI, 0.62−2.35; I 2 =57%; p = .58) ( Fig.…”

Section: Overall Recurrencementioning

confidence: 99%

“…2A) [21,22,24,25,27,30,47,53], 1.08 (95% CI, 0.59−1.98; I 2 = 0%; p = .95) ( Fig. 2B) [21,25,35,40,47,53,59], and 1.21 (95% CI, 0.62−2.35; I 2 =57%; p = .58) ( Fig. 2C) [21,25,47,53,59] when comparing recurrence between shaving and segmental resection, disc excision and segmental resection, and shaving and disc excision, respectively (funnel plots revealed a low risk-of-publication bias [Supplemental Fig.…”

Section: Overall Recurrencementioning

confidence: 99%

“…When considering histologically proven recurrence in 4 articles [21,25,30,47], a significantly lower recurrence rate was observed in patients with segmental resection than in those with rectal shaving (OR, 5.53; 95% CI, 2.33−13.12; I 2 = 0%; p = .001) ( Fig. 3A) [21,25,30,47]. This decrease was not significant when comparing segmental resection with disc excision (OR, 2.63; 95% CI, 0.8−8.65; I 2 = 0%; p = .11) ( Fig.…”

Section: Histologically Proven Recurrencementioning

confidence: 99%

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Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Bendifallah¹,

Vesale

Daraı̈³

et al. 2020

Journal of Minimally Invasive Gynecology

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The recurrence rate after colorectal surgery for endometriosis is up to 50% at 5 years. The aim of the current review and meta-analysis was to assess recurrence associated with shaving, disc excision, and segmental resection for endometriosis with colorectal involvement. Data Sources: A systematic review was performed by searching the PubMed, ClinicalTrials.gov, EMBASE, Cochrane Library, and Web of Science databases for publications before February 28, 2019, using the terms "colorectal endometriosis" and "recurrence" in English. The outcome measure was histologically proven recurrence 1 year after the index surgery. Methods of Study Selection: Studies rated as good or fair by a study quality assessment tool were included. Two reviewers independently assessed the quality of the studies; discrepancies were discussed, and if a consensus was not reached, a third reviewer was consulted. Tabulation, Integration, and Results: Of 156 relevant published trials, 41 were systematically reviewed and 4 were included in the meta-analysis. The risk of recurrence was higher after rectal shaving than after both segmental resection (odds ratio [OR], 5.53; 95% confidence interval [CI], 2.33−13.12; I 2 = 0%; p = .001) and disc excision for histologically proven recurrence (OR, 3.83; 95% CI, 1.33−11.05; I 2 = 0%; p = .01). This difference was not significant when comparing disc excision with segmental resection (OR, 2.63; 95% CI, 0.8−8.65; I 2 = 0%; p = .11). Conclusion: The current analysis shows that the risk of recurrence is lower when segmental resection or disc excision is performed than when rectal shaving is performed. This finding is important when deciding the most appropriate surgical management.

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Section: Study Selectionmentioning

confidence: 99%

Section: Overall Recurrencementioning

confidence: 99%

Section: Overall Recurrencementioning

confidence: 99%

Section: Histologically Proven Recurrencementioning

confidence: 99%

See 2 more Smart Citations

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Bendifallah¹,

Vesale

Daraı̈³

et al. 2020

Journal of Minimally Invasive Gynecology

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show abstract

“…In general, radiological techniques can be used to establish the presence and extent of rectosigmoid endometriosis, particularly when there is suspicion of disease despite negative ultrasonographic findings and/or of the presence of multifocal disease with sigmoid or upper intestinal nodules. Moreover, in order to plan surgery, nowadays the role of radiologic imaging still remains relevant and many patients with clinical suspicion of rectosigmoid endometriosis are routinely referred to radiologists for the diagnosis of intestinal endometriosis [20,21].…”

Section: Introductionmentioning

confidence: 99%

A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

et al. 2020

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(1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2–59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.

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Preoperative ureteral stenting in women with deep posterior endometriosis and ureteral involvement: Is it useful?

Borghese

Raimondo

Esposti

et al. 2021

Intl J Gynecology & Obste

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Objective Systematic placement of a ureteral stent before surgery for posterior deep infiltrating endometriosis (DIE) was previously recommended, but it could increase perioperative complications. We evaluate the role of preoperative ureteral stent in women requiring surgery for ureteral involvement (UI) with large posterior DIE nodules and/or grade I–II hydronephrosis. Methods Women undergoing minimally invasive surgery for DIE with UI having posterior nodules >3 cm and/or grade I–II hydronephrosis from 2014 to 2019 were retrospectively included. We progressively changed our strategy from a systematic pre‐operative stent insertion (S‐PS, up to 2016) to a non‐systematic one (NS‐PS, from 2016). Results Eighty‐eight women in the S‐PS group and 96 in the NS‐PS were included. Low urinary tract infections (UTI) were higher in the S‐PS group (13.6% vs 2.1%, P = 0.003). Hospital stay was longer in women with S‐PS (9.8 ± 5.3 days vs 6.7 ± 2.5 days, P < 0.001). Logistic regression analysis confirmed a significant association between NS‐PS and low UTI (adjusted OR 0.20, 95% CI 0.05–0.81, P = 0.024). Conclusion Systematic placement of a ureteral stent before surgery in women requiring surgery does not reduce overall perioperative complication rate, but it is associated with a longer duration of hospitalization and a higher low UTI rate.

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Surgical, Clinical, and Functional Outcomes in Patients with Rectosigmoid Endometriosis in the Gray Zone: 13-Year Long-Term Follow-up

Cited by 45 publications

References 28 publications

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

Recurrence after Surgery for Colorectal Endometriosis: A Systematic Review and Meta-analysis

A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

Preoperative ureteral stenting in women with deep posterior endometriosis and ureteral involvement: Is it useful?

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