Surgical Management by Disk Excision or Rectal Resection of Low Rectal Endometriosis and Risk of Low Anterior Resection Syndrome: A Retrospective Comparative Study

Abstract

Study Objective: To assess the risk of low anterior resection syndrome (LARS) between women managed by either disk excision or rectal resection for low rectal endometriosis. Design: Retrospective study of a prospective database. Setting: University hospital. Patients: One hundred seventy-two patients managed by disk excision or rectal resection for deep endometriosis infiltrating the rectum <7 cm from the anal verge. Interventions: Rectal disk excision and/or segmental resection using transanal staplers. Measurements and Main Results: One hundred eight patients (62.8%) were treated by disk excision (group D) and 64 (37.2%) by rectal resection (group R). All patients answered the LARS score questionnaire. Follow-up was 33.3 § 22 months for group D (range 12−108 months) and 37.3 § 22.1 months (range 12−96 months) for group R (p = .25). The rates of rectovaginal fistula and pelvis abscess requiring radiologic drainage and surgery in the D and R groups were, respectively, 7.4% and 8.3% vs 7.8% and 9.3%. The rate of women with normal bowel movements postoperatively was higher in group D (61.1% vs 42.8%, p = .05). Women enrolled in group R reported higher frequency of stools (p <.001), clustering of stools (p = .02), and fecal urgency (p = .05). Regression logistic model revealed 2 independent risk factors for minor/major LARS: performing low rectal resection (adjusted odds ratio 2.28; 95% confidence interval, 1.1−4.7) and presenting with bladder atony requiring self-catheterization beyond postoperative day 7 (adjusted odds ratio 2.52; 95% confidence interval, 1.1−5.8). Conclusion:The probability of normal bowel movements is higher after disk excision than after low rectal resection in women with deep endometriosis infiltrating the low rectum.

The Risk Factors of Low Anterior Resection Syndrome After Colorectal Cancer Surgery Compared with the Last Decade Studies

“…Some patients show characteristics of both types. They alternate between the two patterns or experience both at the same time [32][33][34][35]. these symptoms are caused because of damage to several factors, such as nerves and muscles of defecation [22,28,36].…”

Conservative surgery versus colorectal resection for endometrial deposits: a systematic review and meta-analysis of surgical and long-term outcomes

“…Mean BMI was 23.3 in the C group and 23.4 in the SR group. The operative team was formed by both a gynecological and a colorectal surgeon in ten studies [18][19][20][21][22][23][24][25][26]28 , while in seven 16,17,27,29−32 the main operator was a gynecological surgeon.…”

“…Six studies 16, [19][20][21]23,26 including 1433 patients provided data on preoperative Enzian C grading of rectal endometriosis. There was no signi cant difference for C1 grading (OR: 2.99, 95% CI: [0.33, 27.35], p = 0.33, Chi 2 = 50.37, I 2 = 92%) (Fig.…”

“…Ten studies [16][17][18][19][21][22][23]27,31,32 including 1825 patients provided data on the rate of postoperative pelvic abscesses in the two main groups. Overall, there was no signi cant difference between conservative surgery and segmental resection with low inter-study heterogeneity (OR: 0.73, 95% CI: [0.47, 1.16], p = 0.18, Chi 2 = 9.86, I 2 = 9%) (Fig.…”

“…Ten studies 16,18,19,21,23,26,28,29,31,32 including 2083 patients provided data on the incidence of postoperative rectal stenosis between the two main groups. Overall, conservative surgery showed a smaller rate of rectal stenosis development compared to segmental resection with low heterogeneity (OR: 0.26, 95% CI: [0.09, 0.72], p = 0.009, Chi 2 = 11.35, I 2 = 21%) (Fig.…”