Managing the aftermath: complications and outcome after colorectal resection for deep infiltrating endometriosis—insights from a certified surgical endoscopy center
Abstract
Abstract Deep infiltrating endometriosis (DIE) often affects the bowel and may necessitate colorectal resection. While protective ileostomy can reduce complications, it carries relevant morbidity. This study evaluates endoscopic complication management and long-term outcome of patients treated at a certified surgical endoscopy and endometriosis center. All patients undergoing interdisciplinary surgery for DIE (2015–2024) were retrospectively included. Preoperative sigmoidoscopy and postoperative endoscopic evaluation of anastomoses were performed routinely. Surgical approaches included shaving, excision or resection with/without ileostomy. Surgical complications, such as anastomotic leakages and stenoses, were primarily managed endoscopically. 118 women (median age: 33 years) underwent surgery: rectal shaving (25%), sigmoid (6%) and rectal resection (69%). Median anastomotic height was 10 cm, 44% received a protective ileostomy. Anastomotic leakage (8%) and stenosis (9%) were successfully managed endoscopically. Recurrence requiring reoperation occurred in 41% after shaving vs. 27% after resection. Ileostomy reversal was achieved in all cases. Postoperative continence was acceptable (LARS median: 13). General health (EQ-5D-5 L: median 70) was good at a median follow-up of 75 months. 84% would choose surgical treatment again. Colorectal resection for DIE can achieve favorable long-term outcomes in a structured interdisciplinary setting. Proactive endoscopic management supports bowel continuity despite complications. Prospective studies are needed to validate outcomes and refine patient selection.
Article Details
Authors (7)
Isabelle Flammang
Ann-Kathrin Eichelmann
Sebastian Schäfer
Jan Philipp Ramspott
Alexander Bungert
Andreas Pascher
From Bielefeld University, Medical School and University Medical Center Ostwestfalen-Lippe, Campus Hospital Lippe, Detmold, Germany (J.H.); the Department of Radiation Oncology, Medical University of Graz, Graz, Austria (T.B.); the Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany (C.S.); the Institute of Surgical Pathology, University Medical Center Freiburg, Germany (P.B.); the Department of Surgery, University Medical Center Schleswig-Holstein–Campus Lübeck, Lübeck, Germany (B.K., T.K.); Comprehensive Cancer Center Augsburg, Faculty of Medicine, University of Augsburg, Augsburg, Germany (R.C.); the Department of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany (S.U.); the Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg–Eppendorf, Hamburg, Germany (J.R.I.); the Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute and San Raffaele Vita-Salute Universi...
Jennifer Merten