Intraoperative and post-operative complication of segmental bowel resections for endometriosis

Background: Gastrointestinal endometriosis is a challenging subtype of the disease. Segmental bowel resection has traditionally been seen as a highly morbid procedure and complication rates were quoted based on the data from colorectal cancer patient. In this study, we present our series and report our complication rates.Methods: All patients who underwent segmental bowel resection for endometriosis at our referral centre between 2013-2016 were included. Contemporaneous electronic database, patient casenotes and procedure videos were reviewed. All patients were contacted by phone to enquire about late onset complications.Result: 34 patients underwent segmental bowel resection for endometriosis. All procedures were performed by an experienced gynaecologist (SK) in collaboration with a colorectal or general surgeon for the latter parts of the procedure. The mean surgical time was 285.15 minutes (range 160-260). 3 cases (8.82%) were converted to open by the colorectal or general surgeons. There were no anastomosis leak, no peritonitis and no fistula formation in our patient group. Only one patient (2.9%) required a prophylactic ileostomy as the vagina had been opened and the anastomosis line was very low. The same patient required further surgery to extend the rectus sheath incision which was causing ileostomy obstruction. There was one (2.9%) unintended intraoperative enterotomy, which was immediately recognized and repaired laparoscopically with no sequelae. 9% of patients developed high grade and 18.1% low grade pyrexia soon after the procedure. They all responded to antibiotic therapy quickly. One patient required blood transfusion and one developed wound dehiscence.Conclusion: Segmental bowel resection in patients with endometriosis have a significantly better complication rate, compared to the commonly quoted rates for cancer patients undergoing the same procedure

Keywords:

Deep infiltrating endometriosis , Pelvic pain , Recurrence , Uretrolysis , Endometriosis , Segmental bowel resection