Double circular stapler technique for bowel resection in rectosigmoid endometriosis

Area of Science:

• Gynecologic Surgery
• Colorectal Surgery
• Minimally Invasive Surgery

Background:

• Bowel endometriosis poses surgical challenges, often requiring extensive resection.
• Traditional techniques like rectosigmoidectomy and discoid resection carry risks of complications such as anastomotic leakage and urinary retention.
• Minimizing residual disease and preserving organ function are critical surgical goals.

Purpose of the Study:

• To evaluate the efficacy and safety of the double circular stapling (DCS) technique for treating bowel endometriosis.
• To compare DCS with traditional rectosigmoidectomy in terms of operative time and postoperative complications.
• To assess the potential of DCS to avert the need for formal rectosigmoidectomy.

Main Methods:

• Retrospective analysis of 120 patients with bowel endometriosis.
• Comparison of surgical outcomes between intestinal shaving, discoid resection with single circular stapling, rectosigmoidectomy, and DCS technique.
• Focus on operative time, urinary retention rates, and margin status in the DCS group.

Main Results:

• The DCS technique was used in 11 patients for rectosigmoid lesions (2.2-4.2 cm).
• Median operative time for DCS was significantly shorter (100 minutes) than rectosigmoidectomy (150 minutes, p = .04).
• Urinary retention occurred in 9% of DCS patients versus 25% of rectosigmoidectomy patients (not significant). One patient had a positive margin.

Conclusions:

• The double circular stapling (DCS) technique is a viable and promising approach for selected cases of bowel endometriosis.
• DCS may reduce operative time and potentially lower the incidence of urinary retention compared to rectosigmoidectomy.
• Further investigation is warranted to establish DCS as a standard alternative to rectosigmoidectomy.