Complications of colorectal resection for endometriosis

Based on a review of the current literature, we will discuss early and late (more than three months postoperative) complications associated with surgery for colorectal endometriosis resection. The most common surgical complications are: rectovaginal fistulae, anastomotic leakages and abscesses. Postoperative bleeding occurs rarely but has also been reported; and usually requires blood transfusion without surgical interventions. The selection of patients for surgery requires a multidisciplinary approach and complete preoperative imaging work-up by an experienced physician. The surgical procedure is challenging, including resection of all extrarectal DIE lesions, often in a context of patients who already underwent operations. Considering the major complications that may occur, there are three frequently observed risk factors. First is the opening of the vagina at the time of the bowel surgical procedure. However, this is a matter of debate, and experts commonly open the vagina during the procedure, as appropriate, without increasing the rate of complications. Second is excessive use of electrocoagulation, which increases the risk of rectovaginal fistulae and abscesses, due to the risk of necrosis of the posterior vaginal cuff. Third is surgical treatment of low rectal lesions (5-8 cm from the anal verge), which increases the risk of anastomotic leaks. In addition, we refuse to consider functional postoperative complications that affect gastrointestinal and sexual function, as minor complications. These can have a severe impact on the quality of life of young women. Further research is needed to prevent and treat such complications.