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Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep
Luigi Carlo Turco1,2, Lucia Tortorella3, Attilio Tuscano4
1Gynecology and Breast Care Unit, Mater Olbia Hospital, Olbia, Italy. luigicarlo.turco@gmail.com.
Purpose:
Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function.
Methods:
All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien-Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires.
Results:
Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months.
Conclusions:
Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.
Insights
Segmental resection for deep infiltrating endometriosis can cause complications, particularly persistent sexual dysfunction. Bowel and bladder issues are often reversible, but awareness of long-term sexual health impacts is crucial for patients and surgeons.
Area of Science:
- Gynecology
- Surgical Oncology
- Gastroenterology
Background:
- Segmental resection for deep infiltrating endometriosis (DIE) is associated with peri-operative risks.
- While major complications are recognized, minor complications and long-term functional disorders are less frequently reported.
- Understanding these outcomes is vital for patient counseling and surgical decision-making.
Purpose of the Study:
- To investigate surgery-related complications and functional disorders after segmental resection for DIE.
- To evaluate the persistence of these complications during long-term follow-up.
- To specifically assess impairments in bowel, bladder, and sexual function.
Main Methods:
- Retrospective analysis of clinical data from women undergoing segmental resection for intestinal endometriosis (October 2005 - November 2017).
- Perioperative morbidity assessed using the Extended Clavien-Dindo classification.
- Postoperative intestinal, voiding, and sexual morbidity evaluated via specific questionnaires.
Main Results:
- Fifty women were included; 44% experienced overall complications (38% early, 6% late).
- Long-term functional complications included intestinal (30%), urinary (50%), and sexual (64%).
- Median follow-up was 55.5 months, revealing persistent sexual dysfunction.
Conclusions:
- Segmental resection is a feasible approach for bowel DIE, improving quality of life.
- Bowel and bladder complications are generally acceptable and often reversible.
- Postoperative sexual dysfunctions frequently persist, necessitating patient and surgeon awareness.
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