Morbidity of diverting stoma during colorectal surgery for deep infiltrating endometriosis - an observational study

To evaluate stoma-related complications after rectal resection and colorectal anastomosis with diverting stoma for deep infiltrating colorectal endometriosis.

All the consecutive adult women who underwent colorectal resection with low anastomosis and diverting stoma for deep infiltrating endometriosis in one center between 2013 and 2020 were retrospectively included. Stoma-related complications were retrieved during the stoma period and after stoma reversal.

33 patients (mean age = 32 years (±6, range=24-45 years) were included. After the first surgery, overall and surgical morbidities were observed in 42% and 30% of patients, including stoma-related complications in 3 patients (9%): high output (n = 2) and prolapse (n = 1). One patient presented with rectovaginal fistula, requiring several unplanned surgeries. No anastomotic leakage was observed. All the patients underwent stoma reversal, after mean delay of 3 months (±3, range=1-20 months). Overall morbidity after stoma closure occurred in 9 patients (27%), including 1 major morbidity (digestive bleeding). Long-term results were obtained after a mean follow-up of 21 months (±9, range=14-34 months). Four patients presented with hernia at the stoma site (12%). The cumulative rate of stoma-related complications was 45%.

There is no consensus about the impact of diverting stoma after rectal resection with colorectal anastomosis for deep infiltrating colorectal endometriosis. Stoma-related complications are frequently observed but there are major in only 12% of patients. High risk patients of rectovaginal fistula and/or anastomotic leakage need to be identified to better indicate the diverting stoma, waiting for randomized trials evaluating the real impact of diverting stoma.