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INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER.

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Deep penetrating endometriosis (DE) involving the intestines requires surgical treatment. Symptoms like rectal bleeding and diarrhea predict the need for colectomy, but severe complication rates are similar between colectomy and no-colectomy groups.

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Area of Science:

  • Gynecology
  • Colorectal Surgery
  • Surgical Oncology

Background:

  • Deep penetrating endometriosis (DE) frequently affects the bowel and bladder, necessitating effective treatment strategies.
  • Intestinal involvement in DE can cause significant patient morbidity and impact quality of life.

Purpose of the Study:

  • To evaluate clinical and surgical outcomes in patients with DE involving the intestines.
  • To analyze the effectiveness and complication rates of different surgical approaches for intestinal DE.

Main Methods:

  • Retrospective analysis of 76 patients (aged ≥18) with surgically treated intestinal DE from January 2021 to July 2023.
  • Comparison of outcomes between no-colectomy (adhesion lysis, shaving, disc excision) and colectomy (segmental resection/RTS) groups.
  • Primary outcomes included surgical procedures, operative time, hospital stay, and complications (e.g., anastomotic leak, fistulas) within 30 days.

Main Results:

  • 50 patients (65.7%) had no colectomy, while 26 (34.2%) underwent rectosigmoidectomy (RTS).
  • RTS group had higher rates of dyschezia, rectal bleeding, and menstrual diarrhea (19.2% vs. 6%, p<0.001).
  • Segmental resection group had longer operative times (186.5 vs. 104 min) and hospital stays (4 vs. 2 days). Severe complications (Clavien-Dindo ≥3) occurred in 7.9% without significant group difference; no mortality.

Conclusions:

  • Dyschezia, rectal bleeding, and menstrual diarrhea predict the need for rectosigmoidectomy (RTS) in intestinal DE.
  • Surgical management of intestinal DE, whether colectomy or not, shows comparable rates of severe complications.
  • RTS is associated with specific symptoms and larger lesions, while non-colectomy approaches are more common.