Bowel Endometriosis Excision: Approaches and Outcomes Including Hand Sewing of Discoid Excision

Area of Science:

• Gynecologic Surgery
• Gastroenterology
• Surgical Oncology

Background:

• Bowel endometriosis requires surgical intervention, with various techniques for rectal resection.
• Optimal surgical techniques and closure methods for bowel endometriosis are debated.
• Minimally invasive gynecologic surgery is increasingly utilized for complex endometriosis cases.

Purpose of the Study:

• To compare surgical outcomes for bowel endometriosis using shaving, discoid resection with hand-sewn closure, and segmental resection.
• To evaluate complication rates, specifically anastomotic leaks, associated with different surgical techniques for bowel endometriosis.
• To assess the safety and feasibility of hand-sewn closure for discoid excisions in bowel endometriosis surgery.

Main Methods:

• Retrospective cohort study conducted at a large academic hospital.
• Analysis of 112 patients with bowel wall endometriosis undergoing laparoscopic excision between 2009 and 2022.
• Categorization of surgical approaches into shaving (82 patients), discoid excision (23 patients), and segmental resection (7 patients).

Main Results:

• Laparoscopic excision of endometriosis involving the rectum was performed on 112 patients.
• Anastomotic leak complications occurred in 3.66% of the shave group and 4.35% of the discoid excision group; none in the segmental resection group.
• Lesion size varied, with segmental resections involving larger average sizes (38.5 mm) compared to shave (20.9 mm) and discoid (22.5 mm) groups.

Conclusions:

• The study observed similar anastomotic leak complication rates across different surgical closure types for bowel endometriosis.
• Hand-sewn closure for discoid excision is presented as a safe and viable alternative to stapler closures, particularly with experienced surgeons.
• Further research is recommended to validate the safety, explore cost-effectiveness, and assess the applicability of hand-sewn techniques in resource-limited settings.