Intestinal Resection and Redo Anastomosis Following Anastomotic Dehiscence Postsegmental Bowel Endometriosis Surgery:...

To present a case of surgical management of anastomotic dehiscence after laparoscopic bowel deep endometriosis resection.

Anastomosis leakage (AL) is defined as a defect of the integrity in a surgical junction between two hollow viscera with communication between the intraluminal and extraluminal compartments [1,2]. Currently, no consensus exists on the management of AL following bowel surgery for endometriosis. Treatment recommendations are often extrapolated from guidelines for colorectal cancer surgery [2-4]. Management strategies depend on various factors, including the patient's clinical condition, bowel viability, surgeon expertise, time since initial surgery, anastomosis height, patient risk factors, and the underlying indication for bowel surgery [4,5].

A 36-year-old woman with suspected AL postsegmental bowel endometriosis surgery.

A 36-year-old with a history of infertility and chronic pelvic pain underwent a laparoscopic segmental resection because of bowel deep endometriosis. On postoperative Day 5, she experienced pelvic pain in addition to small pelvic collections in a computed tomography scan. Given the suspicion of an anastomotic leakage, exploratory laparoscopy was performed. During the laparoscopy, AL was identified, occurring within 6 days postoperatively and located more than 8 cm from the anal verge. The patient remained hemodynamically stable without signs of sepsis. Consequently, resection and redo anastomosis were performed. Based on the surgical team's experience, a protective stoma was deemed unnecessary.

Early anastomotic leakage can be managed by resecting the anastomotic zone and performing a redo anastomosis. The decision to create a protective stoma should be individualized and tailored to each patient's clinical condition.