DEEPLY INFILTRATING ENDOMETRIOSIS REQUIRING COLORECTAL
RESECTION: NO CHALLENGE ANYMORE?
Jinyu Gu MD, Tommaso Falcone MD, Feza H. Remzi MD, Hermann P. Kessler MD
Purpose : Low postoperative complication rates after surgical treatment for colorectal
endometriosis using a variety of surgical procedures have been reported. However,
data on postoperative complications of bowel resection for deeply invading
endometriosis (DIE) are still limited. The aim of this study is to observe the outcome
after such bowel surgeries.
Methods : All patients with colorectal resection for DIE were identified from the
pathology report database. Patients who only underwent superficial nodule or disc
excision were excluded. Demographics, history of previous treatment, operation
details and postoperative outcomes were collected by retrospective chart review.
Results : From July 1992 until July 2013, forty patients (age: 38.8 ± 8.9 years)
underwent colonic or rectal resection for DIE. Chronic pelvic pain (95%), dyschezia
(45%) and chronic infertility (35%) were the most common preoperative findings.
Twenty-eight patients (70%) had undergone 45 previous operations for endometriosis
including 6 hysterectomies and salpingo-oophorectomies. Twenty seven patients
(67%) underwent laparoscopic bowel resections, six of them (22%) were converted to
open due to heavy adhesion and extensive disease involvement. As shown in the table,
17 patients (43%) underwent low anterior resections five (29%) of them with
diverting ileostomy. In all patients, lysis of adhesions was performed, 30 patients
(75%) also underwent excision of pelvic endometriosis independently on bowel
resection. Concomitant hysterectomies and/or salpingo-oophorectomies and
urological procedures were performed in nine and six patients, respectively. The
intraoperative complication rate was 5%. Mean postoperative stay was 5.1 days,
which was significantly shorter after laparoscopic surgery (4.2 ± 2.5 vs. 7.0 ± 2.7 days,
P=0.003). The overall postoperative complication rate was 20%. Three patients (8%)
were readmitted and one of them required reoperation for right ureter injury.
Conclusions : In patients with extensive spread of pelvic endometriosis and lesions
deeply invading colon and rectum, segmental bowel resection is indicated, often
leading to individualized and complex procedures. Laparoscopic approach is
associated with a recovery benefit.
Table Outcomes of colorectal resection in 40 patients with deeply infiltrating endometriosis
Surgical procedures
(Recto)Sigmoidectomy *
21 (53%)
Low anterior resection
17 (43%)
Ileocolic resection
2 (5%)
Intra-operative complications
Left ureter injury
1 (3%)
Anastomotic leak on air test
1 (3%)
Postoperative length of stay (days)
5.1 ± 2.9
Readmission
3 (8%)
Reoperation
1 (3%)
Postoperative transfusion
6 (15%)
Postoperative complications
8 (20%)
Bleeding
1 (3%)
Wound infection
1 (3%)
Ileus
2 (5%)
Small bowel obstruction
1 (3%)
Urinary tract infection
3 (8%)
* including 1 combined ileocolic resection and 3 combined appendectomies
# Concomitant hysterectomy and/or salpingo-oophorectomy