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Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb)

  • General Gynecology
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Abstract

Purpose

Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function.

Methods

All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien–Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires.

Results

Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months.

Conclusions

Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.

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Acknowledgements

The authors thank Dr. Richard Renston M.D. for his important contribution in revising the form and the English language of this article.

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Authors and Affiliations

  1. Gynecology and Breast Care Unit, Mater Olbia Hospital, Olbia, Italy

    Luigi Carlo Turco

  2. Division of Gynecologic Oncology, Gemelli Molise, Campobasso, Italy

    Luigi Carlo Turco & Francesco Cosentino

  3. Department of Women’s and Children’s Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Lucia Tortorella, Anna Fagotti, Francesco Fanfani, Gabriella Ferrandina, Virginia Vargiu & Giovanni Scambia

  4. Department of Surgery, Università Degli Studi Di Catania, Catania, Italy

    Attilio Tuscano & Marco Antonio Palumbo

  5. Università Cattolica del Sacro Cuore, Rome, Italy

    Anna Fagotti, Francesco Fanfani, Gabriella Ferrandina & Giovanni Scambia

  6. Department of Obstetrics and Gynecology, Ospedale degli Infermi, Biella, Italy

    Stefano Uccella

  7. Medical Management, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Nicola Nicolotti

  8. UOC di Chirurgia del Peritoneo e Retroperitoneo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Claudio Lodoli

  9. Medicina Interna e Gastroenterologia, Area Gastroenterologia ed Oncologia Medica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Franco Scaldaferri

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  1. Luigi Carlo Turco
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Correspondence to Luigi Carlo Turco.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (no. PROT. APROV. IST CICOG-31-10-18\100) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Turco, L.C., Tortorella, L., Tuscano, A. et al. Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb). Arch Gynecol Obstet 302, 983–993 (2020). https://doi.org/10.1007/s00404-020-05694-0

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