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Feasibility, Complications, and Clinical Outcome

Luca Minelli, MD; Francesco Fanfani, MD; Anna Fagotti, MD; Giacomo Ruffo, MD; Marcello Ceccaroni, MD; Liliana Mereu, MD; Stefano Landi, MD; Paola Pomini, MD; Giovanni Scambia, MD

Arch Surg. 2009;144(3):234-239.

Objective  To evaluate the short- and long-term outcomes of laparoscopic colorectal resection for endometriosis.

Design and Patients  This study included 357 consecutive patients who underwent colorectal resection. We evaluated intraoperative and postoperative complications, symptom outcomes, and long-term follow-up.

Main Outcome Measure  Three hundred forty-three patients (96.1%) underwent laparoscopic colorectal resection, and radical endometriosis ablation was in 334 patients (93.6%).

Results  Fourteen (3.9%) required laparoconversion. Median operating time was 300 (range, 85-720) minutes, with a median estimated blood loss of 250 (range, 50-550) mL. Radical endometriosis ablation was achieved in 334 patients (93.6%). Median ileus was 4 (range, 1-8) days, with a median postoperative hospitalization of 8 (range, 3-36) days. Early and late complications were observed in 44 patients (12.3%) and, in 35 of these (79.5%), surgical management was necessary. Median follow-up after colorectal resection was 19.6 (range, 6-48) months. The median preoperative and postoperative dyspareunia scores were 8 (range, 4-10) and 3 (range, 0-10), respectively (P < .04), and the median preoperative and postoperative gastrointestinal tract symptom scores were 7 (range, 2-10) and 2 (range, 0-10), respectively (P < .05). During follow-up, 24 of 286 recurrences (8.4%) were registered. Patients who previously underwent surgery for endometriosis showed a higher risk of recurrence compared with patients undergoing primary surgery (13.2% vs 3.4%; P < .048).

Conclusions  Laparoscopic colorectal resection for severe endometriosis is feasible and markedly improved endometriosis-related symptoms. Despite the risk of major postoperative complications, the procedure shows good results in terms of recurrence rate and could be adopted as the primary approach for patients with symptomatic colorectal infiltrating endometriosis.

Author Affiliations: Departments of Obstetrics and Gynecology (Drs Minelli, Ceccaroni, Mereu, Landi, and Pomini) and General Surgery (Dr Ruffo), Ospedale Sacro Cuore, Negrar, Italy; Division of Gynecologic Oncology, Department of Oncology, Catholic University of the Sacred Heart, Campobasso, Italy (Dr Fanfani); and Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy (Drs Fagotti and Scambia).

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