Bonin Elodie, Bridoux Valérie, Chati Rachid, Kermiche Sabrina, Coget Julien, Tuech Jean Jacques, Roman Horace
Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Rouen University Hospital, Rouen, France.
Department of Surgery, Rouen University Hospital, Rouen, France.
Eur J Obstet Gynecol Reprod Biol. 2019 Jan;232:46-53. doi: 10.1016/j.ejogrb.2018.11.008. Epub 2018 Nov 6.
Deep endometriosis may simultaneously infiltrate the vagina and the rectosigmoid, which associated resection may increase the risk of postoperative complications. Among these complications, rectovaginal fistula is one of the worst. To reduce the risk of rectovaginal fistula and related complications, surgeons may employ diverting stoma. The literature is rich in data concerning the usefulness of stoma in patients managed for low rectal cancer. However, extrapolation of these data to patients managed for rectal endometriosis is disputable. For this reason, there are no guidelines on the role of stoma in preventing rectovaginal fistula in patients managed for colorectal endometriosis. The objective of our study was to assess the risk of complications related to the use of stoma in patients managed for colorectal endometriosis.
A retrospective comparative study has been performed using data prospectively recorded in the CIRENDO database. 163 consecutive women with colorectal endometriosis who had temporary stoma have been enrolled at the University Hospital of Rouen, from June 2009 to December 2016. The main outcome was stoma-related complications rate using Clavien-Dindo classification. No women were lost to follow-up.
Among the 163 women, 158 (96.9%) had a primary diverting stoma and 5 women (3.1%) with an immediate post-surgical bowel fistula had a secondary diverting stoma. Stoma involved the ileum in 28 women (17.2%) and the colon in 135 (82.8%). Surgical management of the rectosigmoid junction was rectal shaving in 2 women (1.2%), disc excision in 62 (38%), colorectal resection in 87 (53.4%), and combined rectal disc excision and sigmoid colon segmental resection in 12 (7.4%). Clavien Dindo I stoma-related complications occurred in 38 patients (23.3%) and were related to abnormal healing of stoma scar. Most Clavien-Dindo II complications were wound or urinary infections following stoma closure. Clavien Dindo III complications occurred in 14 patients (8.6%) and were related to leakage, hemoperitoneum, hernia of the abdominal wall, subcutaneous abscess and bowel obstruction syndrome.
Specific complications may occur directly related to the use of stoma in the surgery of deep endometriosis of the rectosigmoid. The risk of these complications should be taken into account and full preoperative information should be provided to patients and their family.
深部子宫内膜异位症可能同时浸润阴道和直肠乙状结肠，相关切除术可能增加术后并发症的风险。在这些并发症中，直肠阴道瘘是最严重的并发症之一。为降低直肠阴道瘘及相关并发症的风险，外科医生可能会采用转流造口术。关于造口术在低位直肠癌患者治疗中的作用，文献中有丰富的数据。然而，将这些数据外推至直肠子宫内膜异位症患者存在争议。因此，对于造口术在结直肠子宫内膜异位症患者预防直肠阴道瘘中的作用，尚无指南可循。我们研究的目的是评估结直肠子宫内膜异位症患者使用造口术相关的并发症风险。
利用前瞻性记录在CIRENDO数据库中的数据进行了一项回顾性比较研究。2009年6月至2016年12月，鲁昂大学医院纳入了163例连续的患有结直肠子宫内膜异位症且有临时造口的女性。主要结局是使用Clavien-Dindo分类法的造口相关并发症发生率。没有女性失访。
在这163名女性中，158名（96.9%）有原发性转流造口，5名（3.1%）术后即刻发生肠瘘的女性有继发性转流造口。28名女性（17.2%）的造口涉及回肠，135名（82.8%）涉及结肠。直肠乙状结肠交界处的手术处理方式为：2名女性（1.2%）行直肠剃除术，62名（38%）行椎间盘切除术，87名（53.4%）行结直肠切除术，12名（7.4%）行直肠椎间盘切除术联合乙状结肠节段切除术。38例患者（23.3%）发生Clavien Dindo I级造口相关并发症，与造口瘢痕愈合异常有关。大多数Clavien-Dindo II级并发症是造口关闭后的伤口或泌尿系统感染。14例患者（8.6%）发生Clavien Dindo III级并发症，与渗漏、腹腔积血、腹壁疝、皮下脓肿和肠梗阻综合征有关。
在直肠乙状结肠深部子宫内膜异位症手术中，使用造口术可能直接引发特定并发症。应考虑这些并发症的风险，并向患者及其家属提供充分的术前信息。
