Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai).
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Paris, France (Drs. Jayot, Bendifallah, Abo, Arfi, Owen, and Darai); INSERM UMR_S_707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris, France (Dr. Bendifallah).
J Minim Invasive Gynecol. 2020 Jan;27(1):212-219. doi: 10.1016/j.jmig.2019.07.011. Epub 2019 Jul 19.
Laparoscopic discoid colorectal resection is a surgical option for bowel endometriosis, 1 of the most severe forms of endometriosis. However, no study has clearly analyzed the feasibility or the complication and recurrence rates of the procedure in a homogeneous population with specific criteria for discoid resection. The aims of this study were to evaluate the rate of conversion to segmental resection, the need for double discoid resection, and the complication and recurrence rates. We conducted a prospective study of 93 consecutive patients who underwent discoid resection in Tenon University Hospital, Paris, France. The median follow-up was 20 months. We included patients with colorectal endometriosis (≤3 cm long and <90° of bowel circumference) experiencing failure of medical treatment or associated infertility. All the patients underwent a discoid colorectal resection using a transanal circular stapler. The primary end point was the rate of conversion to segmental resection (3.2%). The secondary end point was the rate of double discoid resection (6.5%). The overall complication rate was 24%, and the severe complication rate (i.e., Clavien-Dindo IIIB) was 3% (n = 4). Postoperative voiding dysfunction requiring bladder self-catheterization was observed in 16% (n = 15). The mean duration of bladder self-catherization was 30 days (range, 15-90) including 11 cases (74%) lasting less than 30 days and 4 cases lasting more than 30 days. No patients required bladder self-catheterization over 3 months. No difference in the complication rate or in voiding dysfunction was observed between double and single discoid resection. The low rate of conversion to radical resection confirms the satisfactory preoperative evaluation of bowel endometriosis. Few publications report the rate of conversion to radical surgery. This raises the crucial issue of the right indications for discoid resection. The present study confirms that discoid resection is probably the best option for small lesions because of its high feasibility and low complication rate. Further studies are required to evaluate the technique for larger colorectal endometriotic lesions.
腹腔镜盘状结直肠切除术是一种针对肠子宫内膜异位症的手术选择，这是子宫内膜异位症最严重的形式之一。然而，在一个具有特定盘状切除术标准的同质人群中，尚无研究明确分析该手术的可行性、并发症和复发率。本研究的目的是评估转为节段切除术的比例、需要进行双盘状切除术的比例，以及并发症和复发率。我们在法国巴黎的特农大学医院进行了一项连续 93 例盘状切除术患者的前瞻性研究。中位随访时间为 20 个月。我们纳入了患有结直肠子宫内膜异位症（长度≤3cm 且肠周界<90°）、药物治疗失败或伴有不孕的患者。所有患者均采用经肛门圆形吻合器进行盘状结直肠切除术。主要终点是转为节段切除术的比例（3.2%）。次要终点是双盘状切除术的比例（6.5%）。总体并发症发生率为 24%，严重并发症发生率（即 Clavien-Dindo IIIB 级）为 3%（n=4）。术后排尿功能障碍需行膀胱自我导尿的发生率为 16%（n=15）。膀胱自我导尿的平均持续时间为 30 天（范围 15-90 天），其中 11 例（74%）持续时间<30 天，4 例持续时间>30 天。无患者需要进行超过 3 个月的膀胱自我导尿。双盘状与单盘状切除术的并发症发生率或排尿功能障碍无差异。转为根治性切除术的比例较低，证实术前对肠子宫内膜异位症的评估是令人满意的。很少有文献报告转为根治性手术的比例。这提出了盘状切除术适应证的关键问题。本研究证实，对于小病变，盘状切除术可能是最佳选择，因为其可行性高，并发症发生率低。需要进一步研究来评估该技术在较大的结直肠子宫内膜异位症病变中的应用。
