Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy (Dr. Falcone and Dr. Malzoni).
Unit of Gynecologic Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, ARNAS "Civico-Di Cristina-Benfratelli," University of Palermo, Palermo, Italy (Dr. Laganà).
J Minim Invasive Gynecol. 2023 Jun;30(6):462-472. doi: 10.1016/j.jmig.2023.01.020. Epub 2023 Feb 6.
There is great consensus that the implementation of the enhanced recovery after surgery (ERAS) approach is beneficial for surgical patients, but there is a paucity of data concerning its application in women with deep endometriosis (DE) who are candidates for bowel surgery. The survey described herein was aimed at gathering detailed information on perioperative management of DE patients who were undergoing sigmoid/rectal (discoid or segmental) resection within the Italian Society of Gynecologic Endoscopy (SEGI) group.
Baseline survey.
National survey conducted within the main Italian cooperative group in minimally invasive gynecologic surgery (SEGI).
The study did not involve patients.
A 63-item questionnaire covering ERAS items for gynecologic/elective colorectal surgery was sent to SEGI centers. Only questionnaires from centers that reported performing ≥10 sigmoid/rectal resections per year were considered for this analysis.
Thirty-three of 38 (86.8%) of the questionnaires were analyzed. The rates of concordance with the ERAS guidelines were 40.4%, 64.4%, and 62.6% for preoperative, intraoperative, and postoperative items, respectively. The proportion of overall agreement was 56.6%. Preoperative diet, fasting and bowel preparation, correction of anemia, avoidance of peritoneal drains, postoperative feeding, and early mobilization were the most controversial items. Comparative analysis revealed that the referred rates of complete disease removal and conversion to open surgery were significantly different depending on case volume (p = .044 and p = .003, respectively) and gynecologist's/surgeon's experience (p = .042 and p = .022, respectively), with higher chances of obtaining a complete laparoscopic/robotic excision of endometriosis in centers that reported ≥30 DE surgeries performed per year and/or ≥90% of bowel resections performed by a gynecologist/general surgeon specifically dedicated to DE management. In contrast, the rates of concordance with the ERAS guidelines were not significantly different according to case volume (p = .081) or gynecologist's/surgeon's experience (p = .294).
This is the first study on DE conducted on a national scale. The current survey results revealed suboptimal compliance with the ERAS recommendations and underline the need to improve the quality of perioperative care in DE patients undergoing sigmoid/rectal resection. This study is a first step toward building a consistent, structured reporting platform for the SEGI units and facilitating wide implementation and standardization of the ERAS protocol for DE patients in Italy.
人们普遍认为，手术后强化康复（ERAS）方法对手术患者有益，但关于其在深部子宫内膜异位症（DE）女性患者中的应用的数据很少，这些患者是肠手术的候选者。本文描述的调查旨在收集意大利妇科内镜学会（SEGI）组内接受乙状结肠/直肠（盘状或节段性）切除术的 DE 患者围手术期管理的详细信息。
基线调查。
在意大利微创妇科手术主要合作组（SEGI）内进行的全国性调查。
本研究不涉及患者。
向 SEGI 中心发送了一份涵盖妇科/择期结直肠手术 ERAS 项目的 63 项问卷。仅分析报告每年进行≥10 例乙状结肠/直肠切除术的中心的问卷。
分析了 38 份问卷中的 33 份。术前、术中、术后项目的 ERAS 指南一致性率分别为 40.4%、64.4%和 62.6%。总体一致性比例为 56.6%。术前饮食、禁食和肠道准备、纠正贫血、避免腹膜引流、术后喂养和早期活动是最有争议的项目。比较分析显示，根据病例量（p=0.044 和 p=0.003）和妇科医生/外科医生的经验（p=0.042 和 p=0.022），完全疾病切除和转为开放手术的比例有显著差异，报告每年进行≥30 例 DE 手术和/或≥90%的肠切除术由专门管理 DE 管理的妇科医生/普通外科医生进行的中心，更有可能获得完全的腹腔镜/机器人子宫内膜异位症切除术。相比之下，根据病例量（p=0.081）或妇科医生/外科医生的经验（p=0.294），与 ERAS 指南的一致性率没有显著差异。
这是首次在全国范围内进行的关于 DE 的研究。目前的调查结果显示，与 ERAS 建议的一致性较差，并强调需要提高接受乙状结肠/直肠切除术的 DE 患者围手术期护理的质量。这项研究是朝着为 SEGI 单位建立一致、结构化的报告平台迈出的第一步，并有助于在意大利广泛实施和标准化 DE 患者的 ERAS 方案。
