INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER

BARCHI, Leandro Cardoso; CALLADO, Gustavo Yano; MACHADO, Rogério Bonassi; CHICO, Marcelo Antunes; DAMICO, Daniella Closer; LACERDA, Daniela Pereira; RICCIARDI, Rocco; LEITE, Rodrigo Moises de Almeida

doi:10.1590/0102-6720202400013e1806

Acessibilidade / Reportar erro

Brasil

ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • ABCD, arq. bras. cir. dig. 37 • 2024 • https://doi.org/10.1590/0102-6720202400013e1806 copy

INTESTINAL ENDOMETRIOSIS: OUTCOMES FROM A MULTIDISCIPLINARY SPECIALIZED REFERRAL CENTER

ENDOMETRIOSE INTESTINAL: RESULTADOS DE UM CENTRO DE REFERÊNCIA MULTIDISCIPILINAR ESPECIALIZADO

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Deep penetrating endometriosis (DE) can affect abdominal and pelvic organs like the bowel and bladder, requiring treatment to alleviate symptoms.

AIMS:

To study and investigate clinical and surgical outcomes in patients diagnosed with DE involving the intestines, aiming to analyze the effectiveness of surgical treatments.

METHODS:

All cases treated from January 2021 to July 2023 were included, focusing on patients aged 18 years or older with the disease affecting the intestines. Patients without intestinal involvement and those with less than six months of post-surgery follow-up were excluded. Intestinal involvement was defined as direct invasion of the intestinal wall or requiring adhesion lysis for complete resection. Primary outcomes were adhesion lysis, rectal shaving, disc excision (no-colectomy group), and segmental resection (colectomy group) along with surgical complications like anastomotic leak and fistulas, monitored for up to 30 days.

RESULTS:

Out of 169 patients with DE surgically treated, 76 met the inclusion criteria. No colectomy treatment was selected for 50 (65.7%) patients, while 26 (34.2%) underwent rectosigmoidectomy (RTS). Diarrhea during menstruation was the most prevalent symptom in the RTS group (19.2 vs. 6%, p<0.001). Surgical outcomes indicated longer operative times and hospital stays for the segmental resection group, respectively 186.5 vs. 104 min (p<0.001) and 4 vs. 2 days, (p<0.001). Severe complications (Clavien-Dindo ≥3) had an overall prevalence of 6 (7.9%) cases, without any difference between the groups. There was no mortality reported. Larger lesions and specific symptoms like dyschezia and rectal bleeding were associated with a higher likelihood of RTS. Bayesian regression highlighted diarrhea close to menstruation as a strong predictor of segmental resection.

CONCLUSIONS:

In patients with DE involving the intestines, symptoms such as dyschezia, rectal bleeding, and menstrual period-related diarrhea predict RTS. However, severe complication rates did not differ significantly between the segmental resection group and no-colectomy group.

HEADINGS:
Endometriosis; Intestines; Abdominal pain; Sigmoid colon; Rectum

Variables	All patients	No-colectomy group	Segmental resection group	p-value
n (%)	76 (100)	50 (65.8)	26 (34.2)
Age (years) mean (IQR) or (range)	39.8 (34–43) (24–50)	39 (7.8) (24–59)	40.5 (5.8) (30–55)	0.386
Duration of symptoms (months)	20 (12–24) (0–240)	33 (43.3) (3–240)	30 (28.3) (0–120)	0.067
Dysmenorrhea	49 (64.4)	32 (64)	17 (65.3)	0.868
Dyspareunia	37 (48.6)	23 (46)	14 (53.8)	0.281
Pelvic pain	52 (68.4)	37 (74)	16 (61.5)	0.020
Infertility	15 (19.7)	12 (24)	3 (11.5)	0.200
Abnormal uterine bleed	13 (23.2)	8 (16)	5 (19.2)	0.727
C-section (1 or more)	32 (42.1)	19 (38)	13 (50.0)	0.628
Pregnancy history (1 or more)	39 (51.3)	26 (52)	13 (50.0)	0.670
Abortion (1 or more)	6 (7.8)	6 (12)	0	0.065
Back pain	5 (6.5)	3 (6)	2 (7.6)	0.670
Dyschezia	11 (14.4)	5 (10)	6 (23.0)	0.128
Tenesmus	2 (2.6)	2 (4)	0	0.308
Constipation	14 (18.4)	11 (22)	3 (11.5)	0.211
Diarrhea	8 (10.5)	3 (6)	5 (19.2)	<0.001
Hematochezia	1 (1.3)	0	1 (3.8)	0.167
ASA score 1	51 (67.1)	35 (70)	16 (61.5)	0.463
ASA score 2	25 (32.8)	15 (30)	10 (38.4)	0.463
Previous surgery for endometriosis	16 (21.0)	11 (22)	5 (19.2)	0.378
Previous medical treatment	25 (32.8)	18 (36)	7 (26.9)	0.182

Variables	All patients	Segmental resection group	No-colectomy group	p-value
n (%)	76 (100)	26 (34.2)	50 (65.8)
Operative time (minutes) (range)	133 (45–401)	186.5 (115–305)	104 (45–401)	<0.001
In hospital stay (days)	2 (1–9)	4 (2–6)	2 (1–9)	<0.001
Enterectomy	5 (6.5)	0	5 (10)	>0.050
Appendectomy	14 (18.4)	4 (15.3)	10 (20)	0.296
Omentum	1 (1.3)	1 (1.3)	0	>0.050
Diaphragm	1 (1.3)	1 (1.3)	0	>0.050
Hysterectomy	32 (42.1)	8 (30.7)	24 (48)	<0.001
Right ovarian	22 (28.9)	7 (26.9)	15 (30)	0.385
Left ovarian	28 (26.8)	9 (34.6)	19 (38)	0.614
Retrocervical/uterine torus	53 (69.7)	16 (61.5)	37 (74)	0.020
Vaginal dome	6 (7.8)	1 (3.8)	5 (10)	>0.050
Vesicouterine recess	24 (31.5)	9 (34.6)	15 (30)	0.639
Bladder	7 (9.2)	1 (3.8)	6 (12)	>0.050
Left ureter region	10 (13.1)	5 (19.2)	5 (10)	0.112
Right ureter region	4 (5.2)	2 (7.6)	2 (4)	0.370
Ureter resection	1 (1.3)	1 (2.0)	0	>0.050
Left inferior hypogastric plexus	4 (5.2)	2 (7.6)	2 (4)	0.370
Right inferior hypogastric plexus	1 (1.3)	1 (3.8)	0	>0.050
Ileostomy	1 (1.3)	0	1 (2)	>0.050
30-day hospital readmission	8 (10.5)	3 (11.5)	5 (10)	0.892
Clavien-Dindo 1 and 2	18 (23.6)	7 (26.9)	11 (22)	0.686
Clavien-Dindo 3 and 4	6 (7.9)	2 (7.6)	4 (8)	0.898
Reoperation	2 (2.6)	0	2 (4)	>0.050

	RTS		Rectal shaving		Disc excision	p-value
n (%)	26 (34.2)		31 (40.7)		5 (6.5)
Median Size (cm) (IQR) (range)	3.1 (2.0–3.3) 1–5		1.6 (1– 2.5) (0.5–4.0)		2.6 (2.5–3.1) (2–3.3)	<0.001
	Univariate regression (95%CI)	p-value	Multivariate regression (95%CI)	p-value
Major complications vs. Lesion size	Coef 0.005 (-0.09 +0.10)	0.913	Coef 0.025 (-2.36 +2.41)	0.983

n (%)	Number of events	Segmental resection 26 (34.2)		No-colectomy surgery 50 (65.7)
n (%)	Number of events	Univariate risk ratio (95%CI)	p-value	Multivariate risk ratio (95%CI)	p-value
Surgical outcomes
Major surgical complications (CD≥3)	6	1.92 (0.41–8.86)	0.395	1.95 (0.43–8.83)	0.385
Reoperation	2	-	-	0.29 (0.12–0.70)	<0.001
Concurrent hysterectomy	31	0.56 (0.28–1.12)	0.076	0.52 (0.07–3.47)	0.500
Predictors for segmental resection
Defecation pain	11	2.30 (0.77–6.85)	0.124	1.77 (1.20–3.39)	0.014
Rectal bleed	1	-	-	3.00 (2.17–4.13)	0.016
Constipation	5	1.28 (0.23–7.19)	0.777	0.62 (0.17–2.19)	0.419
Any intestinal symptoms	22	1.33 (0.65–2.69)	0.432	1.29 (0.68–2.45)	0.432
Uterine bleed	13	1.20 (0.43–3.30)	0.722	1.11 (0.39–3.13)	0.843
Diarrhea	8	2.02 (1.06–3.05)	0.047	1.99 (1.03–3.82)	0.038

Colégio Brasileiro de Cirurgia Digestiva Av. Brigadeiro Luiz Antonio, 278 - 6° - Salas 10 e 11, 01318-901 São Paulo/SP Brasil, Tel.: (11) 3288-8174/3289-0741 - São Paulo - SP - Brazil
E-mail: revistaabcd@gmail.com

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Leandro Cardoso Barchi. E-mail: leandrobarchi@hotmail.com