Bowel Resection With Invasive Endometriosis

There are two techniques for a low colorectal anastomosis: The hand-sewn anastomosis technique and the end-to-end anastomosis (EEA) stapler technique. The hand-sewn anastomosis has largely been replaced by the EEA stapler because stapling the proximal colon to the lower rectum is easier to perform, faster, and results in a similar anastomotic leak rate when compared to a hand-sewn anastomosis.

An anastomosis in the upper or mid-rectum has a low risk of leaking (less than 2%). Sometimes, in patients with a deep cul-de-sac, the lesion is attached to the mid-rectum and the anastomosis must be performed in the lower rectum, within a few centimeters of the anus. Low rectal anastomoses have leak rates as high as 10%. A flexible sigmoidoscopy must be performed to check for an air leak. If one is found, the anastomosis should be reconstructed or repaired. Temporary diverting ileostomy should be considered if the anastomosis is suboptimal.

Dr. Park said he had no relevant financial disclosures.