LONDON — Anterior rectal resection and anastomosis for the treatment of rectovaginal endometriosis can provide significant pain relief with an acceptable level of complications, according to a study presented at the annual congress of the International Society for Gynecologic Endoscopy.
“No one knows whether you should perform a rectal resection or simply shave the disease off the surface. An anterior resection is obviously more radical, but the theory is that by doing this you are more likely to remove all of the disease, including microscopic and multifocal disease, and there will be less chance of recurrence,” said Nicholas Kenney, M.D., a clinical fellow at Worthing Hospital (England).
Dr. Kenney presented a review of 37 anterior rectal resections he performed with his colleagues, including his supervisor James English, M.D., a consultant gynecologist at the same hospital.
Of the total 37 procedures, 21 were performed by laparotomy, and the remaining 16 were done by laparoscopy.
In the study, 28 patients (76%) had a primary bowel anastomosis without a stoma, 1 had a preoperative stoma, 2 required a temporary loop colostomy because of low rectal anastomosis, and 6 required a temporary ileostomy because they also underwent either sigmoid, ileal, or cecal resections of endometriosis.
In addition, 31 patients had ovarian preservation, and 14 had their uteri preserved. All 37 patients had positive histology for endometriosis; 21 of those patients had evidence of endometriosis in the muscularis layer of the bowel.
A postoperative survey of patients revealed that in 76% of patients, pain was either completely gone or much better.
Although there were a number of complications, the complication rate was similar to those that have been reported by other groups in association with this surgery, Dr. Kenney said.
In his series, one patient developed a uterovaginal fistula, and another patient developed a rectovaginal fistula, both of which were successfully repaired.
In addition, there were nine rectovaginal anastomotic strictures, which were all managed successfully by balloon dilation under sedation. There also were eight urinary tract infections, one deep vein thrombosis. There was one case of pelvic collection, which was settled with conservative management.
The rectum sticks to the posterior uterine surface in this endometriosis patient. Courtesy Dr. Nicholas Kenney