Louisa R. Chatroux MD, MPH, Parmida Maghsoudlou BA, Mobolaji O. Ajao MD, MPH, Louise P. King MD, JD, Jon I. Einarsson MD, PhD, MPH
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引用次数: 0
Abstract
Study Objective
To examine the outcomes of surgery performed for bowel endometriosis including shaving, discoid resections with hand-sewn closure, and segmental resection.
Design
Retrospective cohort study.
Setting
Large academic hospital.
Patients
All patients with bowel wall endometriosis who underwent surgical excision with the Division of Minimally Invasive Gynecologic Surgery between 2009 and 2022.
Interventions
No interventions administered.
Measurements and Main Results
From 2009 to 2022, a total of 112 patients underwent laparoscopic excision of endometriosis involving the rectum. From this cohort, 82 underwent shaving, 23 underwent discoid excision, and 7 had segmental bowel resection. The discoid excisions were closed in multiple layers with hand sewing and were not closed with a staple device. Average lesion size on preoperative imaging was 20.9 mm in the shave group, 22.5 mm in the discoid group, and 38.5 mm in the segmental group. Complication requiring reoperation for anastomotic leak occurred in 3 cases (3.66%) of the shave group and 1 case (4.35%) of the discoid excision group, but did not occur in any of the segmental resections. The number of layers of closure and type of suture used did not appear to have an effect on complication rate, however, this study was not powered to detect a meaningful difference.
Conclusion
Our data shows a similar rate of anastomotic leak complication for each closure type as that reported in the literature (2.2%, 9.7%, and 9.9% reported for shave, discoid and segmental resection, respectively). While our study is underpowered, these findings support that hand sewing for discoid excision is a safe and reasonable alternative to circular stapler closures and can be considered with an experienced surgeon. Further study is warranted to confirm safety and explore potential cost savings associated with this technique as well as applications in areas with less resources available.
期刊介绍：
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.
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