Multiple nodule removal in multifocal colorectal endometriosis instead of “en bloc” large colorectal resection

• Published in: Gynécologie, obstétrique & fertilité obstétrique & fertilité, 2016-02, Vol.44 (2), p.121-124
• Main Authors: Roman, H., Darwish, B., Bridoux, V., Huet, E., Coget, J., Chati, R., Tuech, J.-J., Abo, C.
• Format: Article
• Language: English
• Subjects: Colonic Diseases - pathology; Colonic Diseases - surgery; Digestive System Surgical Procedures - methods; Endometriosis - pathology; Endometriosis - surgery; Female; Gynecology and obstetrics; Human health and pathology; Humans; Life Sciences; Postoperative Complications - prevention & control; Rectal Diseases - pathology; Rectal Diseases - surgery; Recurrence; Reproductive Biology; Treatment Outcome
• ISSN: 1297-9589; 1769-6682
• DOI: 10.1016/j.gyobfe.2015.10.005

Surgical management of colorectal endometriosis follows the principles of two main philosophies or approaches: radical and conservative. The radical approach has recently been recommended in multifocal colorectal endometriosis, which frequently concerns patients with rectal nodules. However, an alternative conservative management could employ selective retrieval of macroscopic colorectal deep endometriosis nodules by bowel shaving and disc excision, with preservation of the mesorectum. The conservative approach is justified by the evidence that low colorectal resection may lead to postoperative functional digestive symptoms for which management is most challenging. However, there is a lack of data in the literature specifically focusing on patients with multiple excision of deep colorectal endometriosis. No data exist about the minimal length of healthy bowel that should be conserved between two successive transversal bowel sutures, and on consecutive improvement of functional outcomes. Conversely, no evidence exists on presumed reduction of recurrence rate when young patients undergo low large colorectal resection, instead of multiple selective excisions. Further comparative studies would be welcome, among which the ENDORE randomized trial which may play a central role by comparing functional outcomes related to radical and conservative approach in deep endometriosis infiltrating the rectum. Le traitement chirurgical de l’endométriose colorectale suit deux approches principales : radicale et conservatrice. L’approche radicale a été récemment recommandée en cas d’endométriose colorectale multifocale, qui existe chez de nombreuses patientes adressées pour une endométriose profonde infiltrant le rectum. Pourtant, une alternative chirurgicale plus conservatrice peut être proposée, en combinant des exérèses ou des résections sélectives au niveau de chaque nodule digestif. Cette approche conservatrice utilise, au niveau du rectum, le shaving et l’exérèse discoïde, qui permettent la préservation du mésorectum. Cette deuxième approche est justifiée par le risque de troubles fonctionnels digestifs liés à la résection colorectale basse. Pourtant, il existe peu de données dans la littérature concernant de manière spécifique les patientes traitées par des exérèses multiples. Il n’existe de données ni sur la longueur minime du segment rectal qui doit séparer deux sutures étagées, ni sur l’avantage en termes de préservation de la fonction rectale. Inversement, il n’y a