Posterior rectal pouch after large full-thickness disc excision of deep endometriosis infiltrating the low/mid rectum and relationship with digestive functional outcome

• Published in: Journal of gynecology obstetrics and human reproduction 2020-09, Vol.49 (7), p.101792-101792, Article 101792
• Main Authors: d’Avout-Fourdinier, Perrine, Lempicka, Marta, Gilibert, André, Savoye-Collet, Céline, Marpeau, Loïc, Hennetier, Clotilde, Tuech, Jean-Jacques, Roman, Horace
• Format: Article
• Language: English
• Subjects: Deep endometriosis; Disc excision; Life Sciences; MRI; Rectal pouch; rectum
• ISSN: 2468-7847; 2468-8495; 2468-7847
• DOI: 10.1016/j.jogoh.2020.101792

The aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms. Single center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence. Eighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = −0.24, 95%CI -0.51−0.69, p = 0.44). Large disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.