Early Postoperative Outcomes After Laparoscopic Segmental Colorectal Resection for Endometriosis: the Impact of Surgical Experience
Giacomo Ruffo1, Stefano Partelli*2,1, Filippo Scopelliti2,1, Stefano Crippa2,1, Alberto Sartori1, Giuliano Barugola2,1, Lorenzo Rettore1, Massimo Falconi2
1Department of Surgery, Ospedale "Sacro Cuore-Don Calabria", Negrar, Italy; 2Department of Surgery, University of Verona, Verona, Italy
Background: The aim was to determine the predictors of postoperative complications in women undergoing laparoscopic colorectal resection (LCR) for deep bowel endometriosis. Methods: Patients undergoing LCR from 2002 to 2009 were identified (n=720). Demographic and clinical data as well as perioperative details were assessed. A complication was defined by the presence of any deviation from the normal postoperative course. Records were analyzed retrospectively using logistic regression.Results: The median patient age was 35 years (IQR 29; 36). Significant dischezia (visual analogue scale [VAS] >5) was the most common symptom (59%) and 360 (50%) women presented a radiological stenosis >30%. Overall, 468 patients (65%) had previous surgery. In 558 (77%) patients a recto-sigmoid resection was carried out whereas a rectal resection and an ileocolic resection were performed in 19% and 3% of cases, respectively. The median operative time was 300 minutes (IQR 240; 360) with a median blood loss of 200 ml (IQR 150; 400). A temporary ileostomy was performed in 128 cases. Postoperative mortality was nil whereas 71 (10%) women experienced a complication. The patients were discharged on median day 8 (IQR 7; 10). The most frequent complication was anastomotic stricture (3%) followed by hemorrhage (2.5%), rectal vaginal fistula (1%) and anastomotic leakage (1%). At univariate analysis, the presence of a temporary ileostomy, an ultra-low anastomosis and the number of consecutive operations (<300 cases), correlated significantly with postoperative complications (odds ratio: 2.68, 4.13 and 1.93, respectively, P <0.05). A number of consecutive operations <300 proved to be the only independent predictor of complications, shown through multivariate analysis (odds ratio: 2.25, CI 95% 1.33-3.80, P =0.003). Conclusions: LCR for endometriosis is a safe procedure having a 10% rate of complications with no mortality. The surgical experience is the only independent predictor of complications after LCR for intestinal deep endometriosis. A learning curve exists for LCR since a significant improvement of postoperative outcomes was observed after the first 300 cases. Women affected by deep intestinal endometriosis should be referred to experienced laparoscopic surgeons.
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