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Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?
Affiliations- Department of Oncological Gynecology, Centre of Oncology in Opole, Poland
- Faculty of Medicine, University of Opole, Poland
- Department of Oncological Surgery, Centre of Oncology in Opole, Poland
open access
Abstract
Objectives: To evaluate the novel modified laparoscopic technique of the bowel resection for deep infiltrated endometriosis (DIE) of the bowel versus the classical technique of bowel segmental resection in terms of anastomosis leakage.
Material and methods: Patients (n = 138) treated with segmental bowel resections due to DIE were included; 30 patients had the classic, while 108 patients had the modified laparoscopic bowel segmental resection with indocyanine green vascular visualization and fibrin sealant use.
Results: The modified technique was used more often in complex operations (65.7% vs 46.6%). More anastomotic leakages occurred in patients undergoing the classic technique than the modified technique (10% vs 2.8%; p = 0.117). No leakage in modified versus 12% in classic technique was observed in simple segmental bowel resections (p = 0.05); 2.5% of cases with leakage in modified versus 7.1% in classic technique were observed in bowel resections with hysterectomy. In complex cases operated with the modified technique, the frequency of anastomotic leakage was 4.2%, which were even less than leakage in simple cases in classic technique group (10%). Although the low location of the lesions increases the risk of leakage, the modified technique was associated with a small percentage of leakages (25% vs 6.3%). The laparotomy conversion rate was similar in both groups (3.4% for classic and 2.7% for modified).
Conclusions: In DIE, the modified technique of segmental bowel resection showed superiority over the classic technique in terms of the risk of anastomotic leakage. This risk was lower regardless of the complexity of the surgery and lesion location.
Abstract
Objectives: To evaluate the novel modified laparoscopic technique of the bowel resection for deep infiltrated endometriosis (DIE) of the bowel versus the classical technique of bowel segmental resection in terms of anastomosis leakage.
Material and methods: Patients (n = 138) treated with segmental bowel resections due to DIE were included; 30 patients had the classic, while 108 patients had the modified laparoscopic bowel segmental resection with indocyanine green vascular visualization and fibrin sealant use.
Results: The modified technique was used more often in complex operations (65.7% vs 46.6%). More anastomotic leakages occurred in patients undergoing the classic technique than the modified technique (10% vs 2.8%; p = 0.117). No leakage in modified versus 12% in classic technique was observed in simple segmental bowel resections (p = 0.05); 2.5% of cases with leakage in modified versus 7.1% in classic technique were observed in bowel resections with hysterectomy. In complex cases operated with the modified technique, the frequency of anastomotic leakage was 4.2%, which were even less than leakage in simple cases in classic technique group (10%). Although the low location of the lesions increases the risk of leakage, the modified technique was associated with a small percentage of leakages (25% vs 6.3%). The laparotomy conversion rate was similar in both groups (3.4% for classic and 2.7% for modified).
Conclusions: In DIE, the modified technique of segmental bowel resection showed superiority over the classic technique in terms of the risk of anastomotic leakage. This risk was lower regardless of the complexity of the surgery and lesion location.
Keywords
deep infiltrated endometriosis; laparoscopy; modified technique; anastomotic leakage
About this articleTitle
Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?
Journal
Issue
Article type
Research paper
Published online
2022-10-12
Page views
100
Article views/downloads
74
DOI
10.5603/GP.a2022.0122
Keywords
deep infiltrated endometriosis
laparoscopy
modified technique
anastomotic leakage
Authors
Ewa Milnerowicz-Nabzdyk
Krzysztof Nowak
Weronika Ogonowska
Maja Mrugala
Tomasz Sachanbinski
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