Complications in surgical treatment of colorectal endometriosis

In colorectal endometriosis, surgery may involve techniques such as shaving, disc excision or segmental resection with anastomosis (either using hardware or manual methods). A two-stage intestinal resection with stoma removal followed by restoration of intestinal integrity is performed in case of multifocal infiltrative forms. However, it is the order and extent of surgical treatment that is debatable for some patient groups.

The article discusses various approaches to the surgical treatment of colorectal endometriosis. Colorectal endometriosis is the most severe type of deep endometriosis, among all other types. Complications, such as intestinal obstruction, bleeding, and perforation may occur in 4–13% of cases. Surgical intervention is the only effective treatment method. There can be the following types of surgery: segmental bowel resection (35.8%), shaving (31.9%), disc excision (23.1%). Combined treatment is used in 2.9% of cases. According to the Clavien–Dindo classification, perioperative complications range from 10 to 14% (anastomotic failure with the development of pelvic abscesses – 6.6%, rectovaginal fistulas – 3.8%, intestinal paresis in the postoperative period – 12.7%, severe dysuric disorders – 1.5%, hydronephrosis – 4.5%). The frequency of complications depends on several factors, including the surgical access, the size of the infiltrate, the depth of the lesion, and intraoperative approaches.

Conclusion: Colorectal surgery for endometriosis is a high-tech surgical procedure that requires a personalized approach at all stages of treatment. This includes preoperative imaging to create a detailed map of the affected area, which can help to develop an individual treatment plan.