Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltra
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GENERAL GYNECOLOGY
Surgery‑related complications and long‑term functional morbidity after segmental colo‑rectal resection for deep infiltrating endometriosis (ENDO‑RESECT morb) Luigi Carlo Turco1,2 · Lucia Tortorella3 · Attilio Tuscano4 · Marco Antonio Palumbo4 · Anna Fagotti3,5 · Stefano Uccella6 · Francesco Fanfani3,5 · Gabriella Ferrandina3,5 · Nicola Nicolotti7 · Virginia Vargiu3 · Claudio Lodoli8 · Franco Scaldaferri9 · Giovanni Scambia3,5 · Francesco Cosentino2 Received: 20 March 2020 / Accepted: 9 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. Methods All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien–Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. Results Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. Conclusions Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications. Keywords Deep infiltrating endometriosis · Segmental resection · Intestinal disorders · Voiding disorders · Sexual dysfunction · Personalized medicine
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00404-020-05694-0) contains supplementary material, which is available to authorized users. * Luigi Carlo
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