Download PDF
Semin Reprod Med 2017; 35(01): 065-071
DOI: 10.1055/s-0036-1597307
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Strategies for Management of Colorectal Endometriosis

Mauricio Simões Abrão
1   Endometriosis Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
,
Giuliano Moysés Borrelli
1   Endometriosis Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
,
Roberto Clarizia
2   Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar (Verona), Italy
,
Rosanne Marie Kho
3   Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
,
Marcello Ceccaroni
2   Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar (Verona), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
12 December 2016 (online)

    Permissions and Reprints

Abstract

Endometriosis has clearly three distinct clinical presentations and deep endometriosis, especially compromising the rectosigmoid is probably the most concerning one for both patients and surgeons. Currently, with the available tools, it is mandatory to have a precise diagnostic of this type of disease prior to indication of treatment. Strategies to manage this form of endometriosis will take into account several involved aspects, such as age of the patient, reproductive desire or infertility, clinical symptoms, as well as the extension and localization of the disease. Treatment could vary from more conservative to more radical depending on those aspects. As we pointed out in this article, the key to manage colorectal endometriosis is to start with a good diagnosis. Knowing exactly what is the extension and localization of the disease and knowing the patient's wishes as well as the clinical complaints, surgeons are able to define the best option for each patient. Critical points should always be discussed; for example, patients chosen to have clinical treatment should be aware of important issues regarding the follow-up, while patients undergoing surgery must be advised about all surgical possibilities and related complications.

Keywords

colorectal endometriosis - diagnosis - treatment - surgery
 

  • References

  • 1 Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 1997; 68 (4) 585-596
    CrossrefPubMedGoogle Scholar
  • 2 Cornillie FJ, Oosterlynck D, Lauweryns JM, Koninckx PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 1990; 53 (6) 978-983
    PubMedGoogle Scholar
  • 3 Ruffo G, Scopelliti F, Manzoni A , et al. Long-term outcome after laparoscopic bowel resections for deep infiltrating endometriosis: a single-center experience after 900 cases. BioMed Res Int 2014; 2014: 463058
    PubMedGoogle Scholar
  • 4 Wills HJ, Reid GD, Cooper MJ, Morgan M. Fertility and pain outcomes following laparoscopic segmental bowel resection for colorectal endometriosis: a review. Aust N Z J Obstet Gynaecol 2008; 48 (3) 292-295
    CrossrefPubMedGoogle Scholar
  • 5 Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21 (3) 329-339
    CrossrefPubMedGoogle Scholar
  • 6 Fauconnier A, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Hum Reprod Update 2005; 11 (6) 595-606
    CrossrefPubMedGoogle Scholar
  • 7 Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Bréart G. Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Hum Reprod 2003; 18 (4) 760-766
    CrossrefPubMedGoogle Scholar
  • 8 Abrão MS, Gonçalves MO, Dias Jr JA, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 2007; 22 (12) 3092-3097
    CrossrefPubMedGoogle Scholar
  • 9 Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990; 13 (4) 227-236
    CrossrefPubMedGoogle Scholar
  • 10 Possover M. Laparoscopic management of endopelvic etiologies of pudendal pain in 134 consecutive patients. J Urol 2009; 181 (4) 1732-1736
    CrossrefPubMedGoogle Scholar
  • 11 Ceccaroni M, Clarizia R, Alboni C , et al. Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique. Surg Radiol Anat 2010; 32 (6) 601-604
    CrossrefPubMedGoogle Scholar
  • 12 Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Int J Gynaecol Obstet 2003; 82 (1) 31-40
    CrossrefPubMedGoogle Scholar
  • 13 Ballard K, Lowton K, Wright J. What's the delay? A qualitative study of women's experiences of reaching a diagnosis of endometriosis. Fertil Steril 2006; 86 (5) 1296-1301
    CrossrefPubMedGoogle Scholar
  • 14 Nnoaham KE, Hummelshoj L, Webster P , et al; World Endometriosis Research Foundation Global Study of Women's Health consortium. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 2011; 96 (2) 366-373 .e8
    CrossrefPubMedGoogle Scholar
  • 15 Brosens I, Puttemans P, Campo R, Gordts S, Kinkel K. Diagnosis of endometriosis: pelvic endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol 2004; 18 (2) 285-303 [ Review]
    CrossrefPubMedGoogle Scholar
  • 16 Piketty M, Chopin N, Dousset B , et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod 2009; 24 (3) 602-607
    Google Scholar
  • 17 Goncalves MO, Dias Jr JA, Podgaec S, Averbach M, Abrão MS. Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis. Int J Gynaecol Obstet 2009; 104 (2) 156-160
    CrossrefPubMedGoogle Scholar
  • 18 Abrão MS, Podgaec S, Dias Jr JA, Averbach M, Silva LF, Marino de Carvalho F. Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol 2008; 15 (3) 280-285
    CrossrefPubMedGoogle Scholar
  • 19 Medeiros LR, Rosa MI, Silva BR , et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet 2015; 291 (3) 611-621
    CrossrefPubMedGoogle Scholar
  • 20 Landi S, Barbieri F, Fiaccavento A , et al. Preoperative double-contrast barium enema in patients with suspected intestinal endometriosis. J Am Assoc Gynecol Laparosc 2004; 11 (2) 223-228
    CrossrefPubMedGoogle Scholar
  • 21 Faccioli N, Foti G, Manfredi R , et al. Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging. Abdom Imaging 2010; 35 (4) 414-421
    CrossrefPubMedGoogle Scholar
  • 22 Saba L, Sulcis R, Melis GB , et al. Endometriosis: the role of magnetic resonance imaging. Acta Radiol 2015; 56 (3) 355-367
    CrossrefPubMedGoogle Scholar
  • 23 Mohr C, Nezhat FR, Nezhat CH, Seidman DS, Nezhat CR. Fertility considerations in laparoscopic treatment of infiltrative bowel endometriosis. JSLS 2005; 9 (1) 16-24
    PubMedGoogle Scholar
  • 24 Anaf V, Simon P, El Nakadi I , et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod 2000; 15 (8) 1744-1750
    Google Scholar
  • 25 Chapron C, Santulli P, de Ziegler D , et al. Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis. Hum Reprod 2012; 27 (3) 702-711
    CrossrefPubMedGoogle Scholar
  • 26 Vercellini P, Somigliana E, Viganò P, De Matteis S, Barbara G, Fedele L. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online 2010; 21 (2) 259-265
    CrossrefPubMedGoogle Scholar
  • 27 Bianchi PH, Pereira RM, Zanatta A, Alegretti JR, Motta EL, Serafini PC. Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates. J Minim Invasive Gynecol 2009; 16 (2) 174-180
    CrossrefPubMedGoogle Scholar
  • 28 Roman H, Vassilieff M, Gourcerol G , et al. Surgical management of deep infiltrating endometriosis of the rectum: pleading for a symptom-guided approach. Hum Reprod 2011; 26 (2) 274-281
    CrossrefPubMedGoogle Scholar
  • 29 Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E. How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 2005; 20 (8) 2317-2320
    CrossrefPubMedGoogle Scholar
  • 30 Roman H, Moatassim-Drissa S, Marty N , et al. Rectal shaving for deep endometriosis infiltrating the rectum: a 5-year continuous retrospective series. Fertil Steril 2016; 106 (6) 1438-1445
    CrossrefPubMedGoogle Scholar
  • 31 Donnez J, Squifflet J. Complications, pregnancy and recurrence in a prospective series of 500 patients operated on by the shaving technique for deep rectovaginal endometriotic nodules. Hum Reprod 2010; 25 (8) 1949-1958
    CrossrefPubMedGoogle Scholar
  • 32 Roman H, Vassilieff M, Tuech JJ , et al. Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum. Fertil Steril 2013; 99 (6) 1695-1704
    CrossrefPubMedGoogle Scholar
  • 33 Seracchioli R, Ferrini G, Montanari G, Raimondo D, Spagnolo E, Di Donato N. Does laparoscopic shaving for deep infiltrating endometriosis alter intestinal function? A prospective study. Aust N Z J Obstet Gynaecol 2015; 55 (4) 357-362
    CrossrefPubMedGoogle Scholar
  • 34 Roman H, Milles M, Vassilieff M , et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol 2016; 215 (6) 762.e1-762.e9
    CrossrefPubMedGoogle Scholar
  • 35 Hickman LC, Kotlyar A, Luu TH, Falcone T. Do we need a robot in endometriosis surgery?. Minerva Ginecol 2016; 68 (3) 380-387
    PubMedGoogle Scholar
  • 36 Collinet P, Leguevaque P, Neme RM , et al. Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc 2014; 28 (8) 2474-2479
    CrossrefPubMedGoogle Scholar
  • 37 Woods RJ, Heriot AG, Chen FC. Anterior rectal wall excision for endometriosis using the circular stapler. ANZ J Surg 2003; 73 (8) 647-648
    CrossrefPubMedGoogle Scholar
  • 38 Landi S, Pontrelli G, Surico D , et al. Laparoscopic disk resection for bowel endometriosis using a circular stapler and a new endoscopic method to control postoperative bleeding from the stapler line. J Am Coll Surg 2008; 207 (2) 205-209
    CrossrefPubMedGoogle Scholar
  • 39 Oliveira MA, Crispi CP, Oliveira FM, Junior PS, Raymundo TS, Pereira TD. Double circular stapler technique for bowel resection in rectosigmoid endometriosis. J Minim Invasive Gynecol 2014; 21 (1) 136-141
    CrossrefPubMedGoogle Scholar
  • 40 Fanfani F, Fagotti A, Gagliardi ML , et al. Discoid or segmental rectosigmoid resection for deep infiltrating endometriosis: a case-control study. Fertil Steril 2010; 94 (2) 444-449
    CrossrefPubMedGoogle Scholar
  • 41 Roman H, Abo C, Huet E , et al. Full-thickness disc excision in deep endometriotic nodules of the rectum: a prospective cohort. Dis Colon Rectum 2015; 58 (10) 957-966
    CrossrefPubMedGoogle Scholar
  • 42 de Almeida A, Fernandes LF, Averbach M, Abrão MS. Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter. Surg Technol Int 2014; 24: 243-248
    PubMedGoogle Scholar
  • 43 Kondo W, Ribeiro R, Zomer MT, Hayashi R. Laparoscopic double discoid resection with a circular stapler for bowel endometriosis. J Minim Invasive Gynecol 2015; 22 (6) 929-931
    CrossrefPubMedGoogle Scholar
  • 44 Kondo W, Ribeiro R, Zomer MT. Double circular stapler (DCS) or laparoscopic double discoid resection with a circular stapler? Standardization of the procedure's nomenclature. J Minim Invasive Gynecol 2016; 23 (5) 844-845
    PubMedGoogle Scholar
  • 45 Kamergorodsky G, Lemos N, Rodrigues FC , et al. Evaluation of pre- and post-operative symptoms in patients submitted to linear stapler nodulectomy due to anterior rectal wall endometriosis. Surg Endosc 2015; 29 (8) 2389-2393
    CrossrefPubMedGoogle Scholar
  • 46 Ribeiro PA, Rodrigues FC, Kehdi IP , et al. Laparoscopic resection of intestinal endometriosis: a 5-year experience. J Minim Invasive Gynecol 2006; 13 (5) 442-446
    CrossrefPubMedGoogle Scholar
  • 47 Redwine DB, Sharpe DR. Laparoscopic segmental resection of the sigmoid colon for endometriosis. J Laparoendosc Surg 1991; 1 (4) 217-220
    CrossrefPubMedGoogle Scholar
  • 48 Sharpe DR, Redwine DB. Laparoscopic segmental resection of the sigmoid and rectosigmoid colon for endometriosis. Surg Laparosc Endosc 1992; 2 (2) 120-124
    PubMedGoogle Scholar
  • 49 Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril 2012; 98 (3) 564-571
    CrossrefPubMedGoogle Scholar
  • 50 Dubernard G, Piketty M, Rouzier R, Houry S, Bazot M, Darai E. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 2006; 21 (5) 1243-1247
    CrossrefPubMedGoogle Scholar
  • 51 Bassi MA, Podgaec S, Dias Jr JA, D'Amico Filho N, Petta CA, Abrao MS. Quality of life after segmental resection of the rectosigmoid by laparoscopy in patients with deep infiltrating endometriosis with bowel involvement. J Minim Invasive Gynecol 2011; 18 (6) 730-733
    CrossrefPubMedGoogle Scholar
  • 52 Minelli L, Fanfani F, Fagotti A , et al. Laparoscopic colorectal resection for bowel endometriosis: feasibility, complications, and clinical outcome. Arch Surg 2009; 144 (3) 234-239 , discussion 239
    CrossrefPubMedGoogle Scholar
  • 53 De Cicco C, Corona R, Schonman R, Mailova K, Ussia A, Koninckx P. Bowel resection for deep endometriosis: a systematic review. BJOG 2011; 118 (3) 285-291
    CrossrefPubMedGoogle Scholar
  • 54 Ruffo G, Scopelliti F, Scioscia M, Ceccaroni M, Mainardi P, Minelli L. Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc 2010; 24 (1) 63-67
    CrossrefPubMedGoogle Scholar
  • 55 Ceccaroni M, Clarizia R, Bruni F , et al. Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial. Surg Endosc 2012; 26 (7) 2029-2045
    CrossrefPubMedGoogle Scholar
  • 56 Mangler M, Herbstleb J, Mechsner S, Bartley J, Schneider A, Köhler C. Long-term follow-up and recurrence rate after mesorectum-sparing bowel resection among women with rectovaginal endometriosis. Int J Gynaecol Obstet 2014; 125 (3) 266-269
    CrossrefPubMedGoogle Scholar
  • 57 Ercoli A, D'asta M, Fagotti A , et al. Robotic treatment of colorectal endometriosis: technique, feasibility and short-term results. Hum Reprod 2012; 27 (3) 722-726
    CrossrefPubMedGoogle Scholar
  • 58 Millochau JC, Abo C, Darwish B, Huet E, Dietrich G, Roman H. Continuous amenorrhea may be insufficient to stop the progression of colorectal endometriosis. J Minim Invasive Gynecol 2016; 23 (5) 839-842
    CrossrefPubMedGoogle Scholar
  • 59 Ferrari S, Persico P, DI Puppo F , et al. Continuous low-dose oral contraceptive in the treatment of colorectal endometriosis evaluated by rectal endoscopic ultrasonography. Acta Obstet Gynecol Scand 2012; 91 (6) 699-703
    CrossrefPubMedGoogle Scholar
  • 60 Zito G, Luppi S, Giolo E , et al. Medical treatments for endometriosis-associated pelvic pain. BioMed Res Int 2014; 2014: 191967
    PubMedGoogle Scholar
  • 61 Dunselman GA, Vermeulen N, Becker C , et al; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod 2014; 29 (3) 400-412
    CrossrefPubMedGoogle Scholar
  • 62 Ferrero S, Alessandri F, Racca A, Leone Roberti Maggiore U. Treatment of pain associated with deep endometriosis: alternatives and evidence. Fertil Steril 2015; 104 (4) 771-792
    CrossrefPubMedGoogle Scholar