Ukrainian Journal of Perinatology and Pediatrics. 2024. 3(99): 74-78. doi: 10.15574/PP.2024.3(99).7478
Savoliuk S. I., Shevaga O. Y., Zavertylenko D. S.
Shupyk National Healthcare University of Ukraine, Kyiv

For citation: Savoliuk SI, Shevaga OY, Zavertylenko DS. (2024). Personal experience of simultaneous surgical treatment of patients with deep infiltrative endometriosis affecting the rectosigmoid sections of the large intestine. Ukrainian Journal of Perinatology and Pediatrics. 3(99): 74-78. doi: 10.15574/PP.2024.3(99).7478.
Article received: Jul 15, 2024. Accepted for publication: Sep 04, 2024.

Endometriosis affects approximately 10% of women globally and can lead to infertility (30-50% of cases) and a significant decline in quality of life. One of the most severe forms of this disease is deep infiltrative endometriosis (DIE).
Аim – to evaluate the effectiveness of multidisciplinary surgical treatment for patients with DIE in the short term.
Materials and methods. The study included 18 patients with confirmed DIE and bowel involvement, treated. Laparoscopic surgical interventions were performed following Enhanced Recovery After Surgery principles. The parameters assessed included the duration of surgery, pain level, length of hospital stay, and early postoperative complications.
Results. The average duration of surgery was 145.83±15.3 minutes. Bowel involvement was localized to the anterior surface of the rectum in 7 cases and the rectosigmoid area in 4 cases. The average size of endometriotic lesions was 3.83±0.75 cm. All resections were performed with R0 margins, and no protective stoma was placed. Early postoperative complications included transient nausea and vomiting in 6 patients, managed conservatively. Pain levels, measured by the ACCS scale, were 57.51±10.51 points at 12 hours post-operation and 19.7±8.51 points after 24 hours. The average hospital stay was 3.66±0.81 days. After 3 months, 6 patients reported complete symptom relief, 6 noted significant symptom reduction, and 12 experienced improved quality of life.
Conclusions. Multidisciplinary laparoscopic surgical treatment of deep infiltrative endometriosis with bowel involvement is safe and effective in the short term. Patients show significant improvement in quality of life and reduction in pain. However, long-term evaluation of the condition is necessary.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the authors.
Keywords: deep infiltrative endometriosis, laparoscopy, simultaneous surgery, minimally invasive surgery.

REFERENCES

1. De Cassai A, Boscolo A, Tonetti T, Ban I, Ori C. (2019). Assignment of ASA-physical status relates to anesthesiologists' experience: a survey-based national-study. Korean J Anesthesiol. 72(1): 53-59. https://doi.org/10.4097/kja.d.18.00224; PMid:30424587 PMCid:PMC6369346

2. De Lange JS, Jacobs J, Meiring N, Moroane B, Verster T, Olorunju S, Mashola MK. (2020). Reliability and validity of the Readiness for Hospital Discharge Scale in patients with spinal cord injury. S Afr J Physiother. 76(1): 1400. https://doi.org/10.4102/sajp.v76i1.1400; PMid:32537524 PMCid:PMC7276478

3. Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B et al. (2014). ESHRE guideline: management of women with endometriosis. Hum Reprod. 29(3): 400-412. https://doi.org/10.1093/humrep/det457; PMid:24435778

4. Grossi E, Borghi C, Cerchiari EL, Della Puppa T, Francucci B. (1983). Analogue chromatic continuous scale (ACCS): a new method for pain assessment. Clin Exp Rheumatol. 1(4): 337-340.

5. Habib N, Centini G, Lazzeri L, Amoruso N, El Khoury L, Zupi E, Afors K. (2020). Bowel Endometriosis: Current Perspectives on Diagnosis and Treatment. Int J Womens Health. 12: 35-47. https://doi.org/10.2147/IJWH.S190326; PMid:32099483 PMCid:PMC6996110

6. Koninckx PR, Meuleman C, Oosterlynck D, Cornillie FJ. (1996). Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration. Fertil Steril. 65(2): 280-287. https://doi.org/10.1016/S0015-0282(16)58086-8; PMid:8566249

7. Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. (2004). Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 160: 784-796. https://doi.org/10.1093/aje/kwh275; PMid:15466501

8. Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA et al. (2019). Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations – 2019 update. Int J Gynecol Cancer. 29(4): 651-668. https://doi.org/10.1136/ijgc-2019-000356; PMid:30877144

9. Nisolle M, Donnez J. (1997). Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 68(4): 585-596. https://doi.org/10.1016/S0015-0282(97)00191-X; PMid:9341595

10. Scott MJ, Scott MJ, Baldini G, Fearon KC, Feldheiser A, Feldman LS et al. (2015). Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand. 59(10): 1212-1231. https://doi.org/10.1111/aas.12601; PMid:26346577 PMCid:PMC5049676

11. Shafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA. (2018). Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 51: 1-15. Epub 2018 Jul 3. https://doi.org/10.1016/j.bpobgyn.2018.06.001; PMid:30017581

12. Simoens S, Dunselman G, Dirksen C, Hummelshoj L, Bokor A, Brandes I et al. (2012). The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod. 27(5): 1292-1299. https://doi.org/10.1093/humrep/des073; PMid:22422778

13. Veeraswamy A, Lewis M, Mann A, Kotikela S, Hajhosseini B, Nezhat C. (2010). Extragenital endometriosis. Clin Obstet Gynecol. 53(2): 449-466. https://doi.org/10.1097/GRF.0b013e3181e0ea6e; PMid:20436322