Do we need a preventive stoma in surgery for colorectal endometriosis? A retrospective series of 97 patients treated at an expert centre.

Abstract

Background: Various surgical techniques for the treatment of colorectal endometriosis have been described, and the benefit of a preventive stoma remains unclear.

Objectives: The aim of our study is to evaluate the risk of complications in patients who underwent surgery for colorectal endometriosis without a policy of preventive stoma.

Methods: Retrospective cohort study of 97 consecutive patients treated for colorectal endometriosis in an expert centre from January 2022 to January 2024.

Main outcome measures: Complications after colorectal endometriosis surgery in patients without preventive stoma.

Results: Forty-three patients were managed by segmental resection, 20 patients by single-disc excision, 5 patients by double-disc excision and 29 patients by rectal shaving. 48 patients required vaginal suturing. We found complications in 14% of patients. Severe complications (Clavien-Dindo ≥3) were encountered in 8.24% of patients. 3.09% developed a rectovaginal fistula. Patients with a colorectal endometriosis nodule larger than 3 cm had more complications than patients with smaller nodules (57.1% vs. 42.9% of total complications), with a P-value close to the statistical significance.

Conclusions: Surgery for colorectal endometriosis performed in high-volume centres by expert surgeons leads to a reduction in the risk of postoperative complications. In our study, we did not perform routine preventive stoma formation, and we did not find an increase in postoperative complications compared to the literature.

What is new?: This study provides data on the risk of postoperative complications in patients undergoing surgery for colorectal endometriosis without a preventive stoma policy.