Revolutionizing Rectal Endometriosis Surgery: A Mesentery-Sparing Hand-Sewn Technique

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.013

Y Zhou

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引用次数: 0

Abstract

Study Objective

To compare functional and economic outcomes of a mesentery tissue-sparing hand-sewn anastomosis versus conventional stapled resection for rectal endometriosis ≥3 cm, focusing on neurovascular preservation and cost-effectiveness.

Design

Retrospective propensity score-matched cohort study (2021–2024).

Setting

Tertiary referral center specializing in endometriosis surgery.

Patients or Participants

57 reproductive-aged women with histologically confirmed rectal endometriosis (hand-sewn group: n=26; stapled group: n=31).

Interventions

The innovative hand-sewn technique combined full-thickness excision with layered suturing to maintain submucosal arterioles and lymphatic pathways. Propensity score matching was used to control for age, symptoms, and CA125 levels. Outcome assessed included complications, hospitalization costs, and Low Anterior Resection Syndrome (LARS) scores at 3 months postoperatively.

Measurements and Primary Results

The hand-sewn group demonstrated superior surgical efficiency, with a 34% reduction in operative time (222.6±69.3 vs. 336.2±52.3 min, P<0.001), faster bowel recovery (first defecation: 8.5±4.6 vs. 16.9±7.7 days, P<0.001), and fewer complications (3.8% vs. 41.9%, P=0.003), including urinary retention (3.8% vs. 22.6%). Cost savings amounted to 21% ($5,526±1,449 vs. $6,960±925, P<0.001). Preservation of vascular integrity prevented anastomotic ischemia (0% vs. 3.2%), while lymphatic conservation reduced postoperative edema. LARS scores were significantly lower in the hand-sewn group (6.9±5.8 vs. 11.4±8.5, P=0.028).

Conclusion

By conserving mesenteric microvasculature and autonomic innervation, the hand-sewn technique effectively reduces neurogenic morbidity and associated costs. Its comprehensive protection of neurovascular-lymphatic structures provides a safer alternative for treating rectal endometriosis. However, long-term outcomes require further validation through multicenter studies.

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革命性的直肠子宫内膜异位症手术：保留肠系膜的手工缝合技术

研究目的比较保留肠系膜组织的手工缝合吻合术与传统的钉接切除术治疗≥3cm的直肠子宫内膜异位症的功能和经济效果，重点是神经血管保存和成本效益。设计回顾性倾向评分匹配队列研究（2021-2024）。三级转诊中心，专门从事子宫内膜异位症手术。患者或参与者：组织学证实为直肠子宫内膜异位症的育龄妇女57例（手工缝合组26例，缝合组31例）。干预措施：创新的手工缝合技术将全层切除与分层缝合相结合，以维持粘膜下小动脉和淋巴通路。倾向评分匹配用于控制年龄、症状和CA125水平。评估的结果包括并发症、住院费用和术后3个月的低前切除术综合征（LARS）评分。测量结果和主要结果手工缝合组表现出更高的手术效率，手术时间缩短34%(222.6±69.3 vs. 336.2±52.3 min, P<0.001)，肠道恢复更快（首次排便：8.5±4.6 vs. 16.9±7.7天，P<0.001），并发症更少（3.8% vs. 41.9%， P=0.003），包括尿潴留（3.8% vs. 22.6%）。成本节约达21%（5526±1449美元vs 6960±925美元，P<0.001）。保留血管完整性可防止吻合口缺血（0% vs. 3.2%），而保留淋巴可减少术后水肿。手工缝合组LARS评分显著低于手工缝合组（6.9±5.8比11.4±8.5，P=0.028）。结论手工缝合术通过保留肠系膜微血管和自主神经支配，有效降低了神经源性并发症和相关费用。它对神经血管淋巴结构的全面保护为治疗直肠子宫内膜异位症提供了一种更安全的选择。然而，长期结果需要通过多中心研究进一步验证。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.