Colorectal Endometriosis: Diagnosis, Surgical Strategies and Post-Operative Complications

Endometriosis is defined by the presence of endometrial foci outside the uterus. The prevalence of DIE (deep infiltrating endometriosis) involving the bowel has been reported to be 5.3% and 12% of women affected by endometriosis. The rectum and sigmoid are the most frequently affected tracts, accounting for about 90% of cases. Surgical management is mandatory when lesions are symptomatic and impair bowel, urinary, sexual, and/or reproductive functions. However surgery for colorectal endometriosis is associated to complications like bowel fistula and anastomotic leakage with a remarkable impact on patient's quality of life.

The aim of this project is to fully evaluate preoperative assessment, surgical approach and post-operative complications management in symptomatic women with colorectal endometriosis, treated in Reference Endometriosis Centers. Advances in imaging techniques offer high sensitivity and specificity to diagnose the correct localization of bowel endometriosis. Patients managed for deep endometriosis of the rectosigmoid have to be informed about functional outcomes. Indeed, colorectal segmental resection appears to be associated with several postoperative complications when compared with nodule excision. Bowel fistula and anastomosis leakage represent major frightening complications. Recently the introduction of fluorescence guided laparoscopy allows real-time visualization of bowel perfusion in women with recto-sigmoid endometriosis. This technique seems to prevent bowel related post-operative complications.

This project is clearly framed within the general objective of promoting cooperation in the field of gynecological surgery and excellence technique. The topic we are going to address is colorectal endometriosis. The surgery required to treat this condition still represents a challenge.

Indocyanine green (ICG) is a dye, used in surgery to bring out the intraoperative evaluation of tissue perfusion. Its use could help the surgeons to better evaluate the perfusion of the anastomosis after bowel resection during any pelvic procedure for DIE as well as to help the ureteral dissection. Another interesting subject is the approach for specimen retrieval and anastomosis.Although many techniques for NOSE (natural office specimen extraction) have been described, a consensus on the best approach for specimen extraction is still lacking.

It is noteworthy that this project will serve to combine the efforts of professionals with experience in the field of gynecology, surgery, biomedical engineering and clinical research.