Total Laparoscopic Segmental Resection with Transanal Natural Orifice Specimen Extraction for Treatment of Colorectal Endometriosis: Descriptive Analysis from the TrEnd Study Database

Objective: To report our 3-year institutional experience of total laparoscopic (TL) segmental sigmoid colon/rectal resection for treatment of bowel endometriosis (BE).

Design: The TrEnd trial is a single-institutional retrospective/prospective study conducted with the aim of systematically collecting data from consecutive patients undergoing segmental colorectal resection for BE. This paper reports the outcomes of patients undergoing intracorporeal anastomosis and transanal natural orifice specimen extraction (NOSE) from this database. Primary endpoints were to evaluate the safety and efficacy of this approach in terms of complications, conversion to conventional technique/open surgery, endometriosis-free bowel resection margins, recurrence. Secondary endpoints were to assess intraoperative blood loss, operating time, gastrointestinal function recovery, duration of hospital stay, and reproductive outcomes.

Setting: Malzoni Research Hospital, Avellino, Italy.

Participants: Only patients undergoing TL colorectal resection with transanal NOSE were included in the present analysis. Patients were considered noneligible if they had received concomitant hysterectomy and/or transvaginal NOSE.

Interventions: Results presented here are descriptive.

Results: Eighty-one patients were included in the present analysis. Postoperative severe complications occurred in 3.7%. No cases of intraoperative complications or conversion to conventional technique/open surgery occurred. Final pathology showed endometriosis-free resection margins in all colorectal specimens. After a median follow-up of 21 months, all patients were free from BE. Median blood loss was 20 mL. Median length of surgery was 160 minutes. Median hospital length of stay was 3 days. All patients achieved the first passage of flatus on postoperative day 1. Median time to first defecation was 4 days. Twenty-six patients attempted to conceive. Nine of them were pregnant and 2 gave birth to a healthy child.

Conclusion: This study represents the main experience on TL segmental colorectal resection for BE treatment. The observed optimal outcomes seem to recommend further studies to assess safety and efficacy of said surgical technique in women with BE. Clinical trial registry name:ClinicalTrials.gov.