Our Summary

Over the past two decades, a technique called “segmental resection” (SR) has been the most popular way to treat bowel endometriosis. This is a condition where cells similar to the ones in the lining of the uterus are found in other parts of the body, such as the bowel.

These days, the SR procedure is usually performed by laparoscopy, a surgery where small incisions are made in the abdomen and a tiny camera is used to guide the surgeon. However, there’s evidence that it can also be performed safely with the help of a robot.

There are some risks involved with the SR procedure. The two most serious risks are the formation of a hole between the rectum and vagina, and leakage at the site where two sections of the bowel are sewn together. Other possible complications include infection in the pelvic area, bleeding after the operation, damage to the tubes that carry urine from the kidneys to the bladder, and constriction at the site where two sections of the bowel are sewn together.

Despite these risks, various studies have shown that the SR procedure can successfully reduce pain and improve bowel symptoms. A modified version of the SR procedure that spares the nerves may lead to even better results. However, the rates at which bowel endometriosis returns after the operation differ from study to study, perhaps due to different definitions of what counts as a recurrence.

FAQs

  1. What is the most frequently used technique to treat bowel endometriosis?
  2. What are the possible complications of segmental resection?
  3. What are the rates of postoperative recurrence of bowel endometriosis after segmental resection?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to follow a high-fiber diet to help prevent constipation and promote regular bowel movements. It is also important to stay hydrated and avoid straining during bowel movements to prevent complications such as anastomotic leakage. Additionally, gentle exercise such as walking can help promote bowel function and aid in the recovery process. It is important to follow your doctor’s instructions and attend all follow-up appointments to ensure proper healing and monitor for any potential complications.

Suitable For

Patients who are typically recommended for bowel resection include those with severe bowel endometriosis that does not respond to other treatments, such as hormonal therapy or conservative surgery. These patients may experience symptoms such as severe abdominal pain, bowel obstruction, rectal bleeding, and infertility. Additionally, patients with complications such as rectovaginal fistula, bowel perforation, or stricture may also be recommended for bowel resection. It is important for patients to discuss the risks and benefits of surgery with their healthcare provider to determine if bowel resection is the best treatment option for their individual situation.

Timeline

Before bowel resection:

  • Patient may experience symptoms such as abdominal pain, bloating, constipation, diarrhea, and rectal bleeding
  • Patient undergoes diagnostic tests such as colonoscopy, CT scan, and MRI to confirm the presence of bowel endometriosis
  • Patient may undergo hormonal therapy or other conservative treatments to manage symptoms before surgery

After bowel resection:

  • Patient undergoes laparoscopic or robotic-assisted laparoscopic surgery to remove the affected portion of the bowel
  • Patient may experience pain, discomfort, and fatigue in the immediate postoperative period
  • Patient is closely monitored for complications such as rectovaginal fistula, anastomotic leakage, pelvic abscess, and postoperative bleeding
  • Patient may need to follow a special diet and take medication to aid in recovery
  • Patient undergoes follow-up appointments to monitor for recurrence of bowel endometriosis and to assess overall recovery and quality of life.

What to Ask Your Doctor

  1. What are the benefits of bowel resection for treating my bowel endometriosis?
  2. What are the potential risks and complications associated with bowel resection surgery?
  3. How long is the recovery process after bowel resection surgery?
  4. Will I need to follow a special diet or make any lifestyle changes after the surgery?
  5. How likely is it that my symptoms will improve after bowel resection surgery?
  6. Are there any alternative treatment options for my bowel endometriosis?
  7. How experienced are you in performing bowel resection surgery for endometriosis?
  8. What is the success rate of bowel resection surgery for treating endometriosis in your patients?
  9. How often will I need follow-up appointments after the surgery?
  10. Are there any specific warning signs or symptoms that I should watch for after the surgery?

Reference

Authors: Ferrero S, Stabilini C, Barra F, Clarizia R, Roviglione G, Ceccaroni M. Journal: Best Pract Res Clin Obstet Gynaecol. 2021 Mar;71:114-128. doi: 10.1016/j.bpobgyn.2020.05.008. Epub 2020 Jun 9. PMID: 32665125