Our Summary

This research paper discusses the complications that can occur after surgery for endometriosis, particularly those involving the intestines. These can occur immediately after surgery or later and range from issues with the connecting areas of the bowels, fistulas (abnormal connections between the rectum and vagina), bleeding, infections, bowel narrowing or blockage, and changes in bowel movements. Current research suggests that damage to the bowels can be repaired during surgery, even without prior preparation. There are different surgical approaches for treating severe cases of endometriosis affecting the bowel. One is a conservative approach that involves removing the affected part of the bowel, while a more aggressive approach involves removing a larger portion of the bowel, which carries a higher risk of complications. It’s crucial to ensure good blood flow and avoid tension when removing a segment of the bowel. Recognizing these complications early, either during surgery or immediately after, is key to reducing negative health outcomes. The paper focuses on how to prevent these complications when performing minimally invasive surgery for endometriosis.

FAQs

  1. What are the potential complications associated with endometriosis surgery?
  2. What are the surgical treatments for deep bowel endometriosis?
  3. How can bowel complications be prevented during minimally invasive surgery for endometriosis?

Doctor’s Tip

One tip a doctor might give a patient about bowel resection is to follow a strict post-operative care plan, including taking prescribed medications, maintaining a healthy diet, staying hydrated, and avoiding strenuous physical activities. It is important to closely monitor for any signs of infection or complications and to promptly contact your healthcare provider if you experience any concerning symptoms. Additionally, attending follow-up appointments and adhering to a recommended schedule of check-ups and screenings can help ensure a successful recovery.

Suitable For

Patients who are typically recommended bowel resection include those with deep infiltrating endometriosis involving the bowel, as well as those with bowel anastomotic dehiscence, rectovaginal fistula, anastomotic bleeding, intra-abdominal infections, bowel stricture, intestinal obstruction, chronic constipation, and diarrhea. These patients may require conservative surgery or a more radical approach such as bowel resection to address their condition. Good perfusion and no tension at the anastomosis site are essential for successful outcomes in patients undergoing bowel resection. Early recognition of bowel complications is crucial for reducing morbidity and mortality in these patients.

Timeline

Before bowel resection:

  1. Patient undergoes diagnostic tests such as colonoscopy or imaging studies to determine the extent of bowel involvement.
  2. Patient may undergo preoperative bowel preparation to clean out the intestines.
  3. Patient meets with the surgeon to discuss the procedure and potential risks and benefits.
  4. Surgery is scheduled and patient is instructed on preoperative fasting and medication guidelines.

After bowel resection:

  1. Patient undergoes surgery to remove the affected portion of the bowel.
  2. Patient may experience pain and discomfort in the immediate postoperative period.
  3. Patient is monitored closely for signs of complications such as infection or bowel leakage.
  4. Patient is started on a clear liquid diet and gradually advanced to solid foods.
  5. Patient may experience changes in bowel habits, such as diarrhea or constipation, in the weeks following surgery.
  6. Patient follows up with the surgeon for postoperative care and monitoring.
  7. Patient may require physical therapy or dietary changes to aid in recovery and prevent complications.

What to Ask Your Doctor

  1. What type of bowel resection procedure will be performed?
  2. What are the potential risks and complications associated with bowel resection surgery?
  3. How long is the recovery period after bowel resection surgery?
  4. Will I need a temporary colostomy or ileostomy after the surgery?
  5. What dietary and lifestyle changes will I need to make after bowel resection surgery?
  6. How often will I need follow-up appointments after the surgery?
  7. What signs or symptoms should I watch for that may indicate a complication after the surgery?
  8. Will I need any additional treatments or medications after the surgery?
  9. How successful is bowel resection surgery in treating endometriosis-related bowel complications?
  10. Are there any alternative treatment options to bowel resection surgery for my condition?

Reference

Authors: Oliveira MA, Pereira TR, Gilbert A, Tulandi T, de Oliveira HC, De Wilde RL. Journal: Best Pract Res Clin Obstet Gynaecol. 2016 Aug;35:51-62. doi: 10.1016/j.bpobgyn.2015.11.002. Epub 2015 Nov 14. PMID: 26694586