Double disc excision of large deep endometriosis nodules infiltrating the low and mid rectum: a pilot study of 20 cases.

STUDY OBJECTIVE: To report the technique of double disc excision of deep endometriosis nodules infiltrating the mid or low rectum (DEIR) and surgical outcomes.

DESIGN: A retrospective case series using data prospectively recorded in the CIRENDO database.

SETTING: University tertiary referral center.

PATIENTS: Twenty women managed for large DIER.

INTERVENTIONS: Double-disc excision using transanal end to end anastomosis (EEA) circular stapler.

MEASUREMENTS AND MAIN RESULTS: Twenty women managed by double-disc excision from May 2016 to September 2019 were included in the study. The mean time of intervention was 149 ± 74 minutes. The cumulated mean diameter of the excised rectal discs was 53.4 ± 19.1 mm, while in 85% of women, it was ≥ 50mm. The mean distance between the lowest margin between the disc and the anal verge was 66 mm. Vaginal infiltration was removed in 15 patients (75%), and in 6 patients (30%), it exceeded 30 mm in diameter. Due to the presence of sigmoid colon nodules, 2 patients (10%) underwent concomitant segmental sigmoid resection of 4 and 6 cm-length. Transitory stoma was performed in 8 patients (40%) due to concomitant vaginal excision over 3 cm in size. After a follow up varying from 3 to 42 months, no digestive fistula was recorded. The rate of Clavien Dindo 3 complications was 15%.

CONCLUSION: Double-disc excision is suitable to excise large DIER and is associated with a low severe complication rate with good functional outcomes in women. Further studies are required to assess the improvement of functional outcomes in comparison to colorectal resection.