title: Double circular stapler technique for bowel resection in rectosigmoid endometriosis.
abstract: To reduce bladder function impairment and avert the serious complications of anastomotic leakage after segmental rectosigmoidectomy and to minimize the persistence of endometriotic lesions associated with discoid resection, we used the double circular stapling (DCS) technique. This technique enables excision of bowel endometriosis nodules larger than those that can be removed with the single-load technique of the circular stapler. Of 120 patients who underwent surgery to treat bowel endometriosis, intestinal shaving was performed in 24, discoid resection with single circular stapling in 40, and rectosigmoidectomy in 55. Eleven patients (9.2%) underwent the DCS technique. In the DCS group, the size of the rectosigmoid lesion ranged from 2.2 cm to 4.2 cm. Median operative time for the DCS technique was 100 minutes, compared with 150 minutes for rectosigmoidectomy (p = .04). Only 1 of 11 patients (9%) had urinary retention, compared with postoperative urinary retention in 14 of 55 patients (25%) who had undergone rectosigmoidectomy (difference not significant). Only 1 patient, with a 4.2-cm nodule, had a positive margin in the specimen obtained at the second stapling. DCS is a promising technique and may avert rectosigmoidectomy in selected patients.
authors: Department of Gynecology and Obstetrics, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Serra dos Órgãos University Center, UNIFESO, Rio de Janeiro, Brazil. Electronic address: endometriose@gmail.com.
authors: Marco Aurelio Pinho
authors: MA
authors: Oliveira
authors: Serra dos Órgãos University Center, UNIFESO, Rio de Janeiro, Brazil.
authors: Claudio P
authors: CP
authors: Crispi
authors: Serra dos Órgãos University Center, UNIFESO, Rio de Janeiro, Brazil.
authors: Flavio M
authors: FM
authors: Oliveira
authors: Department of Gynecology and Obstetrics, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Serra dos Órgãos University Center, UNIFESO, Rio de Janeiro, Brazil.
authors: Paulo S
authors: PS
authors: Junior
authors: Serra dos Órgãos University Center, UNIFESO, Rio de Janeiro, Brazil.
authors: Thiers S
authors: TS
authors: Raymundo
authors: Department of Gynecology and Obstetrics, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Serra dos Órgãos University Center, UNIFESO, Rio de Janeiro, Brazil.
authors: Thiago D
authors: TD
authors: Pereira
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007420:Intestine, Large / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bowel; Circular stapler; Deep infiltrative; Endometriosis; Rectosigmoidectomy; Resection