title: Functional outcomes after disc excision in deep endometriosis of the rectum using transanal staplers: a series of 111 consecutive patients.
abstract: To assess the postoperative outcomes of patients with rectal endometriosis managed by disc excision using transanal staplers.
  
  
  
  Prospective study using data recorded in the CIRENDO database (NCT02294825).
  
  
  
  University tertiary referral center.
  
  
  
  A total of 111 consecutive patients managed between June 2009 and June 2016.
  
  
  
  We performed rectal disc excision using two different transanal staplers: [1] the Contour Transtar stapler (the Rouen technique); and [2] the end to end anastomosis circular transanal stapler.
  
  
  
  Pre- and postoperative digestive function was assessed using standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index and the Knowles-Eccersley-Scott Symptom Questionnaire.
  
  
  
  The two staplers were used in 42 (37.8%) and 69 patients (62.2%), respectively. The largest diameter of specimens achieved was significantly higher using the Rouen technique (mean ± SD, 59 ± 11 mm vs. 36 ± 7 mm), which was used to remove nodules located lower in the rectum (5.5 ± 1.3 cm vs. 9.7 ± 2.5 cm) infiltrating more frequently the adjacent posterior vaginal wall (83.3% vs. 49.3%). Associated nodules involving sigmoid colon were managed by distinct procedures, either disc excision (2.7%) or segmental resection of sigmoid colon (9.9%). Postoperative values for the Gastrointestinal Quality of Life Index increased 1 and 3 years after the surgery, but improvement in constipation was not significant. The probability of pregnancy at 1 year after the arrest of medical treatment was 73.3% (95% confidence interval 54.9%-88.9%), with a majority of spontaneous conceptions.
  
  
  
  Disc excision using transanal staplers is a valuable alternative to colorectal resection in selected patients presenting with rectal endometriosis, allowing for good preservation of rectal function.
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France; Research Group EA 4308 'Spermatogenesis and Male Gamete Quality,' Rouen University Hospital, Rouen, France. Electronic address: horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.affiliation: Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
authors.forename: Basma
authors.initials: B
authors.lastname: Darwish
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bridoux
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Rachid
authors.initials: R
authors.lastname: Chati
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Kermiche
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Coget
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of Digestive Surgery, Rouen University Hospital, Rouen, France; Digestive Tract Research Group EA3234/IFRMP23, Rouen University Hospital, Rouen, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000328:Adult; D003082:Colectomy / Q000009:adverse effects / Q000295:instrumentation*; D016208:Databases, Factual; D004715:Endometriosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D005298:Fertility; D005602:France; D006785:Hospitals, University; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D011788:Quality of Life; D012002:Rectal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D061685:Time-to-Pregnancy; D016896:Treatment Outcome
keywords: Colorectal endometriosis; colorectal resection; deep endometriosis; disc excision; full-thickness excision; transanal stapler