Perrine d'Avout-Fourdinier1, Marta Lempicka1, André Gilibert2, Céline Savoye-Collet1, Loïc Marpeau3, Clotilde Hennetier3, Jean-Jacques Tuech4, Horace Roman5. 1. Department of Radiology, Rouen University Hospital, 76031 Rouen, France. 2. Health Informatics Department, Rouen University Hospital, 76031 Rouen, France. 3. Expert Center in Diagnosis and Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France. 4. Department of Digestive Surgery, Rouen University Hospital, 76031 Rouen, France; Digestive Tract Research Group EA3234/IFRMP23, Rouen University Hospital, 76031 Rouen, France. 5. Endometriosis Center, Clinique Tivoli-Ducos, 33000 Bordeaux, France; Department of Gynecology, Aarhus Medical University, Aarhus, Denmark. Electronic address: horace.roman@gmail.com.
Abstract
INTRODUCTION: The aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms. MATERIAL AND METHODS: Single center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence. RESULTS: Eighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = -0.24, 95%CI -0.51-0.69, p = 0.44). CONCLUSION: Large disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.
INTRODUCTION: The aim of our study is to describe MRI appearance of a posterior rectal pouch (PRP) for patients managed for low rectal endometriosis by large full-thickness disc excision and to assess its relationship with postoperative functional digestive symptoms. MATERIAL AND METHODS: Single center retrospective study including patients managed by low/mid rectal disc excision using a semi-circular stapler (the Rouen technique) from June 2009 to October 2016. Intraoperative findings and data provided by standardized gastrointestinal self-questionnaires (GIQLI, KESS, Wexner and Bristol), before and 1 year after the surgery, were prospectively recorded. Postoperative pelvic MRI were reviewed and PRP was assessed in three planes and its volume was estimated on a 3D T2 weighted sequence. RESULTS: Eighteen patients were included in the study. All patients had postoperative PRP while none of them presented with rectal stenosis. The mean (± SD) volume of the PRP was estimated at 66 ± 32 mL. The mean antero-posterior diameter was 56 mm ± 22 mm, mean height at 44 mm ± 15 mm and mean width at 46 mm ± 11 mm. No positive correlation between the volume of the PRP and the GIQLI questionnaire was found at one year after surgery (r = -0.24, 95%CI -0.51-0.69, p = 0.44). CONCLUSION: Large disc excision of low and mid rectum leads to a posterior rectal pouch, with no significant impact on postoperative functional digestive outcomes, but it is not followed by bowel stenosis.
Authors: Manuel Maria Ianieri; Diego Raimondo; Andrea Rosati; Laura Cocchi; Rita Trozzi; Manuela Maletta; Antonio Raffone; Federica Campolo; Giuliana Beneduce; Antonio Mollo; Paolo Casadio; Ivano Raimondo; Renato Seracchioli; Giovanni Scambia Journal: Int J Gynaecol Obstet Date: 2022-01-20 Impact factor: 4.447