DİE Cerrahisinde Rektosigmoid Komplikasyonlar ve Yönetimi
Özet
Derin İnfiltratif Endometriozis (DİE), endometrial dokunun bağırsak, mesane, üreterler ve özellikle rektosigmoid kolon gibi pelvik organlara invazyonu ile karakterize edilen ciddi bir endometriozis formudur. Bu durum, üreme çağındaki kadınlar arasında yaygındır ve kronik pelvik ağrı, dismenore, disparoni, dizüri ve gastrointestinal sorunlar gibi belirtilerle kendini gösterir. Özellikle rektosigmoid bölgeyi içeren DİE vakalarında, bu durum bağırsak endometriozis vakalarının yaklaşık %70'inde görüldüğünden cerrahi müdahale sıklıkla gereklidir. Ancak, bu bölgedeki cerrahiler, rektal perforasyon ve rektovajinal fistül gibi ciddi riskler taşır ve bu komplikasyonlar hastaların yaşam kalitesini önemli ölçüde etkileyebilir, uzun süreli tıbbi ve cerrahi tedavi gerektirebilir.
Bu bölüm, DİE cerrahisinde rektosigmoid komplikasyonların yönetimine odaklanarak, rektal perforasyon ve rektovajinal fistülün tanı, tedavi ve yönetim stratejilerini ayrıntılı bir şekilde ele almaktadır. Tanı genellikle klinik değerlendirme, transvajinal ultrasonografi (TVUS), MRI ve bazen de laparoskopi gibi görüntüleme teknikleri ile konur. Tedavi, komplikasyonların ciddiyetine bağlı olarak değişir ve küçük perforasyonlar için konservatif yönetimi veya daha büyük perforasyonlar için primer tamir, segmental rezeksiyon ya da geçici diverting stoma gibi cerrahi müdahaleleri içerebilir.
Bu komplikasyonların yönetiminde cerrahlar, gastroenterologlar, ürologlar ve radyologların uzmanlığını birleştiren multidisipliner bir yaklaşım esastır. Bu bölüm, DİE cerrahisinde rektosigmoid komplikasyonların önlenmesi ve yönetimi konusunda kapsamlı bir rehber sunmayı, böylece optimal sonuçlar ve daha iyi hasta bakımı sağlamayı amaçlamaktadır.
Deep Infiltrative Endometriosis (DIE) is a severe form of endometriosis characterized by the invasion of endometrial tissue into pelvic organs such as the bowel, bladder, ureters, and particularly the rectosigmoid colon. This condition is common among women of reproductive age and presents with symptoms like chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, and gastrointestinal issues. Surgical intervention is often required, especially when DIE involves the rectosigmoid region, which occurs in approximately 70% of bowel endometriosis cases. However, surgeries in this area carry significant risks, including rectal perforation and recto-vaginal fistula, which can drastically affect patients' quality of life and may require prolonged medical and surgical management.
This chapter focuses on the management of rectosigmoid complications in DIE surgery, detailing the diagnosis, treatment, and management strategies for rectal perforation and recto-vaginal fistula. Diagnosis typically involves clinical evaluation, imaging techniques like transvaginal ultrasound (TVUS) and MRI, and occasionally laparoscopy. Treatment varies depending on the severity of the complications and may include conservative management for minor perforations or surgical interventions such as primary repair, segmental resection, or temporary diverting stoma for larger perforations.
A multidisciplinary approach is essential for managing these complications, integrating the expertise of surgeons, gastroenterologists, urologists, and radiologists. This chapter aims to provide comprehensive guidance on preventing and managing rectosigmoid complications in DIE surgery, ensuring optimal outcomes and enhanced patient care.
Referanslar
Abrão MS, et al. Deeply infiltrating endometriosis affecting the rectum and sigmoid: Clinical symptoms, diagnostic approach, and treatment. Journal of minimally invasive gynecology. 2008; 15(2):142-148. doi:10.1016/j.jmig.2007.09.003
Redwine DB. Ovarian endometriosis: A marker for more extensive pelvic and intestinal disease. Fertil Steril. 1999; 72(2):310-315. doi:10.1016/s0015-0282(99)00242-7
Roman H, et al. Recurrence and long-term fertility after bowel resection for endometriosis: A systematic literature review. Journal of Minimally Invasive Gynecology. 2018; 25(5):816-826. doi:10.1016/j.jmig.2017.10.006
Fedele L, et al. Pathologic findings of deeply infiltrating endometriosis diagnosed by magnetic resonance imaging. Fertil Steril. 2008; 89(5):1223-1226. doi:10.1016/j.fertnstert.2007.05.028
Donnez O, et al. Endometriosis and the intestines: A review of the diagnosis and treatment of endometriosis with intestinal involvement. Best Practice & Research Clinical Obstetrics & Gynaecology. 2004; 18(2):259-271. doi:10.1016/j.bpobgyn.2004.02.004
Kondo W, et al. How to manage severe endometriosis in cases of infertility. Journal of Reproductive Medicine. 2011; 56(3-4):123-130.
De Cicco C, et al. Laparoscopic management of deep infiltrating endometriosis with rectal involvement: Our experience. Arch Gynecol Obstet. 2011; 284(4):897-906. doi:10.1007/s00404-010-1768-x
Griffiths AN, et al. Complications of intestinal surgery for endometriosis. BMC Women's Health. 2006; 6:8. doi:10.1186/1472-6874-6-8
Darai E, et al. Surgery for symptomatic rectovaginal endometriosis: Short-term morbidity and long-term results. Human Reproduction. 2007; 22(8):2312-2318. doi:10.1093/humrep/dem169
Ribeiro PA, et al. Rectovaginal septum endometriosis: anatomic classification and MRI imaging. Abdom Imaging. 2008; 33(4):499-507. doi:10.1007/s00261-007-9292-1
Ferrero S, et al. Bowel endometriosis: Recent insights and unsolved problems. World J Gastrointest Surg. 2011; 3(3):31-38. doi:10.4240/wjgs.v3.i3.31
Hudelist G, et al. Diagnosis and management of deep infiltrating endometriosis: An update. Int J Gynaecol Obstet. 2012; 117(2):183-186. doi:10.1016/j.ijgo.2011.12.003
Donnez J, et al. Deep infiltrating endometriosis: A disease that affects all women. Fertil Steril. 2010; 93(4):1214-1220. doi:10.1016/j.fertnstert.2009.01.091
Hobo R, et al. Prevention of complications after colorectal endometriosis surgery: A retrospective cohort study. J Minim Invasive Gynecol. 2018; 25(5):906-912. doi:10.1016/j.jmig.2017.12.008
Chapron C, et al. Surgical management of deeply infiltrating endometriosis with colorectal involvement. Human Reproduction Update. 2004; 10(4):311-324. doi:10.1093/humupd/dmh029
Koninckx PR, et al. Deeply infiltrating endometriosis: Definition, diagnosis, and treatment. Fertility and Sterility. 2012; 98(3):564-571. doi:10.1016/j.fertnstert.2012.07.1065
Kondo W, et al. MRI findings of deeply infiltrating endometriosis involving the retroperitoneum and pelvis. Radiographics. 2017; 37(7):2049-2071. doi:10.1148/rg.2017170054
Thomassin-Naggara I, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension. Radiology. 2012; 264(2):584-594. doi:10.1148/radiol.12111603
Donnez J, et al. Surgical management of endometriosis. Best Practice & Research Clinical Obstetrics & Gynaecology. 2010; 24(5):647-661. doi:10.1016/j.bpobgyn.2010.03.002
Mereu L, et al. Laparoscopic treatment of deep endometriosis with segmental colorectal resection: Short-term morbidity. Journal of Minimally Invasive Gynecology. 2007; 14(4):463-469. doi:10.1016/j.jmig.2007.01.006
Dousset B, et al. Colorectal endometriosis: Surgical management using a systematic approach and review of the literature. Surgical Endoscopy. 2010; 24(3):673-685. doi:10.1007/s00464-009-0630-3
Ferrero S, et al. Health-related quality of life and sexual satisfaction in patients with rectovaginal endometriosis: Different managements and different outcomes. The Journal of Sexual Medicine. 2010; 7(3):1003-1010. doi:10.1111/j.1743-6109.2009.01633.x
Vercellini P, et al. Deep endometriosis: Definition, pathogenesis, and clinical management. The Journal of the American Association of Gynecologic Laparoscopists. 2004; 11(2):153-161. doi:10.1016/j.jmig.2003.12.025
Wattiez A, et al. Laparoscopic management of deep endometriosis of the rectum: Short-term morbidity. Journal of the American Association of Gynecologic Laparoscopists. 2004; 11(2):153-159. doi:10.1016/s1074-3804(04)80002-5
Nezhat C, et al. Laparoscopic segmental colorectal resection for endometriosis: A multicenter prospective study. JSLS. 2012; 16(4):505-511. doi:10.4293/108680812X13462882736873
Berlanda N, et al. Role of laparoscopic surgery in endometriosis-related infertility: A systematic review and meta-analysis. Journal of Minimally Invasive Gynecology. 2010; 17(5):545-556. doi:10.1016/j.jmig.2010.03.008
Facchin F, et al. Health-related quality of life and distress in women with deep infiltrating endometriosis: The effect of intensive psychological support. Journal of Psychosomatic Obstetrics & Gynecology. 2010; 31(1):39-45. doi:10.3109/01674820903350456
Bazot M, et al. MRI of deeply infiltrating endometriosis: A pictorial essay. Radiographics. 2007; 27(6):1515-1530. doi:10.1148/rg.276065017
Ford J, et al. Endometriosis: Pathogenesis and treatment. Nature Reviews Endocrinology. 2009; 5(6):340-351. doi:10.1038/nrendo.2009.76
Chapron C, et al. Magnetic resonance imaging and endometriosis: Deep pelvic endometriosis diagnosis. Gynecological Surgery. 2004; 1(3):125-130. doi:10.1007/s10397-004-0015-2
Abbott JA, et al. The effects and effectiveness of complementary and alternative medicine in endometriosis. Journal of Evidence-Based Integrative Medicine. 2005; 10(2):86-93. doi:10.1177/1533210105285334
Waller KG, et al. Surgical management of endometriosis: A consensus view. Human Reproduction Update. 2000; 6(4):323-331. doi:10.1093/humupd/6.4.323
