Empfehlungen zur operativen Therapie der tief infiltrierenden Endometriose des Rektums

Die vorliegende Arbeit ist das Ergebnis einer Arbeitsgruppe, die sich bei der Weissenseetagung 2024 der Stiftung Endometriose-Forschung zusammengefunden hat. Grundlage war die verfügbare Evidenz zum Thema Darmendometriose, und, wo sie gefehlt hat, die klinische Erfahrung der Autorinnen und Autoren.
Der Text ist gedacht als Handreichung für alle, die im klinischen Alltag Verantwortung für Patientinnen mit dieser Erkrankung tragen. Explizit nicht gedacht ist der Text als Vorgabe im Sinne einer Leitlinie, zumal hierzu die Autorinnen und Autoren nicht berufen sind. Vielmehr will er als Anregung dienen, klinikinterne Standards zu verfassen – mit dem Ziel, die Qualität des Vorgehens zu sichern und dadurch Komplikationen wo möglich zu vermeiden bzw. frühzeitig zu erkennen.

Publication History

Article published online:
05 March 2025

• Literatur

• 1 O'Brien L, Morarasu S, Morarasu BC. et al. Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes, Int. J Colorectal Dis 2023; 38: 55
• 2 Hudelist G, Korell M, Burkhardt M. et al. Rates of severe complications in patients undergoing colorectal surgery for deep endometriosis-a retrospective multicenter observational study. Acta Obstet Gynecol Scand 2022; 101: 1057-1064
• 3 Bokor A, Hudelist G, Dobó N. et al. Low anterior resection syndrome following different surgical approaches for low rectal endometriosis: A retrospective multicenter study. Acta Obstet Gynecol Scand 2021; 100: 860-867
• 4 Vercellini P, Sergenti G, Buggio L. et al. Advances in the medical management of bowel endometriosis. Best Pract Res Clin Obstet Gynaecol 2021; 71: 78-99
• 5 Nezhat C, Li A, Falik R. et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol 2018; 218: 549-562
• 6 Ferrier C, Hini JD, Gaillard T. et al. First-line surgery vs first-line ART to manage infertility in women with deep endometriosis without bowel involvement: A multi-centric propensity-score matching comparison Eur. J Obstet Gynecol Reprod Biol 2023; 280: 184-190
• 7 Hudelist G, Aas-Eng MK, Birsan T. et al. Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis–A prospective cohort study. Acta Obstet Gynecol Scand 2018; 97: 1438-1446
• 8 Roman H, Chanavaz-Lacheray I, Ballester M. et al. High postoperative fertility rate following surgical management of colorectal endometriosis. Hum Reprod 2018; 33: 1669-1676
• 9 Cohen J, Thomin A, Mathieu D’Argent E. et al. Fertility before and after surgery for deep infiltrating endometriosis with and without bowel involvement: a literature review. Minerva Ginecol 2014; 66: 575-587
• 10 Rimbach S, Ulrich U, Schweppe KW. Surgical Therapy of Endometriosis: Challenges and Controversies. Geburtshilfe Frauenheilkd 2013; 73: 918-923
• 11 Alborzi S, Poordast T, Askary E. et al. Evaluation and comparison of the accuracy of transvaginal ultrasound and MRI for the diagnosis of deep rectal endometriosis: A cross-sectional study. Int J Gynaecol Obstet 2023; 161: 586-593
• 12 Condous G, Gerges B, Thomassin-Naggara I. Collaborators. et al. Non-Invasive Imaging Techniques for Diagnosis of Pelvic Deep Endometriosis and Endometriosis Classification Systems: An International Consensus Statement. J Minim Invasive Gynecol 2024; 31: 557-573
• 13 Reid S, Lu C, Casikar I. et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol 2013; 41: 685-691
• 14 Bazot M, Bharwani N, Huchon C. et al. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 2017; 27: 2765-2775
• 15 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Kolorektales Karzinom, Langversion 2.1, AWMF Registrierungsnummer: 021/007OL. 2019 Accessed June 16, 2024 at: http://www.leitlinienprogrammonkologie.de/leitlinien/kolorektales-karzinom/
• 16 Anderson OA, Wearne IM. Informed consent for elective surgery–what is best practice?. J R Soc Med 2007; 100: 97-100
• 17 Keane C, Wells C, O’Grady G. et al. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis 2017; 19: 713-722
• 18 Oliveira MA, Pereira TR, Gilbert A. et al. Bowel complications in endometriosis surgery. Best Pract Res Clin Obstet Gynaecol 2016; 35: 51-62
• 19 Vesale E, Roman H, Moawad G. et al. Voiding Dysfunction after Colorectal Surgery for Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27: 1490-1502.e3
• 20 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Perioperatives Management bei gastrointestinalen Tumoren (POMGAT), Langversion 1.0, AWMF-Registernummer: 088–010OL. 2023 Accessed June 16, 2024 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/perioperatives-managementbei-gastrointestinalen-tumoren-pomgat/
• 21 Tan J, Ryan ÉJ, Davey MG. et al. Mechanical bowel preparation and antibiotics in elective colorectal surgery: network meta-analysis. BJS Open 2023; 7: zrad040
• 22 Roos D, Dijksman LM, Tijssen JG. et al. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Br J Surg 2013; 100: 1579-1588
• 23 Morris MS, Graham LA, Chu DI. et al. Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery. Ann Surg 2015; 261: 1034-1040
• 24 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI). Behandlung akuter perioperativer und posttraumatischer Schmerzen. Accessed June 16, 2024 at: https://register.awmf.org/assets/guidelines/001-025l_S3_Behandlung-akuter-perioperativer-posttraumatischer-Schmerzen_2022-11.pdf
• 25 Huebner M, Blanc C, Roulin D. et al. Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway. Ann Surg 2015; 261: 648-653
• 26 Berríos-Torres S, Umscheid C, Bratzler D. et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017; 152: 784-791
• 27 Bendifallah S, Puchar A, Vesale E. et al. Surgical outcomes after colorectal surgery for endometriosis: Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2021; 28: 453-466
• 28 Keckstein J, Becker CM, Canis M. Working group of ESGE, ESHRE, and WES. et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open 2020; 2020: hoaa002
• 29 Roman H, Milles M, Vassilieff M. et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol 2016; 215: 762.e1-762.e9
• 30 Afors K, Centini G, Fernandes R. et al. Segmental and Discoid Resection are Preferential to Bowel Shaving for Medium-Term Symptomatic Relief in Patients With Bowel Endometriosis. J Minim Invasive Gynecol 2016; 23: 1123-1129
• 31 Roman H, Bubenheim M, Huet E. et al. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod 2018; 33: 47-57
• 32 Roman H, Tuech JJ, Huet E. et al. Excision versus colorectal resection in deep endometriosis infiltrating the rectum: 5-year follow-up of patients enrolled in a randomized controlled trial. Hum Reprod 2019; 34: 2362-2371
• 33 Roman H, Bridoux V, Merlot B. et al. Risk of bowel fistula following surgical management of deep endometriosis of the rectosigmoid: a series of 1102 cases. Hum Reprod 2020; 35: 1601-1611
• 34 Woods RJ, Heriot AG, Chen FC. Anterior rectal wall excision for endometriosis using the circular stapler. ANZ J Surg 2003; 73: 647-648
• 35 Namazov A, Kathurusinghe S, Marabha J. et al. Double Disk Excision of Large Deep Endometriosis Nodules Infiltrating the Low and Mid Rectum: A Pilot Study of 20 Cases. J Minim Invasive Gynecol 2020; 27: 1482-1489
• 36 Alborzi S, Roman H, Askary E. et al. Colorectal endometriosis: Diagnosis, surgical strategies and post-operative complications. Front Surg 2022; 9: 978326
• 37 Fazio VW, Zutshi M, Remzi FH. et al. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg 2007; 246: 481-488
• 38 Siddiqui MR, Sajid MS, Woods WG. et al. A meta-analysis comparing side to end with colonic J-pouch formation after anterior resection for rectal cancer. Tech Coloproctol 2010; 14: 113-123
• 39 Brown CJ, Fenech DS, McLeod RS. Reconstructive techniques after rectal resection for rectal cancer. Cochrane Database Syst Rev 2008; (02) CD006040
• 40 De Cicco C, Corona R, Schonman R. et al. Bowel resection for deep endometriosis: a systematic review. BJOG 2011; 118: 285-291
• 41 Balla A, Quaresima S, Subiela JD. et al. Outcomes after rectosigmoid resection for endometriosis: a systematic literature review. Int J Colorectal Dis 2018; 33: 835-847
• 42 Montedori A, Cirocchi R, Farinella E. et al. Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev 2010; (05) CD006878
• 43 Matthiessen P, Hallböök O, Rutegård J. et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 2007; 246: 207-214
• 44 Jesus E, Karliczek A, Matos D. et al. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev 2004; (04) CD002100
• 45 Spanjersberg WR, Reurings J, Keus F. et al. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2011; (02) CD007635
• 46 Kim JY, Wie GA, Cho YA. et al. Diet Modification Based on the Enhanced Recovery After Surgery Program (ERAS) in Patients Undergoing Laparoscopic Colorectal Resection. Clin Nutr Res 2018; 7: 297-302
• 47 Ni X, Jia D, Chen Y. et al. Is the Enhanced Recovery After Surgery (ERAS) Program Effective and Safe in Laparoscopic Colorectal Cancer Surgery? A Meta-Analysis of Randomized Controlled Trials. J Gastrointest Surg 2019; 23: 1502-1512
• 48 Benedetti M, Ciano P, Pergolini I. et al. Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage. G Chir 2019; 40: 20-25
• 49 Bertocchi E, Barugola G, Ceccaroni M. et al. Laparoscopic colorectal resection for deep infiltrating endometriosis: can we reliably predict anastomotic leakage and major postoperative complications in the early postoperative period?. Surg Endosc 2022; 36: 422-429
• 50 Italian ColoRectal Anastomotic Leakage (iCral) Study Group. Anastomotic leakage after elective colorectal surgery: a prospective multicentre observational study on use of the Dutch leakage score, serum procalcitonin and serum C-reactive protein for diagnosis. BJS Open 2020; 4: 499-507
• 51 Warschkow R, Beutner U, Stefen T. et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients. Ann Surg 2012; 256: 245-250
• 52 Bona D, Danelli P, Sozzi A. et al. C reactive Protein and Procalcitonin Levels to Predict Anastomotic Leak After Colorectal Surgery: Systematic Review and Meta analysis. J Gastrointest Surg 2023; 27: 166-179
• 53 Hogan S, Steffens D, Rangan A. et al. The effect of diets delivered into the gastrointestinal tract on gut motility after colorectal surgery–a systematic review and meta-analysis of randomised controlled trials. Eur J Clin Nutr 2019; 73: 1331-1342
• 54 Ripollés-Melchor J, Ramírez-Rodríguez JM, Casans-Francés R. POWER Study Investigators Group for the Spanish Perioperative Audit and Research Network (REDGERM). et al. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study. JAMA Surg 2019; 154: 725-736
• 55 An V, Chandra R, Lawrence M. Anastomotic Failure in Colorectal Surgery: Where Are We at?. Indian J Surg 2018; 80: 163-170
• 56 Luchristt D, Brown O, Geynisman-Tan J. et al. Timing of diagnosis of complex lower urinary tract injury in the 30-day postoperative period following benign hysterectomy. Am J Obstet Gynecol 2021; 224: 502.e1-502.e10
• 57 Ledderose S, Beck V, Chaloupka M. et al. Management von Harnleiterverletzungen. Urologe 2019; 58: 197-206