"Feasibility of intraoperative proctosigmoidoscopy after discoid bowel resection for deep infiltrating endometriosis: a pilot multi-center study"

Objective: Although surgery is the gold standard treatment for pain refractory to medical management or partial occlusion due to rectosigmoid endometriosis, surgical resection can be associated with major perioperative complications. From general surgery experience, intraoperative proctosigmoidoscopy has shown encouraging results as a feasible, safe and effective technique in reducing the risk of complications related to intestinal anastomosis after segmental resection. Unfortunately, there are no studies evaluating its role after discoid resection for rectosigmoid endometriosis.Design: A pilot, multicentric, observational, prospective, cohort study.Setting: two academic hospitals, from March 1 to December 31, 2022.Participants: We enrolled all consecutive fertile-age patients affected by symptomatic endometriosis scheduled for laparoscopic discoid bowel resection. Inclusion criteria were: 1)age between 18 and 50 years old; 2)diagnosis of rectosigmoid endometriosis performed by transvaginal ultrasound and/or magnetic resonance imaging; 3)women scheduled for laparoscopic discoid bowel resection of endometriosis at low risk of segmental resection.Interventions: During data analysis, enrolled patients were divided into two study groups for comparisons based on whether or not the intraoperative proctosigmoidoscopy was performed upon surgeons' discretion after discoid resection for treating endometriosis, in addition to standard integrity tests. Primary outcome was the rate of intraoperative proctosigmoidoscopy success. Secondary study outcomes were the differences between the intraoperative proctosigmoidoscopy group and the no-intraoperative proctosigmoidoscopy group in: 1)mean of total operative time, and 2)rate of peri-operative complications.Main results: 28 patients were enrolled and equally distributed in the two groups. The rate of intraoperative proctosigmoidoscopy success was 86%. No significant difference was reported between the two groups in terms of total operative time(p=0.1), and intraoperative and post-operative complications(p=0.5 and 1, respectively), with no surgical complication related to intraoperative proctosigmoidoscopy.Conclusion: Intraoperative proctosigmoidoscopy appears as a feasible and non-time-consuming, intraoperative procedure in women undergone discoid resection for rectosigmoid endometriosis. Larger studies with longer follow-up period are necessary to confirm our findings and assess clinical benefits over standard procedure.