Conventional laparoscopic segmental bowel resection with mini-laparotomy specimen extraction compared with Natural Orifice Specimen Extraction (NOSE) procedures in patients with colorectal endometriosis.

BACKGROUND

In patients with colorectal endometriosis the optimal surgical approach for excising disease remains unknown.

OBJECTIVES

To compare the safety and efficacy of classic colorectal resection with mini-laparotomy and extracorporeal specimen removal and anastomosis formation (CLS) and colorectal resection with natural orifice specimen (bowel segment) extraction (NOSE), which is performed entirely in the abdominal cavity.

METHODS

This is a single centre, retrospective observational study of 161 cases of colorectal endometriosis. Women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between 2015 and 2023.

MAIN OUTCOME MEASURES: Hospital stay, complication rate, infectious issues, pain measured on a 10 cm visual analogue scale (VAS) and quality of life [derived from Knowles-Eccersley-Scott-Symptom (KESS)] questionnaire were the outcomes of interest.

RESULTS

No differences in post-operative pain or bowel quality of life at 3 months were observed between CLS and NOSE surgical treatment of colorectal endometriosis (mean VAS score 2 vs. 1, (P=0.62) and mean KESS score 12.3 vs. 10.7 (P=0.28). No clinically significant differences between techniques for intra-abdominal sepsis were seen as judged by C-reactive protein elevation and bacterial contamination from peri-operative cultures.

CONCLUSIONS

NOSE and CLS procedures appear comparable in safety and efficacy for removing colorectal endometriosis. Randomised trials are needed to compare these techniques.

WHAT IS NEW?: The NOSE technique for removing colorectal endometriosis is not associated with poorer safety, inflammatory, infective or efficacy outcomes compared to the classical CLS approach. Randomised controlled trials are needed to compare these techniques.