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Erschienen in:

01.07.2012

Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial

verfasst von: Marcello Ceccaroni, Roberto Clarizia, Francesco Bruni, Elisabetta D’Urso, Maria Lucia Gagliardi, Giovanni Roviglione, Luca Minelli, Giacomo Ruffo

Erschienen in: Surgical Endoscopy | Ausgabe 7/2012

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Abstract

Background

The weight of surgical radicality, together with a lack of anatomical theoretical basis for surgery and inappropriate practical skills, can lead to serious impairments to bladder, rectal, and sexual functions after laparoscopic excision of deep infiltrating endometriosis. Although the “classical” laparoscopic technique for endometriosis excision involving segmental bowel resection has proven to relieve symptoms successfully, it is hampered by several postoperative long-term and/or definitive pelvic dysfunctions.

Methods

In this prospective cohort study, we compare the laparoscopic nerve-sparing approach to the classical laparoscopic procedure in a series of 126 cases. Satisfactory data for bowel, bladder, and sexual function were considered as primary endpoints.

Results

A total of 126 patients were considered for analysis: 61 treated with nerve-sparing radical excision of pelvic endometriosis with segmental bowel resection (group B), and 65 treated with the classical technique (group A). Intraoperative, perioperative, and postoperative complications were similar between the two groups. Mean days of self-catheterization were significantly lower in the nerve-sparing group (39.8 days) compared with the non-nerve-sparing group (121.1 days; p < 0.001). The relapse rate within 12 months after surgery was comparable between the two groups. Patients of group A suffered from urinary retention more frequently between 1 and 6 months (p = 0.035) compared with group B and did not experience any improvement between 6 months and 1 year (p = 0.018). Overall detection of severe bladder/rectal/sexual dysfunctions was significantly different between the two groups, and 56 patients of group A (86.2%) reported a significantly higher rate of severe neurologic pelvic dysfunctions vs. 1 patient (1.6%) of group B (p < 0.001).

Conclusions

Our technique appears to be feasible and offers good results in terms of reduced bladder morbidity and apparently higher satisfaction than the classical technique. Considering that this kind of surgery requires uncommon surgical skills and anatomical knowledge, we believe that it should be performed only in selected reference centers.

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Titel: Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial
verfasst von: Marcello Ceccaroni
Roberto Clarizia
Francesco Bruni
Elisabetta D’Urso
Maria Lucia Gagliardi
Giovanni Roviglione
Luca Minelli
Giacomo Ruffo
Publikationsdatum: 01.07.2012
Verlag: Springer-Verlag
Erschienen in: Surgical Endoscopy / Ausgabe 7/2012
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2153-3

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