OBJECTIVE To evaluate the rate of postoperative complications between conservative surgery and segmental resection in patients with rectal endometriosis. DESIGN Single-center retrospective study. SETTING University hospital. PATIENT(S) A total of 232 women undergoing surgery for deep endometriosis infiltrating the rectum up to 15 cm from the anus with at least involvement of the muscularis layer, stratified into two arms according to surgical technique. Subgroup analysis was performed in patients without previous therapeutic laparoscopy for endometriosis (n = 108). A propensity-score approach was used to correct for group differences. INTERVENTION(S) All patients underwent CO2-laser laparoscopic surgery: 61 underwent conservative surgery, and 171 had a segmental resection. MAIN OUTCOME MEASURE(S) Postoperative complication rate (Clavien-Dindo classification). RESULT(S) Clavien-Dindo type 1 and 2 complications did not differ between both groups. Clavien-Dindo type 3 complications were more frequent in the segmental resection group (1/61 [1.6%] conservative vs. 18/171 [10.5%] segmental), after propensity analysis only a trend was retained. In the subgroup analysis, no difference or trend was found (1/27 [3.7%] conservative vs. 5/81 [6.2%] segmental). A low rate of temporary diverting stoma was recorded: 24/232 (10.3%). CONCLUSION(S) A higher major complication (Clavien-Dindo ≥3) rate for segmental resections compared with conservative surgical treatment was shown in the overall population, although after correction for group differences this was attenuated to a trend only. However, in patients without previous therapeutic laparoscopy no significant difference or trend was found regardless of the surgical technique used. This not only suggests that redo/repeated surgery has a potentially increased morbidity, but also emphasizes the importance of a well executed primary surgery.

中文翻译：

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浸润直肠的深部子宫内膜异位症手术后的结果

目的评价直肠子宫内膜异位症保守手术与节段性切除术的术后并发症发生率。设计 单中心回顾性研究。设置大学医院。患者 共有 232 名因深部子宫内膜异位症浸润直肠至距肛门 15 cm 且至少累及肌层的深部子宫内膜异位症手术，根据手术技术分为两组。对既往未接受过治疗性腹腔镜子宫内膜异位症治疗的患者进行亚组分析（n = 108）。倾向评分方法用于校正组差异。干预（S） 所有患者均接受 CO2 激光腹腔镜手术：61 名接受保守手术，171 名接受节段性切除术。主要结果测量（S）术后并发症发生率（Clavien-Dindo 分类）。结果 两组的 Clavien-Dindo 1 型和 2 型并发症没有差异。Clavien-Dindo 3 型并发症在节段性切除组中更常见（1/61 [1.6%] 保守性 vs. 18/171 [10.5%] 节段性），倾向分析后仅保留了一个趋势。在亚组分析中，未发现差异或趋势（1/27 [3.7%] 保守对 5/81 [6.2%] 节段性）。临时改道造口率较低：24/232 (10.3%)。结论(S) 与保守手术治疗相比，整体人群中节段性切除术的主要并发症（Clavien-Dindo ≥3）发生率更高，尽管在校正组差异后，这仅减弱为趋势。然而，无论使用何种手术技术，未曾接受过治疗性腹腔镜检查的患者均未发现显着差异或趋势。这不仅表明重做/重复手术的发病率可能会增加，而且还强调了执行良好的初次手术的重要性。