Colorectal endometriosis. A proposal of complementary classification and surgical management in stages.

OBJECTIVE: To organize the experience and international knowledge in the surgical management and staging of colorectal endometriosis, with a management proposal in stages. METHOD: An extensive non-systematic review of the literature was carried to organize the disease in stages (limited, intermediate and advanced) according to a scoring system, which considers the characteristics of the endometrioma, the personal history and surgical findings. We tested the proposed staging in a retrospective group of patients. RESULTS: From January 2017 to April 2023, we collected 19 patients with a confirmed diagnosis of colorectal endometriosis, treated laparoscopically, by the same group of surgeons, in whom we found a strong correlation between the stage of the disease and the presence of complications that required reinterventions. CONCLUSIONS: We suggest a sequence of colorectal surgical management in stages according to the staging of the disease and we hope that this work will be followed by joint efforts to test it prospectively in order to compare results between hospital centers and make planned decisions.

OBJETIVO: Organizar la experiencia y el conocimiento internacional en el manejo quirúrgico y la estadificación de la endometriosis colorrectal, con una propuesta de manejo por etapas. MÉTODO: Se realizó una revisión amplia no sistemática de la literatura para organizar la enfermedad en etapas (limitada, intermedia y avanzada) de acuerdo con un sistema de puntuación que considera las características del endometrioma, los antecedentes personales y los hallazgos en la cirugía. La estatificación propuesta se probó en un grupo retrospectivo de pacientes. RESULTADOS: De enero de 2017 a abril de 2023 recopilamos 19 pacientes con diagnóstico confirmado de endometriosis colorrectal, tratadas por vía laparoscópica, por el mismo grupo de cirujanos, en las que encontramos una fuerte correlación entre el estadio de la enfermedad y la presencia de complicaciones que requirieron reintervenciones. CONCLUSIONES: Sugerimos una secuencia de manejo quirúrgico colorrectal en etapas de acuerdo con la estadificación de la enfermedad y esperamos que el presente trabajo sea seguido de esfuerzos compartidos por probarla de manera prospectiva para poder comparar resultados entre centros hospitalarios y tomar decisiones planificadas.

[Modification to stapled mucosectomy technique with PPH. Experience of a surgical group]. / Modificación a la técnica de mucosectomía con engrapadora PPH. Experiencia de un grupo quirúrgico.

BACKGROUND: Haemorrhoidal disease is a common disorder. Surgical treatment is indicated in cases of advanced disease. However, postoperative pain, operative time, and technical difficulties have prompted the search for new procedures and improve the existing ones. A modification is proposed to the technique of PPH (Procedure for Prolapse and Haemorrhoids) stapled haemorrhoidectomy that facilitates and standardises the procedure without altering its benefits. OBJECTIVE: To describe the postoperative results and short-term evolution of patients with internal haemorrhoidal disease, who underwent stapled mucosectomy with PPH with a modified technique. MATERIAL AND METHODS: This is a retrospective review of 35 patients who underwent stapled haemorrhoidectomy with a modified technique by the same surgical team. RESULTS: Twenty-five patients were men (71%) and 10 women (29%). Sixteen patients had grade III internal haemorrhoid disease (46%) and 19 grade IV (54%). The mean operative time was 31 minutes. Six patients had acute urinary retention. There were no cases of severe pain, bleeding, haematoma, stenosis, incontinence, thrombosis, or re-operation. The median hospital stay was 1 day. CONCLUSIONS: The proposed modification of PPH haemorrhoidectomy is performed with greater technical ease without increased morbidity, preserving the advantages of the original technique.