Morbidity of diverting stoma during colorectal surgery for deep infiltrating endometriosis – an observational study

Purpose: To evaluate stoma-related complications after rectal resection and colorectal anastomosis with diverting stoma for deep infiltrating colorectal endometriosis. Methods: All the consecutive adult women who underwent colorectal resection with low anastomosis and diverting stoma for deep infiltrating endometriosis in one center between 2013 and 2020 were retrospec-tively included. Stoma-related complications were retrieved during the stoma period and after stoma reversal. Results: 33 patients (mean age = 32 years (+/- 6, range=24-45 years) were included. After the first surgery, overall and surgical morbidities were observed in 42% and 30% of patients, including stoma-related complica-tions in 3 patients (9%): high output (n = 2) and prolapse (n = 1). One patient presented with rectovaginal fis-tula, requiring several unplanned surgeries. No anastomotic leakage was observed. All the patients underwent stoma reversal, after mean delay of 3 months (+/- 3, range=1-20 months). Overall morbidity after stoma closure occurred in 9 patients (27%), including 1 major morbidity (digestive bleeding). Long-term results were obtained after a mean follow-up of 21 months (+/- 9, range=14-34 months). Four patients presented with hernia at the stoma site (12%). The cumulative rate of stoma-related complications was 45%. Conclusion: There is no consensus about the impact of diverting stoma after rectal resection with colorectal anastomosis for deep infiltrating colorectal endometriosis. Stoma-related complications are frequently observed but there are major in only 12% of patients. High risk patients of rectovaginal fistula and/or anasto-motic leakage need to be identified to better indicate the diverting stoma, waiting for randomized trials eval-uating the real impact of diverting stoma. (c) 2022 Elsevier Masson SAS. All rights reserved.