The Problem of Anastomotic Stricture after Rectosigmoid Resection in Deep Infiltrating Endometriosis

Background: Deep infiltrating endometriosis (DIE) of the large bowel is infiltration of the large-bowel wall by endometrial-like implants and is associated with fibrosis and muscular hyperplasia. Deep endometriosis affects ∼20% of patients with endometriosis. Objective: The aim of this research was to assess the importance of anastomotic stricture (AS) after large-bowel resection for DIE of the colon. Materials and Methods: This was a retrospective analysis of prospectively collected data. A consecutive series of 113 colonic resections for DIE were performed to address pain and/or infertility. There were low and very-low resections (n = 82) with mechanical end-to-end anastomosis associated with or without partial colpectomy, segmental sigmoid resections with side-to-end anastomosis (n = 27), and ileocecal resections with latero-lateral anastomosis (n = 4). Pneumatic balloon dilatation was performed in cases of AS (n = 22 in 13 patients). Patients were asked preoperatively and at 4, 8, 12, and 24 months postoperatively, about symptoms of constipation, small-caliber stools, and abdominal bloating. Patients presenting with those symptoms underwent double-contrast barium enema. When the smallest diameter of the suture was