Journal of the European Society for Gynaecological Endoscopy


Bowel anastomosis leakage following endometriosis surgery: an evidence based analysis of risk factors and  prevention techniques

A.Vigueras Smith 1, R. Sumak 1, R. Cabrera 2, W. Kondo 2, H. Ferreira 1

1 Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal;
2 Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil.


Anastomotic leakage, bowel endometriosis, colorectal anastomosis, endometriosis

Published online: Oct 09 2020


Background: Deep endometriosis most commonly involves the rectosigmoid junction and its management often requires a colorectal resection. Anastomotic leakage is a severe complication after resection and affects 1-6% of the cases.

Objective: To evaluate the risk factors related to anastomotic leakage following endometriosis surgery, its prevention techniques and the role of protective stomas.

Methods: A comprehensive literature review was carried out for English-language publications in Pubmed and Google Scholar. We included all studies including the following MeSH terms and key words: Anastomotic leakage AND bowel surgery OR Endometriosis OR Colorectal surgery OR Bowel endometriosis. Two authors independently made a selection and analysed relevant abstracts according to the aim of this review.

Results: Risk factors and preventive measures were categorised considering the patient condition, the intra-operative setting and the surgical procedure itself. Level I and II recommendations include modifiable risk factors such as the use of stapled or handsewn anastomosis; intra-operative air leak test to check the integrity of the anastomosis; systematic use of pelvic and trans-anal drainage; application of protective or ghost ileostomy in low rectal resections; vaginal closure before the bowel resection; use of oral antibiotics the day before surgery and performing partial mesorectal resection near the bowel wall. Diverting stomas may decrease the morbidity and the clinical consequences of leakage over 65% of low rectal resections but may cause significant adverse effects.

Conclusion: Evidence-based protective actions are crucial to reduce clinical consequences of anastomotic leakage and to minimise the use of protective stomas in endometriosis surgery.